{"hospital_name":"CHI MEMORIAL HOSPITAL - GEORGIA","last_updated_on":"2026-02-28","version":"3.0.0","location_name": ["CHI Memorial Hospital - Georgia"],"hospital_address": ["100 Gross Crescent Circle, Fort Oglethorpe, GA 30742"],"license_information":{"license_number":"not identified on site","state":"GA"},"type_2_npi": ["1356860621"],"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":"Janelle Reilly , Market President, SE Tennessee/N Georgia"},"standard_charge_information":[{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"minimum":122540,"maximum":418329,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":314747.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":304231,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":362719,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":286107,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":331313.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":418329,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":259740,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":259740,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122540,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":184062.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":196947.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":189584.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":193266.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195106.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":193266.01,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0011","type":"APR-DRG"}],"standard_charges":[{"minimum":47237,"maximum":47237,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47237,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47237,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47237,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0012","type":"APR-DRG"}],"standard_charges":[{"minimum":89142,"maximum":89142,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0013","type":"APR-DRG"}],"standard_charges":[{"minimum":89142,"maximum":89142,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT","code_information":[{"code":"0014","type":"APR-DRG"}],"standard_charges":[{"minimum":89142,"maximum":89142,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89142,"methodology":"case rate"}]}]},{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"minimum":73899.57,"maximum":173628,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":126368.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":145631,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":173628,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":129273,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":133019.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163654,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":101613,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":101613,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82512,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":73899.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":79072.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":76116.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":77594.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":78333.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":77594.55,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0021","type":"APR-DRG"}],"standard_charges":[{"minimum":64487,"maximum":64487,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64487,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64487,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64487,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0022","type":"APR-DRG"}],"standard_charges":[{"minimum":64487,"maximum":64487,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64487,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64487,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64487,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0023","type":"APR-DRG"}],"standard_charges":[{"minimum":84345,"maximum":84345,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84345,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84345,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84345,"methodology":"case rate"}]}]},{"description":"HEART AND/OR LUNG TRANSPLANT","code_information":[{"code":"0024","type":"APR-DRG"}],"standard_charges":[{"minimum":134931,"maximum":134931,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":134931,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134931,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":134931,"methodology":"case rate"}]}]},{"description":"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE MOUTH AND NECK WITH MAJOR O.R. PROCEDURES","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"minimum":121668,"maximum":318282,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":279158,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":261730,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":240744.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":218743,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":260796,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":225100,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":253414.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":318282,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":197621,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":197621,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":121668,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":140786.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150641.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145009.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":147825.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":149233.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":147825.34,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"minimum":87643,"maximum":209845,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":179969,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":168734,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":160535.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":148426,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":176960,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":155203,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":168984.47,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209845,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":130293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":130293,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87643,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":93880.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":100451.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":96696.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":98574.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":99513.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":98574.28,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0041","type":"APR-DRG"}],"standard_charges":[{"minimum":35041,"maximum":35041,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35041,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35041,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35041,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0042","type":"APR-DRG"}],"standard_charges":[{"minimum":52922,"maximum":52922,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52922,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52922,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52922,"methodology":"case rate"}]}]},{"description":"HC CT CEREBRAL PERFUSION ANS","code_information":[{"code":"0042T","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3260.25,"maximum":3260.25,"gross_charge":4025,"discounted_cash":1191.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3260.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3260.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3260.25,"methodology":"fee schedule"}]}]},{"description":"HC CT CEREBRAL PERFUSION ANS","code_information":[{"code":"0042T","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":404.79,"maximum":3260.25,"gross_charge":4025,"discounted_cash":1191.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3260.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3260.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3260.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":557.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":441.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":404.79,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2415,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":805,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0043","type":"APR-DRG"}],"standard_charges":[{"minimum":69996,"maximum":69996,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69996,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69996,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69996,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE","code_information":[{"code":"0044","type":"APR-DRG"}],"standard_charges":[{"minimum":171273,"maximum":171273,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171273,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171273,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171273,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"minimum":71520.75,"maximum":182443,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":122300.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":123298,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":147002,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":109275,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":128737.35,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158155,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":98198,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":98198,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":182443,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":71520.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":76527.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":73666.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":75096.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":75812,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":75096.79,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0051","type":"APR-DRG"}],"standard_charges":[{"minimum":32901,"maximum":32901,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32901,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32901,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32901,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0052","type":"APR-DRG"}],"standard_charges":[{"minimum":38273,"maximum":38273,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38273,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38273,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38273,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0053","type":"APR-DRG"}],"standard_charges":[{"minimum":92681,"maximum":92681,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92681,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92681,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92681,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE","code_information":[{"code":"0054","type":"APR-DRG"}],"standard_charges":[{"minimum":118707,"maximum":118707,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118707,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118707,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118707,"methodology":"case rate"}]}]},{"description":"LIVER TRANSPLANT WITHOUT MCC","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"minimum":34260.03,"maximum":83128,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":58584.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51984,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61977,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51068,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":61668.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72016,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":44714,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44714,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83128,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":34260.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36658.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":35287.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35973.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36315.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35973.04,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0061","type":"APR-DRG"}],"standard_charges":[{"minimum":44835,"maximum":44835,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44835,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44835,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44835,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0062","type":"APR-DRG"}],"standard_charges":[{"minimum":44835,"maximum":44835,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44835,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44835,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44835,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0063","type":"APR-DRG"}],"standard_charges":[{"minimum":50463,"maximum":50463,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50463,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50463,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50463,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"0064","type":"APR-DRG"}],"standard_charges":[{"minimum":96967,"maximum":96967,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96967,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96967,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96967,"methodology":"case rate"}]}]},{"description":"LUNG TRANSPLANT","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"minimum":59340,"maximum":194086,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":148877.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":131949,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":157315,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":129509,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":156713.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194086,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":120507,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":120507,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59340,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":87063.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":93157.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":89674.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":91416.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":92286.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":91416.23,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0071","type":"APR-DRG"}],"standard_charges":[{"minimum":46220,"maximum":46220,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46220,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46220,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46220,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0072","type":"APR-DRG"}],"standard_charges":[{"minimum":48636,"maximum":48636,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48636,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48636,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48636,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0073","type":"APR-DRG"}],"standard_charges":[{"minimum":59351,"maximum":59351,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59351,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59351,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59351,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"0074","type":"APR-DRG"}],"standard_charges":[{"minimum":108055,"maximum":108055,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108055,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":108055,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108055,"methodology":"case rate"}]}]},{"description":"VERTEBRAL ARTERY STENT","code_information":[{"code":"0075T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9380.61,"maximum":9380.61,"gross_charge":11581,"discounted_cash":3427.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9380.61,"methodology":"fee schedule"}]}]},{"description":"VERTEBRAL ARTERY STENT","code_information":[{"code":"0075T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9380.61,"gross_charge":11581,"discounted_cash":3427.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2200.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2316.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1737.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2316.2,"methodology":"fee schedule"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"minimum":38062.42,"maximum":80806,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65086.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60434,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72053,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55553,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":68512.36,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80806,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50172,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50172,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52684,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38062.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40726.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39204.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39965.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40346.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39965.55,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0081","type":"APR-DRG"}],"standard_charges":[{"minimum":5236,"maximum":5236,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5236,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5236,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5236,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0082","type":"APR-DRG"}],"standard_charges":[{"minimum":21864,"maximum":21864,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21864,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21864,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21864,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0083","type":"APR-DRG"}],"standard_charges":[{"minimum":57833,"maximum":57833,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57833,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57833,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57833,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY","code_information":[{"code":"0084","type":"APR-DRG"}],"standard_charges":[{"minimum":57833,"maximum":57833,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57833,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57833,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57833,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0091","type":"APR-DRG"}],"standard_charges":[{"minimum":30124,"maximum":30124,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30124,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30124,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30124,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0092","type":"APR-DRG"}],"standard_charges":[{"minimum":36707,"maximum":36707,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36707,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36707,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36707,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0093","type":"APR-DRG"}],"standard_charges":[{"minimum":50328,"maximum":50328,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50328,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50328,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50328,"methodology":"case rate"}]}]},{"description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)","code_information":[{"code":"0094","type":"APR-DRG"}],"standard_charges":[{"minimum":204590,"maximum":204590,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":204590,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":204590,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204590,"methodology":"case rate"}]}]},{"description":"PANCREAS TRANSPLANT","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"minimum":29171,"maximum":118408,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":92899.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44823,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53440,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50822,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":97789.41,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118408,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":73519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73519,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29171,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":54327.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":58130.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":55957.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":57043.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":57587.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":57043.83,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY FOR FACE MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"minimum":25820,"maximum":80135,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48504,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":45854,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29295,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69437,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":65102,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64590.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55831,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66564,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54440,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":67989.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49756,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49756,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25820,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37772.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40416.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38905.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39660.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40038.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39660.66,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY FOR FACE MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"minimum":22753,"maximum":60944,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36888,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":34873,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22753,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54355,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50962,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42258,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50382,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42284,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":53047.64,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60944,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37840,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37840,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29470.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31533.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30355.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30944.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31239.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30944.46,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY FOR FACE MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"minimum":12643,"maximum":44794,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23821,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22520,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15258,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44794,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41997,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34426.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30571,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36448,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28356,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36238.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24436,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12643,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20132.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21541.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20736.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21138.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21340.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21138.9,"methodology":"case rate"}]}]},{"description":"ALLOGENEIC BONE MARROW TRANSPLANT","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"minimum":87275.06,"maximum":194576,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":149240.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":120985,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":144244,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":121004,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":157095.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":194576,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":120812,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":120812,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147398,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":87275.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":93384.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":89893.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":91638.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":92511.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":91638.82,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"minimum":41883.44,"maximum":89640,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":71620.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65766,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65217,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":75390.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89640,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":55657,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55657,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42175,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41883.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44815.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43139.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43977.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44396.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43977.62,"methodology":"case rate"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"minimum":19200,"maximum":89640,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":71620.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47236,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56317,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65217,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":75390.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89640,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":55657,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55657,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19200,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41883.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44815.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43139.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43977.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44396.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43977.62,"methodology":"case rate"}]}]},{"description":"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"minimum":209316,"maximum":624850,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339000,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":320483,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":209316,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":624850,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":585841,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":419594.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":390693,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":465803,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":388985,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":441678.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":560075,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":347750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":347750,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":245377.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":262553.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":252738.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":257645.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":260099.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":257645.97,"methodology":"case rate"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"minimum":45414,"maximum":117729,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71258,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":67366,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":45414,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":92397.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":77118,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":91944,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":84395,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":97260.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117729,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":73098,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73098,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":54033.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":57816.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":55654.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":56735.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":57275.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56735.57,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"minimum":48021,"maximum":129012,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72461,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":68503,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48021,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129012,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":120958,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":93867.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":100559,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":119892,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89240,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":98808.12,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119716,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":74331,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":74331,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58916,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":54893.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":58735.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":56540.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":57638.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58187.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":57638.07,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0201","type":"APR-DRG"}],"standard_charges":[{"minimum":15437,"maximum":15437,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15437,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15437,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15437,"methodology":"case rate"}]}]},{"description":"HC SACROPLASTY BIL","code_information":[{"code":"0201T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2662.47,"maximum":2662.47,"gross_charge":3287,"discounted_cash":972.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2662.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2662.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2662.47,"methodology":"fee schedule"}]}]},{"description":"HC SACROPLASTY BIL","code_information":[{"code":"0201T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"gross_charge":3287,"discounted_cash":972.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2662.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2662.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2662.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":624.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0202","type":"APR-DRG"}],"standard_charges":[{"minimum":15437,"maximum":15437,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15437,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15437,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15437,"methodology":"case rate"}]}]},{"description":"RESP PATHOGEN (RPIP) PCR","code_information":[{"code":"0202U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1431.27,"maximum":1431.27,"gross_charge":1767,"discounted_cash":523.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1431.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1431.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1431.27,"methodology":"fee schedule"}]}]},{"description":"RESP PATHOGEN (RPIP) PCR","code_information":[{"code":"0202U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":373.03,"maximum":1431.27,"gross_charge":1767,"discounted_cash":523.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1431.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1431.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1431.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":662.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":525.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":712.69,"standard_charge_algorithm": "Lesser of $712.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":445.95,"standard_charge_algorithm": "Lesser of $445.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":429.28,"standard_charge_algorithm": "Lesser of $429.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":437.62,"standard_charge_algorithm": "Lesser of $437.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":458.46,"standard_charge_algorithm": "Lesser of $458.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":441.79,"standard_charge_algorithm": "Lesser of $441.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0203","type":"APR-DRG"}],"standard_charges":[{"minimum":18892,"maximum":18892,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18892,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18892,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18892,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY FOR TRAUMA","code_information":[{"code":"0204","type":"APR-DRG"}],"standard_charges":[{"minimum":37049,"maximum":37049,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37049,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37049,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37049,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"minimum":34891,"maximum":112186,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49685,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34891,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":112186,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105183,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":66033.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":73384,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":87492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64841,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":69509.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82086,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50967,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50967,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36852,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38616.17,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41319.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39774.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40546.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40933.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40546.98,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0211","type":"APR-DRG"}],"standard_charges":[{"minimum":16279,"maximum":16279,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16279,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16279,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16279,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0212","type":"APR-DRG"}],"standard_charges":[{"minimum":24178,"maximum":24178,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24178,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24178,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24178,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0213","type":"APR-DRG"}],"standard_charges":[{"minimum":37087,"maximum":37087,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37087,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37087,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37087,"methodology":"case rate"}]}]},{"description":"OPEN CRANIOTOMY EXCEPT TRAUMA","code_information":[{"code":"0214","type":"APR-DRG"}],"standard_charges":[{"minimum":61212,"maximum":61212,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61212,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61212,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61212,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"minimum":22286,"maximum":93881,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31735,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30001,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22286,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93881,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":88020,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44097.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47111,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56168,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41416,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46418.42,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52430,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32554,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32554,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25295,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25788.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27593.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26561.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27077.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27335.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27077.42,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0221","type":"APR-DRG"}],"standard_charges":[{"minimum":10699,"maximum":10699,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10699,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10699,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10699,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0222","type":"APR-DRG"}],"standard_charges":[{"minimum":13546,"maximum":13546,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13546,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13546,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13546,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0223","type":"APR-DRG"}],"standard_charges":[{"minimum":15866,"maximum":15866,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15866,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15866,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15866,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES","code_information":[{"code":"0224","type":"APR-DRG"}],"standard_charges":[{"minimum":33233,"maximum":33233,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33233,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33233,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33233,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"minimum":32206,"maximum":120705,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51283,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":48482,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32206,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":120705,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":113169,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":67986.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":73861,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59851,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":71565.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84727,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":52607,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52607,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34853,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":39758.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":42541.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":40951.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":41746.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42143.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":41746.29,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0231","type":"APR-DRG"}],"standard_charges":[{"minimum":8398,"maximum":8398,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8398,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8398,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8398,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0232","type":"APR-DRG"}],"standard_charges":[{"minimum":16281,"maximum":16281,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16281,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16281,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16281,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0233","type":"APR-DRG"}],"standard_charges":[{"minimum":25317,"maximum":25317,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25317,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25317,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25317,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES","code_information":[{"code":"0234","type":"APR-DRG"}],"standard_charges":[{"minimum":36646,"maximum":36646,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36646,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36646,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36646,"methodology":"case rate"}]}]},{"description":"HC ATHERECTOMY ILIAC;EACH","code_information":[{"code":"0238T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":50752.17,"maximum":50752.17,"gross_charge":62657,"discounted_cash":18546.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50752.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50752.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50752.17,"methodology":"fee schedule"}]}]},{"description":"HC ATHERECTOMY ILIAC;EACH","code_information":[{"code":"0238T","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":50752.17,"gross_charge":62657,"discounted_cash":18546.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50752.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50752.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50752.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11904.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12531.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9398.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12531.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"minimum":19102,"maximum":74825,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34173,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32307,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21525,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":74825,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70154,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47077.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42683,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50888,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40002,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":49555.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56459,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35055,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19102,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27530.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29458.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28356.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28907.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29182.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28907.4,"methodology":"case rate"}]}]},{"description":"COVID/FLU A/B TRIPLEX","code_information":[{"code":"0240U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":476.28,"maximum":476.28,"gross_charge":588,"discounted_cash":174.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"}]}]},{"description":"COVID/FLU A/B TRIPLEX","code_information":[{"code":"0240U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":142.6,"maximum":476.28,"gross_charge":588,"discounted_cash":174.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":316.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":251.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":243.9,"standard_charge_algorithm": "Lesser of $243.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"standard_charge_algorithm": "Lesser of $142.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":152.61,"standard_charge_algorithm": "Lesser of $152.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":146.91,"standard_charge_algorithm": "Lesser of $146.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":149.76,"standard_charge_algorithm": "Lesser of $149.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":156.89,"standard_charge_algorithm": "Lesser of $156.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":151.19,"standard_charge_algorithm": "Lesser of $151.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0241","type":"APR-DRG"}],"standard_charges":[{"minimum":7387,"maximum":7387,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7387,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7387,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7387,"methodology":"case rate"}]}]},{"description":"HC LAB NFCT DS VIR RESP RNA 4 TRGT","code_information":[{"code":"0241U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":476.28,"maximum":476.28,"gross_charge":588,"discounted_cash":174.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"}]}]},{"description":"HC LAB NFCT DS VIR RESP RNA 4 TRGT","code_information":[{"code":"0241U","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":142.6,"maximum":476.28,"gross_charge":588,"discounted_cash":174.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":316.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":251.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":243.9,"standard_charge_algorithm": "Lesser of $243.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"standard_charge_algorithm": "Lesser of $142.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":152.61,"standard_charge_algorithm": "Lesser of $152.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":146.91,"standard_charge_algorithm": "Lesser of $146.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":149.76,"standard_charge_algorithm": "Lesser of $149.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":156.89,"standard_charge_algorithm": "Lesser of $156.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":151.19,"standard_charge_algorithm": "Lesser of $151.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0242","type":"APR-DRG"}],"standard_charges":[{"minimum":11234,"maximum":11234,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11234,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11234,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11234,"methodology":"case rate"}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0243","type":"APR-DRG"}],"standard_charges":[{"minimum":15329,"maximum":15329,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15329,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15329,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15329,"methodology":"case rate"}]}]},{"description":"OPEN EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0244","type":"APR-DRG"}],"standard_charges":[{"minimum":27313,"maximum":27313,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27313,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27313,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27313,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"minimum":25089,"maximum":79679,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40201,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38006,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25089,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":74705,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":54444.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49078,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58513,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46624,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":57309.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66418,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41239,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41239,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29988,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31838.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34067.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32793.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":33430.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":33749.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":33430.76,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"minimum":16778,"maximum":53523,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27494,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":25992,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16778,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53523,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50182,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38914.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32681,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38964,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31179,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":40962.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45423,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28203,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28203,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20277,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22757.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24350.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23439.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23895,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24122.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23895,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0261","type":"APR-DRG"}],"standard_charges":[{"minimum":9622,"maximum":9622,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9622,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9622,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9622,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0262","type":"APR-DRG"}],"standard_charges":[{"minimum":12196,"maximum":12196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12196,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12196,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12196,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0263","type":"APR-DRG"}],"standard_charges":[{"minimum":17727,"maximum":17727,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17727,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17727,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17727,"methodology":"case rate"}]}]},{"description":"OTHER NERVOUS SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"0264","type":"APR-DRG"}],"standard_charges":[{"minimum":32170,"maximum":32170,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32170,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32170,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32170,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"minimum":13822,"maximum":40736,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22183,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13822,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40736,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38193,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32424.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26973,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32158,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25687,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34131.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22756,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22756,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15800,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18961.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20289.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19530.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19909.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20099.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19909.92,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0271","type":"APR-DRG"}],"standard_charges":[{"minimum":11675,"maximum":11675,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11675,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11675,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11675,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0272","type":"APR-DRG"}],"standard_charges":[{"minimum":15305,"maximum":15305,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15305,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15305,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15305,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0273","type":"APR-DRG"}],"standard_charges":[{"minimum":24998,"maximum":24998,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24998,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24998,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24998,"methodology":"case rate"}]}]},{"description":"OTHER OPEN CRANIOTOMY","code_information":[{"code":"0274","type":"APR-DRG"}],"standard_charges":[{"minimum":38332,"maximum":38332,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38332,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38332,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38332,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITH MCC","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"minimum":29812,"maximum":90287,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54649,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51664,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34236,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51851,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48614,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":72099.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63530,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75743,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63624,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":75894.36,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90287,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":56059,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56059,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29812,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42163.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45114.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43428.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44271.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44693.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44271.71,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"minimum":18599,"maximum":51010,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30173,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28525,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19477,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51010,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47826,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42189.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36941,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44043,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36195,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":44409.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49851,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30952,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30952,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18599,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24672.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26399.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25412.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25905.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26152.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25905.76,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0291","type":"APR-DRG"}],"standard_charges":[{"minimum":13372,"maximum":13372,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13372,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13372,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13372,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0292","type":"APR-DRG"}],"standard_charges":[{"minimum":14146,"maximum":14146,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14146,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14146,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14146,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0293","type":"APR-DRG"}],"standard_charges":[{"minimum":18046,"maximum":18046,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18046,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18046,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18046,"methodology":"case rate"}]}]},{"description":"OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES","code_information":[{"code":"0294","type":"APR-DRG"}],"standard_charges":[{"minimum":27366,"maximum":27366,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27366,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27366,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27366,"methodology":"case rate"}]}]},{"description":"SPINAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"minimum":12434,"maximum":33050,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20004,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18911,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13175,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30758,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28838,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29761.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25306,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30171,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24484,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31328.34,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33050,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20520,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20520,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12434,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17404.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18622.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17926.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18274.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18448.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18274.87,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0301","type":"APR-DRG"}],"standard_charges":[{"minimum":17485,"maximum":17485,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17485,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17485,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17485,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0302","type":"APR-DRG"}],"standard_charges":[{"minimum":26281,"maximum":26281,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26281,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26281,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26281,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0303","type":"APR-DRG"}],"standard_charges":[{"minimum":36129,"maximum":36129,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36129,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36129,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36129,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES","code_information":[{"code":"0304","type":"APR-DRG"}],"standard_charges":[{"minimum":49030,"maximum":49030,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49030,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49030,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49030,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH MCC","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"minimum":14984,"maximum":122056,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37669,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":35612,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23388,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":122056,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":114436,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":51349.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44544,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53107,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43463,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":54052.49,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62235,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38642,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38642,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14984,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30029.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":32131.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30930.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31530.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31830.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31530.62,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH CC","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"minimum":9597,"maximum":52915,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19197,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18148,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12236,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52915,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49612,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28775.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22207,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26476,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22740,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30289.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31716,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19692,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9597,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16827.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18005.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17332.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17669.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17837.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17669.14,"methodology":"case rate"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"minimum":7896,"maximum":38973,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14342,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13559,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9220,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38973,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36540,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22842.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18359,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21889,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17135,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24044.64,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23695,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14712,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14712,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7896,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13358.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14293.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13758.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14026.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14159.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14026.04,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH MCC","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"minimum":22165,"maximum":57751,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34955,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33046,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22165,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42581,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39922,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48033.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43230,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51540,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41191,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":50561.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57751,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35858,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26042,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28089.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30056.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28932.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29494.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29775.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29494.23,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH CC","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"minimum":12024,"maximum":33783,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20448,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19331,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13064,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31797,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29812,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30304.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24686,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29431,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24278,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31899.57,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33783,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20976,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20976,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12024,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17721.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18962.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18253.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18608.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18785.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18608.08,"methodology":"case rate"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"minimum":7778,"maximum":28418,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16478,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10273,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28418,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26644,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25452.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20328,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24237,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19091,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26792.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27223,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16903,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16903,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7778,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14884.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15926.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15331.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15628.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15777.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15628.71,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH MCC","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"minimum":15982,"maximum":49319,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29852,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28221,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19178,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37812,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35451,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41796.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36459,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43468,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35640,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":43995.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49319,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30622,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30622,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15982,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24442.17,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25175.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25664.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25908.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25664.28,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH CC","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"minimum":9090,"maximum":27541,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14484,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13693,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9090,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27541,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25821,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23015.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17678,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21077,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16892,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24227.34,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23930,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14858,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10865,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13459.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14401.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13863.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14132.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14267.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14132.62,"methodology":"case rate"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"minimum":6482,"maximum":18756.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10231,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9672,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6482,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18676,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17510,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17818.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12460,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14855,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12047,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18756.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16903,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10495,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10495,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6799,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10420.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11149.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10733.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10941.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11045.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10941.45,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"minimum":17615,"maximum":77699,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33907,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32055,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21876,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77699,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":72848,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46752.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40949,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48821,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40654,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":49213.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56020,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":34783,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34783,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17615,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27340.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29254.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28160.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28707.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28981.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28707.74,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0401","type":"APR-DRG"}],"standard_charges":[{"minimum":5925,"maximum":5925,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5925,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5925,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5925,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0402","type":"APR-DRG"}],"standard_charges":[{"minimum":8851,"maximum":8851,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8851,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8851,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8851,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0403","type":"APR-DRG"}],"standard_charges":[{"minimum":11588,"maximum":11588,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11588,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11588,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11588,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES","code_information":[{"code":"0404","type":"APR-DRG"}],"standard_charges":[{"minimum":20761,"maximum":20761,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20761,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20761,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20761,"methodology":"case rate"}]}]},{"description":"INSERT/REPL PCCM SYS","code_information":[{"code":"0408T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":92315.7,"maximum":92315.7,"gross_charge":113970,"discounted_cash":33735.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92315.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92315.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92315.7,"methodology":"fee schedule"}]}]},{"description":"INSERT/REPL PCCM SYS","code_information":[{"code":"0408T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":92315.7,"gross_charge":113970,"discounted_cash":33735.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92315.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92315.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92315.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48000.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49016,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21654.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22794,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17095.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22794,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28664.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30670.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29524.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30097.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31530.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30384.19,"methodology":"case rate"}]}]},{"description":"INSERT/REPL PULSE GEN ONLY","code_information":[{"code":"0409T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":66144.6,"maximum":66144.6,"gross_charge":81660,"discounted_cash":24171.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66144.6,"methodology":"fee schedule"}]}]},{"description":"INSERT/REPL PULSE GEN ONLY","code_information":[{"code":"0409T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":66144.6,"gross_charge":81660,"discounted_cash":24171.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34391.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34315.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15515.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16332,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12249,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16332,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20067.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21472.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20669.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21071.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22074.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21271.86,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"minimum":12673,"maximum":33537,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20299,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19190,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12673,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29516,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27673,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30122.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25273,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30131,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23552,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31707.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33537,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20823,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17163,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17615.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18848.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18143.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18496.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18672.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18496.11,"methodology":"case rate"}]}]},{"description":"INSERT/REPL ATRIAL LEAD ONLY","code_information":[{"code":"0410T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":23838.3,"maximum":23838.3,"gross_charge":29430,"discounted_cash":8711.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23838.3,"methodology":"fee schedule"}]}]},{"description":"INSERT/REPL ATRIAL LEAD ONLY","code_information":[{"code":"0410T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":23838.3,"gross_charge":29430,"discounted_cash":8711.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5591.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5886,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4414.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5886,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0411","type":"APR-DRG"}],"standard_charges":[{"minimum":5387,"maximum":5387,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5387,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5387,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5387,"methodology":"case rate"}]}]},{"description":"INSERT/REPL VENT LEAD ONLY","code_information":[{"code":"0411T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":23838.3,"maximum":23838.3,"gross_charge":29430,"discounted_cash":8711.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23838.3,"methodology":"fee schedule"}]}]},{"description":"INSERT/REPL VENT LEAD ONLY","code_information":[{"code":"0411T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":23838.3,"gross_charge":29430,"discounted_cash":8711.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5591.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5886,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4414.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5886,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0412","type":"APR-DRG"}],"standard_charges":[{"minimum":9127,"maximum":9127,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9127,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9127,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9127,"methodology":"case rate"}]}]},{"description":"REMO PCCM GEN ONLY","code_information":[{"code":"0412T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11020.05,"maximum":11020.05,"gross_charge":13605,"discounted_cash":4027.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11020.05,"methodology":"fee schedule"}]}]},{"description":"REMO PCCM GEN ONLY","code_information":[{"code":"0412T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11020.05,"gross_charge":13605,"discounted_cash":4027.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2584.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2040.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0413","type":"APR-DRG"}],"standard_charges":[{"minimum":14314,"maximum":14314,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14314,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14314,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14314,"methodology":"case rate"}]}]},{"description":"REMO PCCM LEADS(A OR V)","code_information":[{"code":"0413T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11020.05,"maximum":11020.05,"gross_charge":13605,"discounted_cash":4027.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11020.05,"methodology":"fee schedule"}]}]},{"description":"REMO PCCM LEADS(A OR V)","code_information":[{"code":"0413T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11020.05,"gross_charge":13605,"discounted_cash":4027.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11020.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2584.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2040.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2721,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM MALIGNANCY","code_information":[{"code":"0414","type":"APR-DRG"}],"standard_charges":[{"minimum":14314,"maximum":14314,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14314,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14314,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14314,"methodology":"case rate"}]}]},{"description":"REMO/REPL PCCM GEN ONLY","code_information":[{"code":"0414T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":66144.6,"maximum":66144.6,"gross_charge":81660,"discounted_cash":24171.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66144.6,"methodology":"fee schedule"}]}]},{"description":"REMO/REPL PCCM GEN ONLY","code_information":[{"code":"0414T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":66144.6,"gross_charge":81660,"discounted_cash":24171.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66144.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34391.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34315.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15515.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16332,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12249,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16332,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20067.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21472.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20669.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21071.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22074.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21271.86,"methodology":"case rate"}]}]},{"description":"REPOS PCCM LEADS (A OR V)","code_information":[{"code":"0415T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1761.75,"maximum":1761.75,"gross_charge":2175,"discounted_cash":643.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1761.75,"methodology":"fee schedule"}]}]},{"description":"REPOS PCCM LEADS (A OR V)","code_information":[{"code":"0415T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7669,"gross_charge":2175,"discounted_cash":643.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"minimum":8591,"maximum":28952,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15799,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14936,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9884,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28952,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27144,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24623.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23837,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18369,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25919.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16207,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16207,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8591,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14399.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15407.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14831.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15119.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15263.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15119.45,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0421","type":"APR-DRG"}],"standard_charges":[{"minimum":4352,"maximum":4352,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4352,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4352,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4352,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0422","type":"APR-DRG"}],"standard_charges":[{"minimum":8664,"maximum":8664,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8664,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8664,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8664,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0423","type":"APR-DRG"}],"standard_charges":[{"minimum":8664,"maximum":8664,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8664,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8664,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8664,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS","code_information":[{"code":"0424","type":"APR-DRG"}],"standard_charges":[{"minimum":14611,"maximum":14611,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14611,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14611,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14611,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0431","type":"APR-DRG"}],"standard_charges":[{"minimum":6964,"maximum":6964,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6964,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6964,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6964,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0432","type":"APR-DRG"}],"standard_charges":[{"minimum":9869,"maximum":9869,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9869,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9869,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9869,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0433","type":"APR-DRG"}],"standard_charges":[{"minimum":12297,"maximum":12297,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12297,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12297,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12297,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES","code_information":[{"code":"0434","type":"APR-DRG"}],"standard_charges":[{"minimum":22739,"maximum":22739,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22739,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22739,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22739,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0441","type":"APR-DRG"}],"standard_charges":[{"minimum":5311,"maximum":5311,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5311,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5311,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5311,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0442","type":"APR-DRG"}],"standard_charges":[{"minimum":12201,"maximum":12201,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12201,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12201,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12201,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0443","type":"APR-DRG"}],"standard_charges":[{"minimum":14937,"maximum":14937,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14937,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14937,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14937,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE","code_information":[{"code":"0444","type":"APR-DRG"}],"standard_charges":[{"minimum":25280,"maximum":25280,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25280,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25280,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25280,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0451","type":"APR-DRG"}],"standard_charges":[{"minimum":6729,"maximum":6729,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6729,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6729,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6729,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0452","type":"APR-DRG"}],"standard_charges":[{"minimum":8572,"maximum":8572,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0453","type":"APR-DRG"}],"standard_charges":[{"minimum":14668,"maximum":14668,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14668,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14668,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14668,"methodology":"case rate"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION","code_information":[{"code":"0454","type":"APR-DRG"}],"standard_charges":[{"minimum":27293,"maximum":27293,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27293,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27293,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27293,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0461","type":"APR-DRG"}],"standard_charges":[{"minimum":5958,"maximum":5958,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5958,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5958,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5958,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0462","type":"APR-DRG"}],"standard_charges":[{"minimum":6947,"maximum":6947,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6947,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6947,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6947,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0463","type":"APR-DRG"}],"standard_charges":[{"minimum":6947,"maximum":6947,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6947,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6947,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6947,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION","code_information":[{"code":"0464","type":"APR-DRG"}],"standard_charges":[{"minimum":13066,"maximum":13066,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13066,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13066,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13066,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0471","type":"APR-DRG"}],"standard_charges":[{"minimum":3616,"maximum":3616,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3616,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3616,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3616,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0472","type":"APR-DRG"}],"standard_charges":[{"minimum":5978,"maximum":5978,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5978,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5978,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5978,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0473","type":"APR-DRG"}],"standard_charges":[{"minimum":6303,"maximum":6303,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6303,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6303,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6303,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA","code_information":[{"code":"0474","type":"APR-DRG"}],"standard_charges":[{"minimum":9315,"maximum":9315,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9315,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9315,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9315,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0481","type":"APR-DRG"}],"standard_charges":[{"minimum":4897,"maximum":4897,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4897,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4897,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4897,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0482","type":"APR-DRG"}],"standard_charges":[{"minimum":5104,"maximum":5104,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5104,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5104,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5104,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0483","type":"APR-DRG"}],"standard_charges":[{"minimum":9911,"maximum":9911,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9911,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9911,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9911,"methodology":"case rate"}]}]},{"description":"PERIPHERAL CRANIAL AND AUTONOMIC NERVE DISORDERS","code_information":[{"code":"0484","type":"APR-DRG"}],"standard_charges":[{"minimum":14326,"maximum":14326,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14326,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14326,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14326,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0491","type":"APR-DRG"}],"standard_charges":[{"minimum":6953,"maximum":6953,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6953,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6953,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6953,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0492","type":"APR-DRG"}],"standard_charges":[{"minimum":12700,"maximum":12700,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12700,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12700,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12700,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0493","type":"APR-DRG"}],"standard_charges":[{"minimum":15088,"maximum":15088,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15088,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15088,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15088,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM","code_information":[{"code":"0494","type":"APR-DRG"}],"standard_charges":[{"minimum":22421,"maximum":22421,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22421,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22421,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22421,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0501","type":"APR-DRG"}],"standard_charges":[{"minimum":5013,"maximum":5013,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5013,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5013,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5013,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0502","type":"APR-DRG"}],"standard_charges":[{"minimum":7520,"maximum":7520,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0503","type":"APR-DRG"}],"standard_charges":[{"minimum":12646,"maximum":12646,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12646,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12646,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12646,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS","code_information":[{"code":"0504","type":"APR-DRG"}],"standard_charges":[{"minimum":25416,"maximum":25416,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25416,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25416,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25416,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0511","type":"APR-DRG"}],"standard_charges":[{"minimum":4078,"maximum":4078,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4078,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4078,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4078,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0512","type":"APR-DRG"}],"standard_charges":[{"minimum":4478,"maximum":4478,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4478,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4478,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4478,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0513","type":"APR-DRG"}],"standard_charges":[{"minimum":8844,"maximum":8844,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8844,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8844,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8844,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS","code_information":[{"code":"0514","type":"APR-DRG"}],"standard_charges":[{"minimum":9432,"maximum":9432,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9432,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9432,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9432,"methodology":"case rate"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITH CC/MCC","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"minimum":11047,"maximum":46572,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18090,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17102,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11047,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33532,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31438,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27423.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19243,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22943,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20530,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28866.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29888,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18557,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18557,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46572,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16036.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17159.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16518.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16838.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16999.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16838.81,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0521","type":"APR-DRG"}],"standard_charges":[{"minimum":4474,"maximum":4474,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4474,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4474,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4474,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0522","type":"APR-DRG"}],"standard_charges":[{"minimum":6758,"maximum":6758,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0523","type":"APR-DRG"}],"standard_charges":[{"minimum":8401,"maximum":8401,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8401,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8401,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8401,"methodology":"case rate"}]}]},{"description":"ALTERATION IN CONSCIOUSNESS","code_information":[{"code":"0524","type":"APR-DRG"}],"standard_charges":[{"minimum":12712,"maximum":12712,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12712,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12712,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12712,"methodology":"case rate"}]}]},{"description":"LOWER RESP TRACT INF DETECTION AMP PROBE","code_information":[{"code":"0528U","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":234.09,"maximum":234.09,"gross_charge":289,"discounted_cash":85.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.09,"methodology":"fee schedule"}]}]},{"description":"LOWER RESP TRACT INF DETECTION AMP PROBE","code_information":[{"code":"0528U","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":43.35,"maximum":234.09,"gross_charge":289,"discounted_cash":85.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.8,"methodology":"fee schedule"}]}]},{"description":"SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"minimum":4832,"maximum":16249.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8282,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7830,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5589,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14724,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13804,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15437.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11055,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13181,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10387,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16249.85,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13684,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8496,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8496,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4832,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9027.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9298.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9479.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9569.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9479.08,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0531","type":"APR-DRG"}],"standard_charges":[{"minimum":3609,"maximum":3609,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0532","type":"APR-DRG"}],"standard_charges":[{"minimum":5808,"maximum":5808,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5808,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5808,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5808,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0533","type":"APR-DRG"}],"standard_charges":[{"minimum":8906,"maximum":8906,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8906,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8906,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8906,"methodology":"case rate"}]}]},{"description":"SEIZURE","code_information":[{"code":"0534","type":"APR-DRG"}],"standard_charges":[{"minimum":22823,"maximum":22823,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22823,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22823,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22823,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITH MCC","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":8371,"maximum":27884,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13475,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12739,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27884,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26143,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21783.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14992,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17874,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15557,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22929.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22263,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13823,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10130,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12738.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13630.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13121.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13375.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13503.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13375.8,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0541","type":"APR-DRG"}],"standard_charges":[{"minimum":3888,"maximum":3888,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3888,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3888,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3888,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0542","type":"APR-DRG"}],"standard_charges":[{"minimum":5431,"maximum":5431,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5431,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5431,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5431,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0543","type":"APR-DRG"}],"standard_charges":[{"minimum":5431,"maximum":5431,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5431,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5431,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5431,"methodology":"case rate"}]}]},{"description":"MIGRAINE AND OTHER HEADACHES","code_information":[{"code":"0544","type":"APR-DRG"}],"standard_charges":[{"minimum":9620,"maximum":9620,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9620,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9620,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9620,"methodology":"case rate"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITHOUT MCC","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"minimum":6097,"maximum":24652,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9807,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9271,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6097,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24652,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23113,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17300.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10899,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12994,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11331,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18210.96,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16203,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10060,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10060,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8073,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10117.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10825.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10420.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10623.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10724.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10623.06,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0551","type":"APR-DRG"}],"standard_charges":[{"minimum":4453,"maximum":4453,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4453,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4453,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4453,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0552","type":"APR-DRG"}],"standard_charges":[{"minimum":8576,"maximum":8576,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8576,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8576,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8576,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0553","type":"APR-DRG"}],"standard_charges":[{"minimum":14146,"maximum":14146,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14146,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14146,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14146,"methodology":"case rate"}]}]},{"description":"HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE","code_information":[{"code":"0554","type":"APR-DRG"}],"standard_charges":[{"minimum":17791,"maximum":17791,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17791,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17791,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17791,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":13601,"maximum":37189,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22509,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21280,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13601,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17897,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16780,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32823.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24113,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28748,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25276,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34551.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23090,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23090,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17358,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19195.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20538.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19770.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20154.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20346.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20154.77,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0561","type":"APR-DRG"}],"standard_charges":[{"minimum":5014,"maximum":5014,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0562","type":"APR-DRG"}],"standard_charges":[{"minimum":6070,"maximum":6070,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6070,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6070,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6070,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0563","type":"APR-DRG"}],"standard_charges":[{"minimum":8724,"maximum":8724,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8724,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8724,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8724,"methodology":"case rate"}]}]},{"description":"BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0564","type":"APR-DRG"}],"standard_charges":[{"minimum":13973,"maximum":13973,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13973,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13973,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13973,"methodology":"case rate"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":7745,"maximum":21025.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11995,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11340,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7745,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13353,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12519,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19974.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14068,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16772,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14393,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21025.46,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19817,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12305,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9492,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11680.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12498.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12031.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12264.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12381.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12264.86,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0571","type":"APR-DRG"}],"standard_charges":[{"minimum":3023,"maximum":3023,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3023,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3023,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3023,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0572","type":"APR-DRG"}],"standard_charges":[{"minimum":5527,"maximum":5527,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0573","type":"APR-DRG"}],"standard_charges":[{"minimum":10455,"maximum":10455,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10455,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10455,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10455,"methodology":"case rate"}]}]},{"description":"CONCUSSION CLOSED SKULL FRACTURE NOS AND UNCOMPLICATED INTRACRANIAL INJURY COMA < 1 HOUR OR NO COMA","code_information":[{"code":"0574","type":"APR-DRG"}],"standard_charges":[{"minimum":15363,"maximum":15363,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15363,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15363,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15363,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"minimum":7786,"maximum":27414,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16593,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15686,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9817,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18001,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16877,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25593.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18649,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22234,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18243,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26940.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27414,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17021,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17021,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7786,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14966.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16014.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15415.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15715.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15864.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15715.05,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0581","type":"APR-DRG"}],"standard_charges":[{"minimum":6230,"maximum":6230,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6230,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6230,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6230,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0582","type":"APR-DRG"}],"standard_charges":[{"minimum":8165,"maximum":8165,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8165,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8165,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8165,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0583","type":"APR-DRG"}],"standard_charges":[{"minimum":12839,"maximum":12839,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12839,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12839,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12839,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM","code_information":[{"code":"0584","type":"APR-DRG"}],"standard_charges":[{"minimum":20879,"maximum":20879,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20879,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20879,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20879,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"minimum":6745,"maximum":19744.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10999,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10398,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6745,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13048,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12233,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18757.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12360,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14736,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12534,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19744.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18172,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11283,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11283,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7768,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10969.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11736.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11298.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11517.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11627.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11517.49,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0591","type":"APR-DRG"}],"standard_charges":[{"minimum":3869,"maximum":3869,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3869,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3869,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3869,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0592","type":"APR-DRG"}],"standard_charges":[{"minimum":6001,"maximum":6001,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6001,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6001,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6001,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0593","type":"APR-DRG"}],"standard_charges":[{"minimum":8963,"maximum":8963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8963,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8963,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8963,"methodology":"case rate"}]}]},{"description":"ANOXIC AND OTHER SEVERE BRAIN DAMAGE","code_information":[{"code":"0594","type":"APR-DRG"}],"standard_charges":[{"minimum":11888,"maximum":11888,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11888,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11888,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11888,"methodology":"case rate"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"minimum":5048,"maximum":15914.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8022,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7584,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5098,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10616,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9953,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15118.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9796,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11679,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9475,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15914.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13253,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8229,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8229,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8841.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9460.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9106.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9283.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9371.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9283.46,"methodology":"case rate"}]}]},{"description":"ISCHEMIC STROKE PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"minimum":13756,"maximum":42753,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24301,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22973,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15924,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42753,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40084,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35012.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31698,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37792,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29592,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36855.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24928,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24928,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13756,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20475.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21908.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21089.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21499.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21703.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21499.09,"methodology":"case rate"}]}]},{"description":"ISCHEMIC STROKE PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"minimum":10046,"maximum":34961,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16008,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15134,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10634,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34961,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32778,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24879.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20723,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24707,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19761,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26188.47,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26448,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16422,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16422,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10046,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14549.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15567.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14985.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15276.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15422.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15276.61,"methodology":"case rate"}]}]},{"description":"ISCHEMIC STROKE PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"minimum":8447,"maximum":31205,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12628,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11938,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8447,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31205,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29257,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20747.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17089,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20374,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15698,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21839.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20863,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12954,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12954,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8851,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12133.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12982.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12497.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12739.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12861.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12739.73,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":11380,"maximum":29542,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17881,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16904,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11380,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26126,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24495,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27167.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21315,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25413,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21148,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28597.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29542,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18342,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15959,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15887.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16999.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16363.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16681.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16840.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16681.65,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":5775,"maximum":17354.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9141,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8642,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5775,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15089,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14147,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16486.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10986,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13098,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10731,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17354.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9377,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8626,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9641.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10316.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9930.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10123.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10219.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10123.24,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":3906,"maximum":13554.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6187,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5849,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3906,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11819,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11082,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12876.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7550,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9002,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7259,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13554.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10222,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6347,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6347,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4874,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7530.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8057.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7756.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7906.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7982.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7906.76,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"minimum":6722,"maximum":29877,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13078,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12364,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8050,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29877,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28012,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21297.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15285,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18224,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14960,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22418.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21607,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13416,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13416,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6722,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12454.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13326.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12828.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13077.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13202.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13077.66,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"minimum":4705,"maximum":15788.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7924,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7491,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4948,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14514,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13608,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14999.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9768,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11646,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9196,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15788.47,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13091,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8128,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8128,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4705,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8771.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9385.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9034.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9209.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9297.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9209.94,"methodology":"case rate"}]}]},{"description":"TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":4515,"maximum":14847.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7192,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6799,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4538,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9108,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8539,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14104.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8624,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10283,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8433,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14847.21,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11882,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7378,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7378,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4515,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8248.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8825.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8495.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8660.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8743.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8660.88,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"minimum":10167,"maximum":25823,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15630,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14776,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10167,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15696,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14716,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24416.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18637,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22220,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18894,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25701.66,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16033,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16033,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11255,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14278.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15278.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14707.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14992.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15135.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14992.64,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"minimum":6032,"maximum":17781.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9473,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8956,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6032,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14255,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13365,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16892.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11555,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13776,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11210,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17781.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15652,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9718,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9718,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7167,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9878.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10570.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10175.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10372.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10471.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10372.82,"methodology":"case rate"}]}]},{"description":"NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"minimum":4043,"maximum":14270.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6744,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6375,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4448,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11590,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10867,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13556.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8345,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9949,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8267,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14270.21,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11141,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6918,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6918,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4043,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7927.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8482.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8165.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8324.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8403.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8324.29,"methodology":"case rate"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"minimum":8596,"maximum":23467.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13893,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13134,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8596,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22055,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20678,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22294.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19321,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15974,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23467.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22954,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14252,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14252,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8878,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13037.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13950.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13428.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13689.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13819.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13689.45,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0731","type":"APR-DRG"}],"standard_charges":[{"minimum":7773,"maximum":7773,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7773,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7773,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7773,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0732","type":"APR-DRG"}],"standard_charges":[{"minimum":9759,"maximum":9759,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9759,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9759,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9759,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0733","type":"APR-DRG"}],"standard_charges":[{"minimum":14009,"maximum":14009,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14009,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14009,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14009,"methodology":"case rate"}]}]},{"description":"ORBIT AND EYE PROCEDURES","code_information":[{"code":"0734","type":"APR-DRG"}],"standard_charges":[{"minimum":25882,"maximum":25882,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25882,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25882,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25882,"methodology":"case rate"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":5637,"maximum":17648.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9370,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8858,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5830,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10827,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10151,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16766.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11064,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13191,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10835,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17648.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15481,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9612,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9612,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5637,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9804.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10491.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10099.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10295.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10393.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10295.24,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS WITH CC/MCC","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"minimum":5505,"maximum":25579,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15483,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14637,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10873,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12199,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11438,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24236.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19726,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23519,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20206,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25512.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25579,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15882,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15882,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5505,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14173.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15165.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14598.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14882.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15023.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14882.01,"methodology":"case rate"}]}]},{"description":"VIRAL MENINGITIS WITHOUT CC/MCC","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"minimum":3285,"maximum":16197.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8242,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7792,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5241,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7650,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7172,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15387.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10672,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12723,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9740,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16197.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13617,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8455,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8455,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3285,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8998.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9628.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9268.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9448.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9538.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9448.72,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH MCC","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"minimum":6471,"maximum":23475.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13900,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13140,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8584,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20902,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19597,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22301.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16907,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20158,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15952,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23475.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22964,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14258,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14258,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6471,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13042.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13955.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13433.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13694.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13824.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13694.18,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH CC","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"minimum":5777,"maximum":17134.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8970,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8480,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5777,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12548,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11764,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16277.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10731,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12794,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10736,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17134.42,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14820,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9202,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9202,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5906,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9519.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10185.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9804.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9995.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10090.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9995.08,"methodology":"case rate"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"minimum":3957,"maximum":13304.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5993,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5666,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4209,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11306,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10600,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12639.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7933,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9458,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7821,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13304.67,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6148,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3957,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7391.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7908.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7613.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7761.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7834.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7761.06,"methodology":"case rate"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITH MCC","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"minimum":4677,"maximum":29521,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17868,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16892,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12548,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14088,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27151.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22048,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26287,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23319,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28580.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29521,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18330,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18330,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4677,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15878.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16989.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16354.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16672.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16830.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16672.2,"methodology":"case rate"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"minimum":3124,"maximum":16057.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8133,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7689,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5167,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7958,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15255,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9712,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11579,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9602,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16057.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13437,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8343,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8343,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3124,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8921.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9545.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9188.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9367.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9456.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9367.11,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"minimum":10635,"maximum":39847,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20856,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19717,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12944,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39847,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37360,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30803.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24486,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29193,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24054,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32424.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34457,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21395,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21395,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10635,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18013.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19274.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18554.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18914.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19094.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18914.32,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0821","type":"APR-DRG"}],"standard_charges":[{"minimum":3893,"maximum":3893,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3893,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3893,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3893,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0822","type":"APR-DRG"}],"standard_charges":[{"minimum":6063,"maximum":6063,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6063,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6063,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6063,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0823","type":"APR-DRG"}],"standard_charges":[{"minimum":6866,"maximum":6866,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6866,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6866,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6866,"methodology":"case rate"}]}]},{"description":"EYE INFECTIONS AND OTHER EYE DISORDERS","code_information":[{"code":"0824","type":"APR-DRG"}],"standard_charges":[{"minimum":14254,"maximum":14254,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14254,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14254,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14254,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":7079,"maximum":21673.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12498,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11816,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7706,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20561,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19277,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20589.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14573,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17374,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14321,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21673.01,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12821,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12821,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7079,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12040.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12883.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12401.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12642.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12763,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12642.59,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"minimum":5222,"maximum":16651.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8594,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8125,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5225,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13942,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13072,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15818.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9906,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11811,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9710,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16651.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8816,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8816,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5222,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9250.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9898.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9528.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9713.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9805.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9713.13,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":9224,"maximum":33653,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20369,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19256,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12913,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29342,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27510,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30207.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25247,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30100,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23996,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31797.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33653,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20895,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20895,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9224,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17665.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18902.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18195.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18548.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18725.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18548.73,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"minimum":5147,"maximum":20761.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11790,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11146,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7483,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18853,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17676,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19723.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14048,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16749,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13906,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20761.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12094,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12094,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5147,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11534.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12341.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11880.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12111.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12226.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12111.07,"methodology":"case rate"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"minimum":3981,"maximum":15817.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7946,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7512,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5035,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10144,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9511,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15026.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9430,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11243,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9356,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15817.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13128,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8151,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8151,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3981,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8787.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9402.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9051.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9226.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9314.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9226.81,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITH MCC","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"minimum":7969,"maximum":21907.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12681,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11988,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8714,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21317,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19986,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20812.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17038,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20314,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16194,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21907.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20950,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13008,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13008,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7969,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12170.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13022.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12536.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12779.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12901.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12779.52,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITH CC","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"minimum":6385,"maximum":17992.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9637,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9111,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6533,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13184,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12361,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17092.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12622,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15048,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12141,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17992.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9886,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9886,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6385,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9995.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10695.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10295.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10495.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10595.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10495.58,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0891","type":"APR-DRG"}],"standard_charges":[{"minimum":16571,"maximum":16571,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16571,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16571,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16571,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0892","type":"APR-DRG"}],"standard_charges":[{"minimum":17604,"maximum":17604,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17604,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17604,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17604,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0893","type":"APR-DRG"}],"standard_charges":[{"minimum":45972,"maximum":45972,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45972,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45972,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45972,"methodology":"case rate"}]}]},{"description":"MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0894","type":"APR-DRG"}],"standard_charges":[{"minimum":45972,"maximum":45972,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45972,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45972,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45972,"methodology":"case rate"}]}]},{"description":"CONCUSSION WITHOUT CC/MCC","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"minimum":3805,"maximum":15508.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7706,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7285,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5311,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8129,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14733.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8897,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10607,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9870,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15508.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12732,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7905,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7905,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3805,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8615.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9219.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8874.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9046.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9132.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9046.7,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"minimum":10165,"maximum":27072,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16386,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15491,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10165,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25398,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23813,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25340.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18671,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22261,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18890,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26674.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27072,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16809,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16809,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13696,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14818.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15856.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15263.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15559.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15708.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15559.91,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0911","type":"APR-DRG"}],"standard_charges":[{"minimum":9290,"maximum":9290,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9290,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9290,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9290,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0912","type":"APR-DRG"}],"standard_charges":[{"minimum":22845,"maximum":22845,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22845,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22845,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22845,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0913","type":"APR-DRG"}],"standard_charges":[{"minimum":47792,"maximum":47792,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47792,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47792,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47792,"methodology":"case rate"}]}]},{"description":"COA ELUDING BALLOON","code_information":[{"code":"0913T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":17416.62,"maximum":17416.62,"gross_charge":21502,"discounted_cash":6364.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17416.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17416.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17416.62,"methodology":"fee schedule"}]}]},{"description":"COA ELUDING BALLOON","code_information":[{"code":"0913T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3225.3,"maximum":17416.62,"gross_charge":21502,"discounted_cash":6364.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17416.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17416.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17416.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4085.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4300.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3225.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4300.4,"methodology":"fee schedule"}]}]},{"description":"OTHER MAJOR HEAD AND NECK PROCEDURES","code_information":[{"code":"0914","type":"APR-DRG"}],"standard_charges":[{"minimum":48426,"maximum":48426,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48426,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48426,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48426,"methodology":"case rate"}]}]},{"description":"AD-ON COA DRUG ELUDING BALLOON","code_information":[{"code":"0914T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8710.74,"maximum":8710.74,"gross_charge":10754,"discounted_cash":3183.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8710.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8710.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8710.74,"methodology":"fee schedule"}]}]},{"description":"AD-ON COA DRUG ELUDING BALLOON","code_information":[{"code":"0914T","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1613.1,"maximum":8710.74,"gross_charge":10754,"discounted_cash":3183.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8710.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8710.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8710.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2043.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2150.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1613.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2150.8,"methodology":"fee schedule"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITH CC","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":5830,"maximum":17837.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9517,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8997,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5830,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15475,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14509,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16945.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10747,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12814,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10834,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17837.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9762,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9762,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6817,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9909.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10603.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10207.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10405.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10504.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10405.2,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0921","type":"APR-DRG"}],"standard_charges":[{"minimum":17737,"maximum":17737,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17737,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17737,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17737,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0922","type":"APR-DRG"}],"standard_charges":[{"minimum":17737,"maximum":17737,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17737,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17737,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17737,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0923","type":"APR-DRG"}],"standard_charges":[{"minimum":20250,"maximum":20250,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20250,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20250,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20250,"methodology":"case rate"}]}]},{"description":"FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES","code_information":[{"code":"0924","type":"APR-DRG"}],"standard_charges":[{"minimum":36409,"maximum":36409,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36409,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36409,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36409,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":4400,"maximum":15058,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7095,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6707,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4400,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15058,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14118,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13986.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8267,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9856,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8176,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14722.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11722,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7278,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7278,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4987,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8179.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8751.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8424.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8588.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8669.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8588.03,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"minimum":20582,"maximum":68250,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32798,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":31007,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20582,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68250,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":63989,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45397.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38626,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46052,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38248,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":47786.35,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54187,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33645,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33645,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27345,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26547.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28406.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27344.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27875.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28140.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27875.37,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"minimum":13545,"maximum":35601,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21548,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13545,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34208,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32072,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31649.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27636,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32949,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25172,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33314.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35601,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22105,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22105,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21883,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18508.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19803.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19063.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19433.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19618.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19433.7,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0951","type":"APR-DRG"}],"standard_charges":[{"minimum":7249,"maximum":7249,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7249,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7249,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7249,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0952","type":"APR-DRG"}],"standard_charges":[{"minimum":7249,"maximum":7249,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7249,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7249,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7249,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0953","type":"APR-DRG"}],"standard_charges":[{"minimum":11187,"maximum":11187,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11187,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11187,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11187,"methodology":"case rate"}]}]},{"description":"CLEFT LIP AND PALATE REPAIR","code_information":[{"code":"0954","type":"APR-DRG"}],"standard_charges":[{"minimum":15971,"maximum":15971,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15971,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15971,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15971,"methodology":"case rate"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"minimum":11640,"maximum":35601,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21548,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12384,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21153,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19833,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31649.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24691,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29438,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23013,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33314.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35601,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22105,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22105,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18508.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19803.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19063.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19433.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19618.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19433.7,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"minimum":20662,"maximum":53235,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32222,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30462,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20662,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37209,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34886,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44692.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42028,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50107,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38398,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":47045.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53235,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33054,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33054,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20799,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26136.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27965.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26920.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27443,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27704.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27443,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0971","type":"APR-DRG"}],"standard_charges":[{"minimum":3397,"maximum":3397,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0972","type":"APR-DRG"}],"standard_charges":[{"minimum":5808,"maximum":5808,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5808,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5808,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5808,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0973","type":"APR-DRG"}],"standard_charges":[{"minimum":8670,"maximum":8670,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8670,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8670,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8670,"methodology":"case rate"}]}]},{"description":"TONSIL AND ADENOID PROCEDURES","code_information":[{"code":"0974","type":"APR-DRG"}],"standard_charges":[{"minimum":19916,"maximum":19916,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19916,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19916,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19916,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"minimum":12028,"maximum":32216,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19500,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18435,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12240,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22715,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21297,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29145.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22528,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26859,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22747,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30679.64,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32216,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20003,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20003,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12028,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17044.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18237.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17555.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17896.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18066.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17896.46,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0981","type":"APR-DRG"}],"standard_charges":[{"minimum":6292,"maximum":6292,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6292,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6292,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6292,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0982","type":"APR-DRG"}],"standard_charges":[{"minimum":9448,"maximum":9448,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9448,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9448,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9448,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0983","type":"APR-DRG"}],"standard_charges":[{"minimum":12358,"maximum":12358,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12358,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12358,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12358,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT PROCEDURES","code_information":[{"code":"0984","type":"APR-DRG"}],"standard_charges":[{"minimum":23797,"maximum":23797,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23797,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23797,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23797,"methodology":"case rate"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"minimum":5854,"maximum":21706.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12524,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11840,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7501,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11751,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11017,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20621.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15116,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18022,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13939,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21706.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12848,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12848,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5854,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12059.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12903.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12420.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12662.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12782.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12662.15,"methodology":"case rate"}]}]},{"description":"SEIZURES WITH MCC","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"minimum":10091,"maximum":29484,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17846,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16871,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11263,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16247,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15233,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27124.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20764,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24756,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20931,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28552,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29484,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18306,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18306,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10091,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15862.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16972.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16338.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16655.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16813.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16655.34,"methodology":"case rate"}]}]},{"description":"FNA BX W/O IMG GDN EA ADDL","code_information":[{"code":"10004","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ASPIRATION FINE NEEDLE 10005","code_information":[{"code":"10005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2202.39,"maximum":2202.39,"gross_charge":2719,"discounted_cash":804.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2202.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202.39,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION FINE NEEDLE 10005","code_information":[{"code":"10005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2719,"discounted_cash":804.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2202.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2202.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2202.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"US FINE NDLE ASP ADDL LESION","code_information":[{"code":"10006","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1101.6,"maximum":1101.6,"gross_charge":1360,"discounted_cash":402.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1101.6,"methodology":"fee schedule"}]}]},{"description":"US FINE NDLE ASP ADDL LESION","code_information":[{"code":"10006","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1360,"discounted_cash":402.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":272,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":204,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":272,"methodology":"fee schedule"}]}]},{"description":"HC FINE NEEDLE ASPIRATION","code_information":[{"code":"10007","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1960.2,"maximum":1960.2,"gross_charge":2420,"discounted_cash":716.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1960.2,"methodology":"fee schedule"}]}]},{"description":"HC FINE NEEDLE ASPIRATION","code_information":[{"code":"10007","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2420,"discounted_cash":716.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":484,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":363,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":484,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"FNA BX W/FLUOR GDN EA ADDL","code_information":[{"code":"10008","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FINE NEEDLE ASPIRAT DEEP TISS","code_information":[{"code":"10009","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1079.73,"maximum":1079.73,"gross_charge":1333,"discounted_cash":394.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1079.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1079.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1079.73,"methodology":"fee schedule"}]}]},{"description":"HC FINE NEEDLE ASPIRAT DEEP TISS","code_information":[{"code":"10009","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1333,"discounted_cash":394.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1079.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1079.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1079.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"CT FINE NEEDLE ASP ADDL LESION","code_information":[{"code":"10010","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1101.6,"maximum":1101.6,"gross_charge":1360,"discounted_cash":402.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1101.6,"methodology":"fee schedule"}]}]},{"description":"CT FINE NEEDLE ASP ADDL LESION","code_information":[{"code":"10010","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1360,"discounted_cash":402.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1101.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":272,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":204,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":272,"methodology":"fee schedule"}]}]},{"description":"FNA BX W/MR GDN 1ST LES","code_information":[{"code":"10011","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"FNA BX W/MR GDN EA ADDL","code_information":[{"code":"10012","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC NEEDLE ASPIRATION FAT PAD","code_information":[{"code":"10021","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1057.05,"maximum":1057.05,"gross_charge":1305,"discounted_cash":386.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1057.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1057.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1057.05,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE ASPIRATION FAT PAD","code_information":[{"code":"10021","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1305,"discounted_cash":386.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1057.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1057.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1057.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":261,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":261,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC IMAGE GUIDED CATH PLACEMENT","code_information":[{"code":"10030","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1145.34,"maximum":1145.34,"gross_charge":1414,"discounted_cash":418.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1145.34,"methodology":"fee schedule"}]}]},{"description":"HC IMAGE GUIDED CATH PLACEMENT","code_information":[{"code":"10030","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1414,"discounted_cash":418.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1145.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":989.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"PERQ DEV SOFT TISS 1ST IMAG","code_information":[{"code":"10035","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"PERQ DEV SOFT TISS ADD IMAG","code_information":[{"code":"10036","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ACNE SURGERY","code_information":[{"code":"10040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC I&D ABSC SIMPL OR SGL","code_information":[{"code":"10060","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":562.95,"maximum":562.95,"gross_charge":695,"discounted_cash":205.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":562.95,"methodology":"fee schedule"}]}]},{"description":"HC I&D ABSC SIMPL OR SGL","code_information":[{"code":"10060","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":695,"discounted_cash":205.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":486.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC I&D ABSCESS COMPL/MULTI","code_information":[{"code":"10061","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1520.37,"maximum":1520.37,"gross_charge":1877,"discounted_cash":555.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1520.37,"methodology":"fee schedule"}]}]},{"description":"HC I&D ABSCESS COMPL/MULTI","code_information":[{"code":"10061","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"gross_charge":1877,"discounted_cash":555.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1520.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1313.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PILONIDAL CYST","code_information":[{"code":"10080","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PILONIDAL CYST","code_information":[{"code":"10081","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"SEIZURES WITHOUT MCC","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":4550,"maximum":16253.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8285,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7833,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5168,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8765,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8217,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15440.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9744,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11618,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9604,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16253.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13688,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8499,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8499,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4550,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9029.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9661.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9300.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9481.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9571.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9481.1,"methodology":"case rate"}]}]},{"description":"HC REMO FB SOFT TISSUE","code_information":[{"code":"10120","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1048.95,"maximum":1048.95,"gross_charge":1295,"discounted_cash":383.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1048.95,"methodology":"fee schedule"}]}]},{"description":"HC REMO FB SOFT TISSUE","code_information":[{"code":"10120","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1295,"discounted_cash":383.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":906.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY","code_information":[{"code":"10121","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC I&D HEMATOMA FLUID","code_information":[{"code":"10140","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2191.05,"maximum":2191.05,"gross_charge":2705,"discounted_cash":800.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2191.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2191.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2191.05,"methodology":"fee schedule"}]}]},{"description":"HC I&D HEMATOMA FLUID","code_information":[{"code":"10140","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":2705,"discounted_cash":800.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2191.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2191.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2191.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1893.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":541,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":541,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"I&D SKINSUBCU & OTHER STRUCT","code_information":[{"code":"10140","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1095.12,"maximum":1095.12,"gross_charge":1352,"discounted_cash":400.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1095.12,"methodology":"fee schedule"}]}]},{"description":"I&D SKINSUBCU & OTHER STRUCT","code_information":[{"code":"10140","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":1352,"discounted_cash":400.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":946.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC I&D PUNCTURE ASPIRATION","code_information":[{"code":"10160","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1095.12,"maximum":1095.12,"gross_charge":1352,"discounted_cash":400.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1095.12,"methodology":"fee schedule"}]}]},{"description":"HC I&D PUNCTURE ASPIRATION","code_information":[{"code":"10160","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1352,"discounted_cash":400.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1095.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":946.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC I&D POST OP WOUND INFECT","code_information":[{"code":"10180","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1939.95,"maximum":1939.95,"gross_charge":2395,"discounted_cash":708.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1939.95,"methodology":"fee schedule"}]}]},{"description":"HC I&D POST OP WOUND INFECT","code_information":[{"code":"10180","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":2395,"discounted_cash":708.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":479,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":479,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"HEADACHES WITH MCC","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"minimum":5439,"maximum":19003.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10423,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9853,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6855,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12795,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11996,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18052.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12429,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14819,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12739,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19003.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17220,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10692,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5439,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10557.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11296.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10873.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11085.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11190.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11085.12,"methodology":"case rate"}]}]},{"description":"HEADACHES WITHOUT MCC","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":4190,"maximum":15426.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7642,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7225,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4786,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8348,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7827,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14655.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8998,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10728,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8894,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15426.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12626,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7840,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7840,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4190,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8570.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9170.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8827.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8998.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9084.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8998.81,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"minimum":16569,"maximum":16569,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16569,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"minimum":4409,"maximum":4409,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4409,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"minimum":3108,"maximum":3108,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3108,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"minimum":4511,"maximum":4511,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4511,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"minimum":6473,"maximum":6473,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6473,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"minimum":2987,"maximum":2987,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2987,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"minimum":6685,"maximum":6685,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6685,"methodology":"case rate"}]}]},{"description":"HC DEBR EXZ/INF SKIN TO 10%","code_information":[{"code":"11000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":966.33,"maximum":966.33,"gross_charge":1193,"discounted_cash":353.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":966.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":966.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":966.33,"methodology":"fee schedule"}]}]},{"description":"HC DEBR EXZ/INF SKIN TO 10%","code_information":[{"code":"11000","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1193,"discounted_cash":353.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":966.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":966.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":966.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":835.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"DEBRIDE INFECTED SKIN ADD-ON","code_information":[{"code":"11001","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DEBRIDE GENITALIA  PERINEUM","code_information":[{"code":"11004","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DEBRIDEMENT OF FATTY NECROSIS","code_information":[{"code":"11005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3001.86,"maximum":3001.86,"gross_charge":3706,"discounted_cash":1096.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3001.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3001.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3001.86,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDEMENT OF FATTY NECROSIS","code_information":[{"code":"11005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3706,"discounted_cash":1096.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3001.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3001.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3001.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2594.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.2,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE GENIT/PER/ABDOM WALL","code_information":[{"code":"11006","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE MESH FROM ABD WALL","code_information":[{"code":"11008","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1101","type":"APR-DRG"}],"standard_charges":[{"minimum":5871,"maximum":5871,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5871,"methodology":"case rate"}]}]},{"description":"DEBRIDE SKIN AT FX SITE","code_information":[{"code":"11010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DEBRIDE SKIN MUSC AT FX SITE","code_information":[{"code":"11011","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DEB SKIN BONE AT FX SITE","code_information":[{"code":"11012","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1102","type":"APR-DRG"}],"standard_charges":[{"minimum":6396,"maximum":6396,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6396,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6396,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6396,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1103","type":"APR-DRG"}],"standard_charges":[{"minimum":8536,"maximum":8536,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8536,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8536,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8536,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL MALIGNANCIES","code_information":[{"code":"1104","type":"APR-DRG"}],"standard_charges":[{"minimum":14762,"maximum":14762,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14762,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14762,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14762,"methodology":"case rate"}]}]},{"description":"HC DEB SQ TISS IST 20SQCM/<","code_information":[{"code":"11042","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1878.39,"maximum":1878.39,"gross_charge":2319,"discounted_cash":686.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1878.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1878.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1878.39,"methodology":"fee schedule"}]}]},{"description":"HC DEB SQ TISS IST 20SQCM/<","code_information":[{"code":"11042","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2319,"discounted_cash":686.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1878.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1878.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1878.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC DEB MUSC/FASC 20SQCM/<","code_information":[{"code":"11043","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2629.26,"maximum":2629.26,"gross_charge":3246,"discounted_cash":960.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2629.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2629.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2629.26,"methodology":"fee schedule"}]}]},{"description":"HC DEB MUSC/FASC 20SQCM/<","code_information":[{"code":"11043","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2629.26,"gross_charge":3246,"discounted_cash":960.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2629.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2629.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2629.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"HC DEB BONE 20SQCM/<","code_information":[{"code":"11044","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3362.31,"maximum":3362.31,"gross_charge":4151,"discounted_cash":1228.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3362.31,"methodology":"fee schedule"}]}]},{"description":"HC DEB BONE 20SQCM/<","code_information":[{"code":"11044","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":4151,"discounted_cash":1228.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC DEBRIDE BONE 1ST 20CM","code_information":[{"code":"11044","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3362.31,"maximum":3362.31,"gross_charge":4151,"discounted_cash":1228.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3362.31,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE BONE 1ST 20CM","code_information":[{"code":"11044","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":4151,"discounted_cash":1228.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3362.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC DEB SQ TISS ADD 20SQCM<","code_information":[{"code":"11045","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":507.06,"maximum":507.06,"gross_charge":626,"discounted_cash":185.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"}]}]},{"description":"HC DEB SQ TISS ADD 20SQCM<","code_information":[{"code":"11045","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":626,"discounted_cash":185.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":438.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"}]}]},{"description":"HC DEB MUSC/FAS + 20SQCM<","code_information":[{"code":"11046","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":507.06,"maximum":507.06,"gross_charge":626,"discounted_cash":185.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"}]}]},{"description":"HC DEB MUSC/FAS + 20SQCM<","code_information":[{"code":"11046","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":626,"discounted_cash":185.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":438.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"}]}]},{"description":"HC DEBRID MUSCLE ADDL 20SQ CM","code_information":[{"code":"11046","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":507.06,"maximum":507.06,"gross_charge":626,"discounted_cash":185.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"}]}]},{"description":"HC DEBRID MUSCLE ADDL 20SQ CM","code_information":[{"code":"11046","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":626,"discounted_cash":185.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":438.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"}]}]},{"description":"HC DEB BONE(5) ADDL 20SQCM","code_information":[{"code":"11047","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2253.42,"maximum":2253.42,"gross_charge":2782,"discounted_cash":823.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2253.42,"methodology":"fee schedule"}]}]},{"description":"HC DEB BONE(5) ADDL 20SQCM","code_information":[{"code":"11047","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2782,"discounted_cash":823.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1947.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.4,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE BONE ADDL 20CM","code_information":[{"code":"11047","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2253.42,"maximum":2253.42,"gross_charge":2782,"discounted_cash":823.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2253.42,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE BONE ADDL 20CM","code_information":[{"code":"11047","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2782,"discounted_cash":823.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2253.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1947.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.4,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;SGL","code_information":[{"code":"11055","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":464.94,"maximum":464.94,"gross_charge":574,"discounted_cash":169.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.94,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;SGL","code_information":[{"code":"11055","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":574,"discounted_cash":169.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":401.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC PARE BENIGN LESION;2-4 LES","code_information":[{"code":"11056","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":464.94,"maximum":464.94,"gross_charge":574,"discounted_cash":169.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.94,"methodology":"fee schedule"}]}]},{"description":"HC PARE BENIGN LESION;2-4 LES","code_information":[{"code":"11056","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":574,"discounted_cash":169.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":401.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"TRIM SKIN LESIONS OVER 4","code_information":[{"code":"11057","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"minimum":13106,"maximum":13106,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13106,"methodology":"case rate"}]}]},{"description":"HC TANGENTIAL BIOPSY SINGLE","code_information":[{"code":"11102","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":707.13,"maximum":707.13,"gross_charge":873,"discounted_cash":258.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"}]}]},{"description":"HC TANGENTIAL BIOPSY SINGLE","code_information":[{"code":"11102","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":873,"discounted_cash":258.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC TANGENTIAL BIOPSY ADDITIONAL","code_information":[{"code":"11103","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":353.97,"maximum":353.97,"gross_charge":437,"discounted_cash":129.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.97,"methodology":"fee schedule"}]}]},{"description":"HC TANGENTIAL BIOPSY ADDITIONAL","code_information":[{"code":"11103","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":437,"discounted_cash":129.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BIOPSY SINGLE","code_information":[{"code":"11104","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":707.13,"maximum":707.13,"gross_charge":873,"discounted_cash":258.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BIOPSY SINGLE","code_information":[{"code":"11104","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":873,"discounted_cash":258.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC PUNCH BX SKIN SINGLE LESION","code_information":[{"code":"11104","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":707.13,"maximum":707.13,"gross_charge":873,"discounted_cash":258.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BX SKIN SINGLE LESION","code_information":[{"code":"11104","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":873,"discounted_cash":258.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC PUNCH BIOP ADDITIONAL","code_information":[{"code":"11105","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":353.97,"maximum":353.97,"gross_charge":437,"discounted_cash":129.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.97,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH BIOP ADDITIONAL","code_information":[{"code":"11105","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":437,"discounted_cash":129.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"}]}]},{"description":"HC INCISIONAL BIOP SINGLE","code_information":[{"code":"11106","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1257.93,"maximum":1257.93,"gross_charge":1553,"discounted_cash":459.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1257.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1257.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1257.93,"methodology":"fee schedule"}]}]},{"description":"HC INCISIONAL BIOP SINGLE","code_information":[{"code":"11106","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1553,"discounted_cash":459.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1257.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1257.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1257.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"HC INCISIONAL BIOP ADDITIONAL","code_information":[{"code":"11107","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":629.37,"maximum":629.37,"gross_charge":777,"discounted_cash":230,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":629.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":629.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":629.37,"methodology":"fee schedule"}]}]},{"description":"HC INCISIONAL BIOP ADDITIONAL","code_information":[{"code":"11107","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":777,"discounted_cash":230,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":629.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":629.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":629.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.4,"methodology":"fee schedule"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1111","type":"APR-DRG"}],"standard_charges":[{"minimum":4981,"maximum":4981,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4981,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4981,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4981,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1112","type":"APR-DRG"}],"standard_charges":[{"minimum":4981,"maximum":4981,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4981,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4981,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4981,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1113","type":"APR-DRG"}],"standard_charges":[{"minimum":6179,"maximum":6179,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6179,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6179,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6179,"methodology":"case rate"}]}]},{"description":"VERTIGO AND OTHER LABYRINTH DISORDERS","code_information":[{"code":"1114","type":"APR-DRG"}],"standard_charges":[{"minimum":9924,"maximum":9924,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9924,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9924,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9924,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"minimum":2689,"maximum":2689,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2689,"methodology":"case rate"}]}]},{"description":"HC REM SKIN TAGS <=15 LESIONS","code_information":[{"code":"11200","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":182.25,"maximum":182.25,"gross_charge":225,"discounted_cash":66.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"}]}]},{"description":"HC REM SKIN TAGS <=15 LESIONS","code_information":[{"code":"11200","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":33.75,"maximum":2204,"gross_charge":225,"discounted_cash":66.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"REMOVE SKIN TAGS ADD-ON","code_information":[{"code":"11201","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORBITAL PROCEDURES WITH CC/MCC","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"minimum":10768,"maximum":33513,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20285,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19177,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14245,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22193,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30104.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24269,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28935,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26472,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31689.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33513,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20808,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20808,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17605.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18837.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18133.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18485.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18661.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18485.32,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.6-1.0 CM","code_information":[{"code":"11301","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11302","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11303","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.6-1.0 CM","code_information":[{"code":"11306","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11307","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11308","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1131","type":"APR-DRG"}],"standard_charges":[{"minimum":2512,"maximum":2512,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2512,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2512,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2512,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 0.5 CM/<","code_information":[{"code":"11310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC SHAVE EXCISION","code_information":[{"code":"11311","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":571.05,"maximum":571.05,"gross_charge":705,"discounted_cash":208.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":571.05,"methodology":"fee schedule"}]}]},{"description":"HC SHAVE EXCISION","code_information":[{"code":"11311","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":705,"discounted_cash":208.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":493.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION 1.1-2.0 CM","code_information":[{"code":"11312","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"SHAVE SKIN LESION >2.0 CM","code_information":[{"code":"11313","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1132","type":"APR-DRG"}],"standard_charges":[{"minimum":3838,"maximum":3838,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3838,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3838,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3838,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1133","type":"APR-DRG"}],"standard_charges":[{"minimum":7267,"maximum":7267,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7267,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7267,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7267,"methodology":"case rate"}]}]},{"description":"INFECTIONS OF UPPER RESPIRATORY TRACT","code_information":[{"code":"1134","type":"APR-DRG"}],"standard_charges":[{"minimum":8196,"maximum":8196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"}]}]},{"description":"ORBITAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"minimum":6930,"maximum":19264.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10626,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10045,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6998,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17228,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16152,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18301.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14082,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16789,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13005,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19264.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17555,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10900,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10900,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10702.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11451.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11023.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11237.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11344.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11237.56,"methodology":"case rate"}]}]},{"description":"HC EXC TR-EXT B9+MARG 0.5CM/<","code_information":[{"code":"11400","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1975.59,"maximum":1975.59,"gross_charge":2439,"discounted_cash":721.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1975.59,"methodology":"fee schedule"}]}]},{"description":"HC EXC TR-EXT B9+MARG 0.5CM/<","code_information":[{"code":"11400","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2439,"discounted_cash":721.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1707.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG .6-1CM","code_information":[{"code":"11401","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1975.59,"maximum":1975.59,"gross_charge":2439,"discounted_cash":721.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1975.59,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG .6-1CM","code_information":[{"code":"11401","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2439,"discounted_cash":721.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1707.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG 1.1-2CM","code_information":[{"code":"11402","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1975.59,"maximum":1975.59,"gross_charge":2439,"discounted_cash":721.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1975.59,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG 1.1-2CM","code_information":[{"code":"11402","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2439,"discounted_cash":721.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1975.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1707.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG 2.1-3CM","code_information":[{"code":"11403","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2879.55,"maximum":2879.55,"gross_charge":3555,"discounted_cash":1052.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2879.55,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG 2.1-3CM","code_information":[{"code":"11403","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2879.55,"gross_charge":3555,"discounted_cash":1052.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2488.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG 3.1-4CM","code_information":[{"code":"11404","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3241.62,"maximum":3241.62,"gross_charge":4002,"discounted_cash":1184.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3241.62,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG 3.1-4CM","code_information":[{"code":"11404","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"gross_charge":4002,"discounted_cash":1184.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG >4.0CM","code_information":[{"code":"11406","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3651.48,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES TR/ARM/LEG >4.0CM","code_information":[{"code":"11406","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1141","type":"APR-DRG"}],"standard_charges":[{"minimum":3203,"maximum":3203,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3203,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3203,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3203,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1142","type":"APR-DRG"}],"standard_charges":[{"minimum":4649,"maximum":4649,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4649,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4649,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4649,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET .5CM","code_information":[{"code":"11420","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2988.09,"maximum":2988.09,"gross_charge":3689,"discounted_cash":1091.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2988.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2988.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2988.09,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET .5CM","code_information":[{"code":"11420","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3689,"discounted_cash":1091.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2988.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2988.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2988.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2582.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET .6-1CM","code_information":[{"code":"11421","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET .6-1CM","code_information":[{"code":"11421","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET 1.1-2CM","code_information":[{"code":"11422","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET 1.1-2CM","code_information":[{"code":"11422","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET 2.1-3CM","code_information":[{"code":"11423","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3241.62,"maximum":3241.62,"gross_charge":4002,"discounted_cash":1184.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3241.62,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET 2.1-3CM","code_information":[{"code":"11423","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":4002,"discounted_cash":1184.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3241.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2801.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":800.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET 3.1-4CM","code_information":[{"code":"11424","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3651.48,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET 3.1-4CM","code_information":[{"code":"11424","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES HAND/FEET >4.0CM","code_information":[{"code":"11426","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4001.4,"maximum":4001.4,"gross_charge":4940,"discounted_cash":1462.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES HAND/FEET >4.0CM","code_information":[{"code":"11426","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4940,"discounted_cash":1462.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1143","type":"APR-DRG"}],"standard_charges":[{"minimum":4653,"maximum":4653,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4653,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4653,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4653,"methodology":"case rate"}]}]},{"description":"DENTAL DISEASES AND DISORDERS","code_information":[{"code":"1144","type":"APR-DRG"}],"standard_charges":[{"minimum":11265,"maximum":11265,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11265,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11265,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11265,"methodology":"case rate"}]}]},{"description":"HC EXC FACE-MM B9+MARG 0.5CM/<","code_information":[{"code":"11440","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2199.96,"maximum":2199.96,"gross_charge":2716,"discounted_cash":803.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2199.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2199.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2199.96,"methodology":"fee schedule"}]}]},{"description":"HC EXC FACE-MM B9+MARG 0.5CM/<","code_information":[{"code":"11440","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2716,"discounted_cash":803.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2199.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2199.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2199.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1901.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES FACE .6-1.0CM","code_information":[{"code":"11441","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2117.34,"maximum":2117.34,"gross_charge":2614,"discounted_cash":773.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES FACE .6-1.0CM","code_information":[{"code":"11441","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2614,"discounted_cash":773.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1829.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES FACE 1.1-2.0CM","code_information":[{"code":"11442","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES FACE 1.1-2.0CM","code_information":[{"code":"11442","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES FACE 2.1-3.0CM","code_information":[{"code":"11443","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES FACE 2.1-3.0CM","code_information":[{"code":"11443","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES FACE 3.1-4.0CM","code_information":[{"code":"11444","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES FACE 3.1-4.0CM","code_information":[{"code":"11444","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC BEN LES FACE > 4.0CM","code_information":[{"code":"11446","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4001.4,"maximum":4001.4,"gross_charge":4940,"discounted_cash":1462.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"}]}]},{"description":"HC EXC BEN LES FACE > 4.0CM","code_information":[{"code":"11446","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4940,"discounted_cash":1462.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11451","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11462","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11463","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11470","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL SWEAT GLAND LESION","code_information":[{"code":"11471","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXTRAOCULAR PROCEDURES EXCEPT ORBIT","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"minimum":7473,"maximum":23298.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13762,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13010,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8888,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19416,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18203,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22133.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16420,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19577,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16517,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23298.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22737,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14117,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14117,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7473,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12943.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13849.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13332.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13590.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13720.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13590.97,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1151","type":"APR-DRG"}],"standard_charges":[{"minimum":4300,"maximum":4300,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4300,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4300,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4300,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1152","type":"APR-DRG"}],"standard_charges":[{"minimum":7015,"maximum":7015,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7015,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1153","type":"APR-DRG"}],"standard_charges":[{"minimum":11732,"maximum":11732,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11732,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11732,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11732,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH THROAT AND CRANIAL OR FACIAL DIAGNOSES","code_information":[{"code":"1154","type":"APR-DRG"}],"standard_charges":[{"minimum":13416,"maximum":13416,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13416,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13416,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13416,"methodology":"case rate"}]}]},{"description":"INTRAOCULAR PROCEDURES WITH CC/MCC","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"minimum":7633,"maximum":62075,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14999,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14180,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10401,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":62075,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58200,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23645.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20391,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24311,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19330,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24889.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24780,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15386,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15386,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7633,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13827.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14795.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14242.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14519.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14657.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14519.12,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEGS .5CM","code_information":[{"code":"11600","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2579.85,"maximum":2579.85,"gross_charge":3185,"discounted_cash":942.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2579.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2579.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2579.85,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEGS .5CM","code_information":[{"code":"11600","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3185,"discounted_cash":942.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2579.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2579.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2579.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2229.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":637,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":637,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG .6-1CM","code_information":[{"code":"11601","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2117.34,"maximum":2117.34,"gross_charge":2614,"discounted_cash":773.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG .6-1CM","code_information":[{"code":"11601","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2614,"discounted_cash":773.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1829.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG 1.1-2CM","code_information":[{"code":"11602","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG 1.1-2CM","code_information":[{"code":"11602","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG 2.1-3CM","code_information":[{"code":"11603","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG 2.1-3CM","code_information":[{"code":"11603","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG 3.1-4CM","code_information":[{"code":"11604","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3308.85,"maximum":3308.85,"gross_charge":4085,"discounted_cash":1209.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3308.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3308.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3308.85,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG 3.1-4CM","code_information":[{"code":"11604","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3308.85,"gross_charge":4085,"discounted_cash":1209.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3308.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3308.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3308.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":817,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":612.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":817,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG >4CM","code_information":[{"code":"11606","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3651.48,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES TR/ARM/LEG >4CM","code_information":[{"code":"11606","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES HAND/FEET .5CM","code_information":[{"code":"11620","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES HAND/FEET .5CM","code_information":[{"code":"11620","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES HAND/FEET .6-1CM","code_information":[{"code":"11621","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2117.34,"maximum":2117.34,"gross_charge":2614,"discounted_cash":773.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES HAND/FEET .6-1CM","code_information":[{"code":"11621","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2614,"discounted_cash":773.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1829.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES HAND/FEET 1.1-2CM","code_information":[{"code":"11622","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES HAND/FEET 1.1-2CM","code_information":[{"code":"11622","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES HAND/FEET 2.1-3CM","code_information":[{"code":"11623","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3705.75,"maximum":3705.75,"gross_charge":4575,"discounted_cash":1354.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3705.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3705.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3705.75,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES HAND/FEET 2.1-3CM","code_information":[{"code":"11623","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3705.75,"gross_charge":4575,"discounted_cash":1354.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3705.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3705.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3705.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3202.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":915,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":915,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES HAND/FEET 3.1-4CM","code_information":[{"code":"11624","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3658.77,"maximum":3658.77,"gross_charge":4517,"discounted_cash":1337.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3658.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3658.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3658.77,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES HAND/FEET 3.1-4CM","code_information":[{"code":"11624","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3658.77,"gross_charge":4517,"discounted_cash":1337.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3658.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3658.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3658.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":858.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES HAND/FEET >4CM","code_information":[{"code":"11626","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4001.4,"maximum":4001.4,"gross_charge":4940,"discounted_cash":1462.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES HAND/FEET >4CM","code_information":[{"code":"11626","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4940,"discounted_cash":1462.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES FACE .5CM","code_information":[{"code":"11640","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES FACE .5CM","code_information":[{"code":"11640","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES FACE .6-1CM","code_information":[{"code":"11641","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES FACE .6-1CM","code_information":[{"code":"11641","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES FACE 1.1-2CM","code_information":[{"code":"11642","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES FACE 1.1-2CM","code_information":[{"code":"11642","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES FACE 2.1-3CM","code_information":[{"code":"11643","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2877.12,"maximum":2877.12,"gross_charge":3552,"discounted_cash":1051.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES FACE 2.1-3CM","code_information":[{"code":"11643","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3552,"discounted_cash":1051.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2877.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2486.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES FACE 3.1-4CM","code_information":[{"code":"11644","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3651.48,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES FACE 3.1-4CM","code_information":[{"code":"11644","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC EXC MAL LES FACE >4CM","code_information":[{"code":"11646","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4001.4,"maximum":4001.4,"gross_charge":4940,"discounted_cash":1462.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"}]}]},{"description":"HC EXC MAL LES FACE >4CM","code_information":[{"code":"11646","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4940,"discounted_cash":1462.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"INTRAOCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"minimum":5593,"maximum":18067.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9696,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9166,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6809,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13962,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13090,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17164.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10731,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12794,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12653,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18067.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16018,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9946,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9946,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5593,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10037.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10740.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10338.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10539.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10639.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10539.42,"methodology":"case rate"}]}]},{"description":"TRIM NAIL(S) ANY NUMBER","code_information":[{"code":"11719","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC DEBRIDE NAIL 1-5","code_information":[{"code":"11720","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE NAIL 1-5","code_information":[{"code":"11720","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"DEBRIDE NAIL 6 OR MORE","code_information":[{"code":"11721","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC AVULSION OF SGL NAIL PLATE","code_information":[{"code":"11730","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":349.92,"maximum":349.92,"gross_charge":432,"discounted_cash":127.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.92,"methodology":"fee schedule"}]}]},{"description":"HC AVULSION OF SGL NAIL PLATE","code_information":[{"code":"11730","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":2204,"gross_charge":432,"discounted_cash":127.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC NAIL PLATE SIMPLE ADDL","code_information":[{"code":"11732","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":263.25,"maximum":263.25,"gross_charge":325,"discounted_cash":96.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":263.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":263.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":263.25,"methodology":"fee schedule"}]}]},{"description":"HC NAIL PLATE SIMPLE ADDL","code_information":[{"code":"11732","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":325,"discounted_cash":96.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":263.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":263.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":263.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65,"methodology":"fee schedule"}]}]},{"description":"DRAIN BLOOD FROM UNDER NAIL","code_information":[{"code":"11740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC REMOVAL OF NAIL BED","code_information":[{"code":"11750","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1066.77,"maximum":1066.77,"gross_charge":1317,"discounted_cash":389.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1066.77,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL OF NAIL BED","code_information":[{"code":"11750","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1317,"discounted_cash":389.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":921.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"BIOPSY NAIL UNIT","code_information":[{"code":"11755","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"REPAIR OF NAIL BED","code_information":[{"code":"11760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF NAIL BED","code_information":[{"code":"11762","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"WEDGE EXC OF NAIL FOLD TOE","code_information":[{"code":"11765","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1072.44,"maximum":1072.44,"gross_charge":1324,"discounted_cash":391.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1072.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1072.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1072.44,"methodology":"fee schedule"}]}]},{"description":"WEDGE EXC OF NAIL FOLD TOE","code_information":[{"code":"11765","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":1324,"discounted_cash":391.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1072.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1072.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1072.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":926.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"REMOVE PILONIDAL CYST SIMPLE","code_information":[{"code":"11770","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE PILONIDAL CYST EXTEN","code_information":[{"code":"11771","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE PILONIDAL CYST COMPL","code_information":[{"code":"11772","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"minimum":4494,"maximum":4494,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4494,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"minimum":3782,"maximum":3782,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3782,"methodology":"case rate"}]}]},{"description":"HC INJECT INTRALESIONAL 7 LESIONS 11900","code_information":[{"code":"11900","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":592.92,"maximum":592.92,"gross_charge":732,"discounted_cash":216.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":592.92,"methodology":"fee schedule"}]}]},{"description":"HC INJECT INTRALESIONAL 7 LESIONS 11900","code_information":[{"code":"11900","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":732,"discounted_cash":216.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":512.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC INJECT INTRALES MORE 7 LESIONS 11901","code_information":[{"code":"11901","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":592.92,"maximum":592.92,"gross_charge":732,"discounted_cash":216.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":592.92,"methodology":"fee schedule"}]}]},{"description":"HC INJECT INTRALES MORE 7 LESIONS 11901","code_information":[{"code":"11901","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":732,"discounted_cash":216.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":592.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":512.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"CORRECT SKIN COLOR 6.0 CM/<","code_information":[{"code":"11920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CORRECT SKN COLOR 6.1-20.0CM","code_information":[{"code":"11921","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CORRECT SKIN COLOR EA 20.0CM","code_information":[{"code":"11922","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TX CONTOUR DEFECTS 1 CC/<","code_information":[{"code":"11950","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"TX CONTOUR DEFECTS 1.1-5.0CC","code_information":[{"code":"11951","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"TX CONTOUR DEFECTS 5.1-10CC","code_information":[{"code":"11952","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"TX CONTOUR DEFECTS >10.0 CC","code_information":[{"code":"11954","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"INSERT TISSUE EXPANDER(S)","code_information":[{"code":"11960","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REPLACE TISSUE EXPANDER","code_information":[{"code":"11970","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE TISSUE EXPANDER(S)","code_information":[{"code":"11971","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE CONTRACEPTIVE CAPSULE","code_information":[{"code":"11976","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"IMPLANT HORMONE PELLET(S)","code_information":[{"code":"11980","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"INSERT DRUG IMPLANT DEVICE","code_information":[{"code":"11981","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"REMOVE DRUG IMPLANT DEVICE","code_information":[{"code":"11982","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"REMOVE/INSERT DRUG IMPLANT","code_information":[{"code":"11983","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"minimum":14687,"maximum":14687,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14687,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIMSCLP 2.5CM/<","code_information":[{"code":"12001","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":538.65,"maximum":538.65,"gross_charge":665,"discounted_cash":196.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.65,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIMSCLP 2.5CM/<","code_information":[{"code":"12001","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":665,"discounted_cash":196.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM SCLP 2.6-7.5CM","code_information":[{"code":"12002","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":538.65,"maximum":538.65,"gross_charge":665,"discounted_cash":196.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.65,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM SCLP 2.6-7.5CM","code_information":[{"code":"12002","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":665,"discounted_cash":196.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM SCLP 7.6-12.5CM","code_information":[{"code":"12004","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":680.4,"maximum":680.4,"gross_charge":840,"discounted_cash":248.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":680.4,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM SCLP 7.6-12.5CM","code_information":[{"code":"12004","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":840,"discounted_cash":248.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":588,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":168,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":168,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"RPR S/N/A/GEN/TRK12.6-20.0CM","code_information":[{"code":"12005","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"RPR S/N/A/GEN/TRK20.1-30.0CM","code_information":[{"code":"12006","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"RPR S/N/AX/GEN/TRNK >30.0 CM","code_information":[{"code":"12007","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1201","type":"APR-DRG"}],"standard_charges":[{"minimum":12064,"maximum":12064,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12064,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12064,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12064,"methodology":"case rate"}]}]},{"description":"RPR F/E/E/N/L/M 2.5 CM/<","code_information":[{"code":"12011","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"median_amount":177.67,"10th_percentile":177.67,"90th_percentile":177.67,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM FACE 2.6-5CM","code_information":[{"code":"12013","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":599.4,"maximum":599.4,"gross_charge":740,"discounted_cash":219.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":599.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":599.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":599.4,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM FACE 2.6-5CM","code_information":[{"code":"12013","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":740,"discounted_cash":219.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":599.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":599.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":599.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":518,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"RPR F/E/E/N/L/M 5.1-7.5 CM","code_information":[{"code":"12014","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM FACE 7.6-12.5CM","code_information":[{"code":"12015","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":545.94,"maximum":545.94,"gross_charge":674,"discounted_cash":199.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":545.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":545.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":545.94,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM FACE 7.6-12.5CM","code_information":[{"code":"12015","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":674,"discounted_cash":199.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":545.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":545.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":545.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":471.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"RPR FE/E/EN/L/M 12.6-20.0 CM","code_information":[{"code":"12016","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"RPR FE/E/EN/L/M 20.1-30.0 CM","code_information":[{"code":"12017","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"RPR F/E/E/N/L/M >30.0 CM","code_information":[{"code":"12018","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1202","type":"APR-DRG"}],"standard_charges":[{"minimum":14785,"maximum":14785,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14785,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14785,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14785,"methodology":"case rate"}]}]},{"description":"HC REPAIR SIM WND DEHISC","code_information":[{"code":"12020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1092.69,"maximum":1092.69,"gross_charge":1349,"discounted_cash":399.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1092.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1092.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1092.69,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR SIM WND DEHISC","code_information":[{"code":"12020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1349,"discounted_cash":399.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1092.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1092.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1092.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"REPR/SEPARATION/WOUND CLOSURE","code_information":[{"code":"12020","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1660.5,"maximum":1660.5,"gross_charge":2050,"discounted_cash":606.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"}]}]},{"description":"REPR/SEPARATION/WOUND CLOSURE","code_information":[{"code":"12020","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2050,"discounted_cash":606.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CLOSURE OF SPLIT WOUND","code_information":[{"code":"12021","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1203","type":"APR-DRG"}],"standard_charges":[{"minimum":23573,"maximum":23573,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23573,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23573,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23573,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 2.5CM /<","code_information":[{"code":"12031","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":262.44,"maximum":262.44,"gross_charge":324,"discounted_cash":95.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":262.44,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 2.5CM /<","code_information":[{"code":"12031","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":324,"discounted_cash":95.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 2.6-7.5CM","code_information":[{"code":"12032","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 2.6-7.5CM","code_information":[{"code":"12032","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":490,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 7.6-12.5CM","code_information":[{"code":"12034","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":674.73,"maximum":674.73,"gross_charge":833,"discounted_cash":246.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":674.73,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 7.6-12.5CM","code_information":[{"code":"12034","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"gross_charge":833,"discounted_cash":246.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":674.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR S/A/T/EXT 12.6-20","code_information":[{"code":"12035","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC REPAIR INT SCLP 20.1-30CM","code_information":[{"code":"12036","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1027.08,"maximum":1027.08,"gross_charge":1268,"discounted_cash":375.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1027.08,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR INT SCLP 20.1-30CM","code_information":[{"code":"12036","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"gross_charge":1268,"discounted_cash":375.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"INTMD RPR S/TR/EXT >30.0 CM","code_information":[{"code":"12037","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1204","type":"APR-DRG"}],"standard_charges":[{"minimum":36316,"maximum":36316,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36316,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36316,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36316,"methodology":"case rate"}]}]},{"description":"INTMD RPR N-HF/GENIT 2.5CM/<","code_information":[{"code":"12041","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR N-HF/GENIT2.6-7.5","code_information":[{"code":"12042","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR N-HF/GENIT7.6-12.5","code_information":[{"code":"12044","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"INTMD RPR N-HF/GENIT12.6-20","code_information":[{"code":"12045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"INTMD RPR N-HF/GENIT20.1-30","code_information":[{"code":"12046","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"INTMD RPR N-HF/GENIT >30.0CM","code_information":[{"code":"12047","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM 2.5 CM/<","code_information":[{"code":"12051","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM 2.6-5.0 CM","code_information":[{"code":"12052","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM 5.1-7.5 CM","code_information":[{"code":"12053","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM 7.6-12.5CM","code_information":[{"code":"12054","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM 12.6-20 CM","code_information":[{"code":"12055","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM 20.1-30.0","code_information":[{"code":"12056","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INTMD RPR FACE/MM >30.0 CM","code_information":[{"code":"12057","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"minimum":3723,"maximum":19045.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10456,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9885,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7279,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8043,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7541,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18093.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13244,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15790,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13527,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19045.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17275,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10726,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10726,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3723,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10581.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11321.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10898.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11110.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11215.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11110.08,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1211","type":"APR-DRG"}],"standard_charges":[{"minimum":10643,"maximum":10643,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10643,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10643,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10643,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1212","type":"APR-DRG"}],"standard_charges":[{"minimum":14269,"maximum":14269,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14269,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14269,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14269,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1213","type":"APR-DRG"}],"standard_charges":[{"minimum":23267,"maximum":23267,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23267,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23267,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23267,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY AND CHEST PROCEDURES","code_information":[{"code":"1214","type":"APR-DRG"}],"standard_charges":[{"minimum":35743,"maximum":35743,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35743,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35743,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35743,"methodology":"case rate"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"minimum":3174,"maximum":13438.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6097,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5764,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4230,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6373,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5975,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12766.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7467,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8902,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7860,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13438.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10073,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6255,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6255,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3174,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7466,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7988.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7689.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7839.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7913.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7839.3,"methodology":"case rate"}]}]},{"description":"NEUROLOGICAL EYE DISORDERS","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"minimum":4568,"maximum":14883.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7220,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6826,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4568,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8887,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8332,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14138.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8580,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10230,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8489,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14883.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11928,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7406,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7406,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4928,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8268.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8847.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8516.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8681.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8764.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8681.78,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"minimum":5144,"maximum":20672.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11721,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11081,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7510,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13041,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12227,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19639.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15140,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18051,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13957,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20672.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19364,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12023,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12023,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5144,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11484.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12288.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11829.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12059.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12173.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12059.13,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITHOUT MCC","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"minimum":3207,"maximum":15143.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7422,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7017,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4531,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7690,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7210,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14386.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9318,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11110,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8420,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15143.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12263,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7614,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7614,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3207,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8412.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9001.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8665.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8833.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8917.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8833.55,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"minimum":13297,"maximum":13297,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13297,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"minimum":8211,"maximum":8211,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1301","type":"APR-DRG"}],"standard_charges":[{"minimum":23896,"maximum":23896,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23896,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23896,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23896,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1302","type":"APR-DRG"}],"standard_charges":[{"minimum":43791,"maximum":43791,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43791,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43791,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43791,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1303","type":"APR-DRG"}],"standard_charges":[{"minimum":53418,"maximum":53418,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53418,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53418,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53418,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS","code_information":[{"code":"1304","type":"APR-DRG"}],"standard_charges":[{"minimum":56458,"maximum":56458,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56458,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56458,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56458,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"minimum":11967,"maximum":11967,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11967,"methodology":"case rate"}]}]},{"description":"HC COMP REPR TRUNK 1.1CM-2.5CM","code_information":[{"code":"13100","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1618.38,"maximum":1618.38,"gross_charge":1998,"discounted_cash":591.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.38,"methodology":"fee schedule"}]}]},{"description":"HC COMP REPR TRUNK 1.1CM-2.5CM","code_information":[{"code":"13100","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"gross_charge":1998,"discounted_cash":591.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":399.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":399.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"HC COMP REPR TRUNK 2.6CM-7.5CM","code_information":[{"code":"13101","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1618.38,"maximum":1618.38,"gross_charge":1998,"discounted_cash":591.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.38,"methodology":"fee schedule"}]}]},{"description":"HC COMP REPR TRUNK 2.6CM-7.5CM","code_information":[{"code":"13101","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"gross_charge":1998,"discounted_cash":591.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1618.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":379.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":399.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":399.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CMPLX RPR TRUNK ADDL 5CM/<","code_information":[{"code":"13102","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1311","type":"APR-DRG"}],"standard_charges":[{"minimum":7932,"maximum":7932,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7932,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7932,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7932,"methodology":"case rate"}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1312","type":"APR-DRG"}],"standard_charges":[{"minimum":21229,"maximum":21229,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"}]}]},{"description":"HC REPAIR COMP S/A/L 1.1-2.5CM","code_information":[{"code":"13120","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1749.6,"maximum":1749.6,"gross_charge":2160,"discounted_cash":639.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1749.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1749.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1749.6,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR COMP S/A/L 1.1-2.5CM","code_information":[{"code":"13120","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"gross_charge":2160,"discounted_cash":639.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1749.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1749.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1749.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":432,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CMPLX RPR S/A/L 2.6-7.5 CM","code_information":[{"code":"13121","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CMPLX RPR S/A/L ADDL 5 CM/>","code_information":[{"code":"13122","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1313","type":"APR-DRG"}],"standard_charges":[{"minimum":21229,"maximum":21229,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"}]}]},{"description":"CMPLX RPR F/C/C/M/N/AX/G/H/F","code_information":[{"code":"13131","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"CMPLX RPR F/C/C/M/N/AX/G/H/F","code_information":[{"code":"13132","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CMPLX RPR F/C/C/M/N/AX/G/H/F","code_information":[{"code":"13133","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CYSTIC FIBROSIS - PULMONARY DISEASE","code_information":[{"code":"1314","type":"APR-DRG"}],"standard_charges":[{"minimum":21229,"maximum":21229,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21229,"methodology":"case rate"}]}]},{"description":"CMPLX RPR E/N/E/L 1.1-2.5 CM","code_information":[{"code":"13151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CMPLX RPR E/N/E/L 2.6-7.5 CM","code_information":[{"code":"13152","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CMPLX RPR E/N/E/L ADDL 5CM/<","code_information":[{"code":"13153","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SECONDARY CLOSURE/SURG WOUND","code_information":[{"code":"13160","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2783.16,"maximum":2783.16,"gross_charge":3436,"discounted_cash":1017.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2783.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2783.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2783.16,"methodology":"fee schedule"}]}]},{"description":"HC SECONDARY CLOSURE/SURG WOUND","code_information":[{"code":"13160","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"gross_charge":3436,"discounted_cash":1017.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2783.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2783.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2783.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"minimum":9811,"maximum":9811,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1321","type":"APR-DRG"}],"standard_charges":[{"minimum":2867,"maximum":2867,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2867,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2867,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2867,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1322","type":"APR-DRG"}],"standard_charges":[{"minimum":3764,"maximum":3764,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3764,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3764,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3764,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1323","type":"APR-DRG"}],"standard_charges":[{"minimum":11221,"maximum":11221,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11221,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11221,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11221,"methodology":"case rate"}]}]},{"description":"BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD","code_information":[{"code":"1324","type":"APR-DRG"}],"standard_charges":[{"minimum":15894,"maximum":15894,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15894,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15894,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15894,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"minimum":8927,"maximum":8927,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8927,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1331","type":"APR-DRG"}],"standard_charges":[{"minimum":3284,"maximum":3284,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3284,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3284,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3284,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1332","type":"APR-DRG"}],"standard_charges":[{"minimum":8292,"maximum":8292,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8292,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8292,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8292,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1333","type":"APR-DRG"}],"standard_charges":[{"minimum":14381,"maximum":14381,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14381,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14381,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14381,"methodology":"case rate"}]}]},{"description":"RESPIRATORY FAILURE","code_information":[{"code":"1334","type":"APR-DRG"}],"standard_charges":[{"minimum":18570,"maximum":18570,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18570,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18570,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18570,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"minimum":4054,"maximum":4054,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4054,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1341","type":"APR-DRG"}],"standard_charges":[{"minimum":4224,"maximum":4224,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1342","type":"APR-DRG"}],"standard_charges":[{"minimum":5963,"maximum":5963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1343","type":"APR-DRG"}],"standard_charges":[{"minimum":10748,"maximum":10748,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10748,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10748,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10748,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM","code_information":[{"code":"1344","type":"APR-DRG"}],"standard_charges":[{"minimum":14248,"maximum":14248,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14248,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14248,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14248,"methodology":"case rate"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITH CC/MCC","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"minimum":12076,"maximum":35807,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21673,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20490,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15067,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19362,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18153,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31801.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26490,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31582,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28001,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33475.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35807,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22233,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22233,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12076,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18597.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19899.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19155.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19527.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19713.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19527.46,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1351","type":"APR-DRG"}],"standard_charges":[{"minimum":5775,"maximum":5775,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5775,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5775,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5775,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1352","type":"APR-DRG"}],"standard_charges":[{"minimum":6047,"maximum":6047,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6047,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6047,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6047,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1353","type":"APR-DRG"}],"standard_charges":[{"minimum":11515,"maximum":11515,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11515,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11515,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11515,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST AND RESPIRATORY TRAUMA","code_information":[{"code":"1354","type":"APR-DRG"}],"standard_charges":[{"minimum":13665,"maximum":13665,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13665,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13665,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13665,"methodology":"case rate"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"minimum":5933,"maximum":16906.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8793,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8313,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5933,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14401,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13502,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16061.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12542,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14953,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11026,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16906.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9020,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9020,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6154,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9392.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10050.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9674.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9862.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9956.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9862.2,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1361","type":"APR-DRG"}],"standard_charges":[{"minimum":4372,"maximum":4372,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4372,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4372,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4372,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1362","type":"APR-DRG"}],"standard_charges":[{"minimum":7882,"maximum":7882,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7882,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7882,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7882,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1363","type":"APR-DRG"}],"standard_charges":[{"minimum":12701,"maximum":12701,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12701,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12701,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12701,"methodology":"case rate"}]}]},{"description":"RESPIRATORY MALIGNANCY","code_information":[{"code":"1364","type":"APR-DRG"}],"standard_charges":[{"minimum":16618,"maximum":16618,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16618,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16618,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16618,"methodology":"case rate"}]}]},{"description":"MOUTH PROCEDURES WITH CC/MCC","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"minimum":5499,"maximum":24730,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12572,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11885,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8549,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24730,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23186,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20679.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16209,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19325,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15887,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21767.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20771,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5499,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12093.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12939.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12456.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12697.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12818.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12697.91,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1371","type":"APR-DRG"}],"standard_charges":[{"minimum":3832,"maximum":3832,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3832,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3832,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3832,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1372","type":"APR-DRG"}],"standard_charges":[{"minimum":7307,"maximum":7307,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1373","type":"APR-DRG"}],"standard_charges":[{"minimum":7307,"maximum":7307,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307,"methodology":"case rate"}]}]},{"description":"MAJOR RESPIRATORY INFECTIONS AND INFLAMMATIONS","code_information":[{"code":"1374","type":"APR-DRG"}],"standard_charges":[{"minimum":14090,"maximum":14090,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14090,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14090,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14090,"methodology":"case rate"}]}]},{"description":"MOUTH PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"minimum":4065,"maximum":21138,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7313,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6913,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4918,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21138,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19818,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14252.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9558,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11396,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9140,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15002.16,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7501,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7501,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4065,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8334.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8917.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8584.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8751.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8834.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8751.26,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1381","type":"APR-DRG"}],"standard_charges":[{"minimum":2676,"maximum":2676,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2676,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2676,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2676,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1382","type":"APR-DRG"}],"standard_charges":[{"minimum":4125,"maximum":4125,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4125,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4125,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4125,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1383","type":"APR-DRG"}],"standard_charges":[{"minimum":5863,"maximum":5863,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5863,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5863,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5863,"methodology":"case rate"}]}]},{"description":"BRONCHIOLITIS AND RSV PNEUMONIA","code_information":[{"code":"1384","type":"APR-DRG"}],"standard_charges":[{"minimum":9348,"maximum":9348,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9348,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9348,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9348,"methodology":"case rate"}]}]},{"description":"SALIVARY GLAND PROCEDURES","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"minimum":6115,"maximum":21471.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12342,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11668,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6748,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18184,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20398.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13592,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16205,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21471.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20391,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12660,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12660,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6115,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11928.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12763.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12286.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12525.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12644.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12525.22,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1391","type":"APR-DRG"}],"standard_charges":[{"minimum":3406,"maximum":3406,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3406,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3406,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3406,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1392","type":"APR-DRG"}],"standard_charges":[{"minimum":5434,"maximum":5434,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5434,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5434,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5434,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1393","type":"APR-DRG"}],"standard_charges":[{"minimum":8109,"maximum":8109,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8109,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8109,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8109,"methodology":"case rate"}]}]},{"description":"OTHER PNEUMONIA","code_information":[{"code":"1394","type":"APR-DRG"}],"standard_charges":[{"minimum":14659,"maximum":14659,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14659,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14659,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14659,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH MCC","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"minimum":3931,"maximum":66631,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38016,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":35940,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21465,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66631,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62472,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":51773.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44925,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53562,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39889,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":54498.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62808,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38997,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38997,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3931,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30277.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":32396.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31185.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31790.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32093.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31790.98,"methodology":"case rate"}]}]},{"description":"TIS TRNFR TRUNK 10 SQ CM/<","code_information":[{"code":"14000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"TIS TRNFR TRUNK 10.1-30SQCM","code_information":[{"code":"14001","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1401","type":"APR-DRG"}],"standard_charges":[{"minimum":4859,"maximum":4859,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4859,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4859,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4859,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1402","type":"APR-DRG"}],"standard_charges":[{"minimum":5945,"maximum":5945,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5945,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5945,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5945,"methodology":"case rate"}]}]},{"description":"TIS TRNFR S/A/L 10 SQ CM/<","code_information":[{"code":"14020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"TIS TRNFR S/A/L 10.1-30 SQCM","code_information":[{"code":"14021","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1403","type":"APR-DRG"}],"standard_charges":[{"minimum":7554,"maximum":7554,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7554,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7554,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7554,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE","code_information":[{"code":"1404","type":"APR-DRG"}],"standard_charges":[{"minimum":11553,"maximum":11553,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11553,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11553,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11553,"methodology":"case rate"}]}]},{"description":"TIS TRNFR F/C/C/M/N/A/G/H/F","code_information":[{"code":"14040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"TIS TRNFR F/C/C/M/N/A/G/H/F","code_information":[{"code":"14041","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"TIS TRNFR E/N/E/L 10 SQ CM/<","code_information":[{"code":"14060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"TIS TRNFR E/N/E/L10.1-30SQCM","code_information":[{"code":"14061","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH CC","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"minimum":3301,"maximum":36951,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19313,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18258,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11770,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36951,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34645,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28917.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24132,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28772,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21873,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30439.12,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31908,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19811,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19811,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3301,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16910.62,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18094.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17417.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17756.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17925.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17756.16,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1411","type":"APR-DRG"}],"standard_charges":[{"minimum":2876,"maximum":2876,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1412","type":"APR-DRG"}],"standard_charges":[{"minimum":4505,"maximum":4505,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4505,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4505,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4505,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1413","type":"APR-DRG"}],"standard_charges":[{"minimum":5815,"maximum":5815,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5815,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5815,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5815,"methodology":"case rate"}]}]},{"description":"ASTHMA","code_information":[{"code":"1414","type":"APR-DRG"}],"standard_charges":[{"minimum":10236,"maximum":10236,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10236,"methodology":"case rate"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"minimum":7897,"maximum":26930,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14134,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13362,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8778,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26930,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25249,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22588.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18394,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21930,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16312,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23777.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23352,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14499,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14499,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7897,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13209.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14134.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13606.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13870.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14002.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13870.23,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1421","type":"APR-DRG"}],"standard_charges":[{"minimum":3774,"maximum":3774,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3774,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3774,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3774,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1422","type":"APR-DRG"}],"standard_charges":[{"minimum":5207,"maximum":5207,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5207,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5207,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5207,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1423","type":"APR-DRG"}],"standard_charges":[{"minimum":6507,"maximum":6507,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6507,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6507,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6507,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL AND ALVEOLAR LUNG DISEASES","code_information":[{"code":"1424","type":"APR-DRG"}],"standard_charges":[{"minimum":9625,"maximum":9625,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9625,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9625,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9625,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT O.R. PROCEDURES WITH MCC","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"minimum":13431,"maximum":49611,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29681,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28060,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18894,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49611,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46514,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41587.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34293,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40885,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35112,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":43776.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49037,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30447,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13431,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24320.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26022.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25049.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25536.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25779.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25536.12,"methodology":"case rate"}]}]},{"description":"TIS TRNFR ANY 30.1-60 SQ CM","code_information":[{"code":"14301","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"TIS TRNFR ADDL 30 SQ CM","code_information":[{"code":"14302","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1431","type":"APR-DRG"}],"standard_charges":[{"minimum":4101,"maximum":4101,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4101,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4101,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4101,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1432","type":"APR-DRG"}],"standard_charges":[{"minimum":6148,"maximum":6148,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6148,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6148,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6148,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1433","type":"APR-DRG"}],"standard_charges":[{"minimum":9325,"maximum":9325,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9325,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9325,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9325,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1434","type":"APR-DRG"}],"standard_charges":[{"minimum":17887,"maximum":17887,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17887,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17887,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17887,"methodology":"case rate"}]}]},{"description":"FILLETED FINGER/TOE FLAP","code_information":[{"code":"14350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT O.R. PROCEDURES WITH CC","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"minimum":3775,"maximum":29302,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15791,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14928,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9832,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29302,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27472,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24613.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19557,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23316,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18271,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25908.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16199,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3775,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14393.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15401.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14825.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15113.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15257.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15113.38,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1441","type":"APR-DRG"}],"standard_charges":[{"minimum":3527,"maximum":3527,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3527,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3527,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3527,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1442","type":"APR-DRG"}],"standard_charges":[{"minimum":5319,"maximum":5319,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5319,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5319,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5319,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1443","type":"APR-DRG"}],"standard_charges":[{"minimum":5764,"maximum":5764,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5764,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5764,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5764,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS SYMPTOMS AND MISCELLANEOUS DIAGNOSES","code_information":[{"code":"1444","type":"APR-DRG"}],"standard_charges":[{"minimum":10236,"maximum":10236,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10236,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"minimum":4168,"maximum":20313,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10650,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10068,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6937,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20313,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19045,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18330.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13055,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15565,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12892,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19295.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17596,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10925,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10925,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10719.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11470.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11041.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11255.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11362.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11255.77,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1451","type":"APR-DRG"}],"standard_charges":[{"minimum":2955,"maximum":2955,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2955,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2955,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2955,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1452","type":"APR-DRG"}],"standard_charges":[{"minimum":5119,"maximum":5119,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5119,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5119,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5119,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1453","type":"APR-DRG"}],"standard_charges":[{"minimum":5119,"maximum":5119,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5119,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5119,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5119,"methodology":"case rate"}]}]},{"description":"ACUTE BRONCHITIS AND RELATED SYMPTOMS","code_information":[{"code":"1454","type":"APR-DRG"}],"standard_charges":[{"minimum":10076,"maximum":10076,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10076,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10076,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10076,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITH MCC","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"minimum":8009,"maximum":52122,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20622,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19495,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11993,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52122,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48868,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30516.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21771,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25957,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22288,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32122.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34070,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21154,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21154,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8009,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17845.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19095.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18381.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18738.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18916.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18738.27,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITH CC","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"minimum":5984,"maximum":22000,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11189,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10578,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7021,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22000,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20627,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18989.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13091,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15607,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13048,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19989.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18487,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11478,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11478,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5984,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11105.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11882.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11438.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11771.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11660.49,"methodology":"case rate"}]}]},{"description":"EAR NOSE MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"minimum":4528,"maximum":14854.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7197,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6804,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5055,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12894,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12089,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14111.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8837,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10536,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9393,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14854.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11891,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7383,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7383,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4528,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8252.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8829.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8499.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8664.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8747.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8664.92,"methodology":"case rate"}]}]},{"description":"DYSEQUILIBRIUM","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":3992,"maximum":14238.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6719,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6352,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4231,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7343,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6885,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13527.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8161,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9730,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7863,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14238.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6893,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6893,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3992,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7910.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8464.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8147.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8306.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8385.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8306.07,"methodology":"case rate"}]}]},{"description":"EPISTAXIS WITH MCC","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"minimum":4953,"maximum":21578.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12425,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11746,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7468,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17293,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16213,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20499.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14909,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17775,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13878,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21578.19,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12745,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12745,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4953,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11987.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12827.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12347.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12587.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12707.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12587.28,"methodology":"case rate"}]}]},{"description":"HC SURG PREP LEGS ARMS TRUNK","code_information":[{"code":"15002","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6214.32,"maximum":6214.32,"gross_charge":7672,"discounted_cash":2270.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6214.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6214.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6214.32,"methodology":"fee schedule"}]}]},{"description":"HC SURG PREP LEGS ARMS TRUNK","code_information":[{"code":"15002","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6214.32,"gross_charge":7672,"discounted_cash":2270.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6214.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6214.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6214.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1457.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1534.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"WOUND PREP ADDL 100 CM","code_information":[{"code":"15003","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SURG PREP FEET HANDS","code_information":[{"code":"15004","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1926.99,"maximum":1926.99,"gross_charge":2379,"discounted_cash":704.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1926.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1926.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1926.99,"methodology":"fee schedule"}]}]},{"description":"HC SURG PREP FEET HANDS","code_information":[{"code":"15004","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2379,"discounted_cash":704.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1926.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1926.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1926.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"WND PREP F/N/HF/G ADDL CM","code_information":[{"code":"15005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HARVEST CULTURED SKIN GRAFT","code_information":[{"code":"15040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN PINCH GRAFT","code_information":[{"code":"15050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"EPISTAXIS WITHOUT MCC","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"minimum":3032,"maximum":14360.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6814,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6441,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4379,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7350,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6891,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13642.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8334,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9936,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8137,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14360.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11257,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6990,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6990,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3032,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7978,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8536.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8217.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8376.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8456.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8376.9,"methodology":"case rate"}]}]},{"description":"SKIN SPLT GRFT TRNK/ARM/LEG","code_information":[{"code":"15100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN SPLT GRFT T/A/L ADD-ON","code_information":[{"code":"15101","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EPIDRM AUTOGRFT TRNK/ARM/LEG","code_information":[{"code":"15110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"EPIDRM AUTOGRFT T/A/L ADD-ON","code_information":[{"code":"15111","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EPIDRM A-GRFT FACE/NCK/HF/G","code_information":[{"code":"15115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"EPIDRM A-GRFT F/N/HF/G ADDL","code_information":[{"code":"15116","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKN SPLT A-GRFT FAC/NCK/HF/G","code_information":[{"code":"15120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"SKN SPLT A-GRFT F/N/HF/G ADD","code_information":[{"code":"15121","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DERM AUTOGRAFT TRNK/ARM/LEG","code_information":[{"code":"15130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DERM AUTOGRAFT T/A/L ADD-ON","code_information":[{"code":"15131","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DERM AUTOGRAFT FACE/NCK/HF/G","code_information":[{"code":"15135","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"DERM AUTOGRAFT F/N/HF/G ADD","code_information":[{"code":"15136","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CULT SKIN GRFT T/ARM/LEG","code_information":[{"code":"15150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"CULT SKIN GRFT T/A/L ADDL","code_information":[{"code":"15151","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CULT SKIN GRAFT T/A/L +%","code_information":[{"code":"15152","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CULT SKIN GRAFT F/N/HF/G","code_information":[{"code":"15155","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"CULT SKIN GRFT F/N/HFG ADD","code_information":[{"code":"15156","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CULT EPIDERM GRFT F/N/HFG +%","code_information":[{"code":"15157","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTITIS MEDIA AND URI WITH MCC","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"minimum":4488,"maximum":18717.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10201,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9644,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6751,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13152,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12331,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17781.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12946,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15435,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12545,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18717.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16853,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10464,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10464,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4488,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10398.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11126.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10710.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10918.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11022.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10918.51,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT TRUNK","code_information":[{"code":"15200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT TRUNK ADD-ON","code_information":[{"code":"15201","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN FULL GRAFT SCLP/ARM/LEG","code_information":[{"code":"15220","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15221","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN FULL GRFT FACE/GENIT/HF","code_information":[{"code":"15240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15241","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN FULL GRAFT EEN  LIPS","code_information":[{"code":"15260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN FULL GRAFT ADD-ON","code_information":[{"code":"15261","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APP/SKIN SUBS/LEGS 1ST 25SQCM","code_information":[{"code":"15271","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5533.11,"maximum":5533.11,"gross_charge":6831,"discounted_cash":2021.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5533.11,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBS/LEGS 1ST 25SQCM","code_information":[{"code":"15271","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5533.11,"gross_charge":6831,"discounted_cash":2021.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4781.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"APP/SKIN SUBST/LEGS ADD 25SQ","code_information":[{"code":"15272","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2766.96,"maximum":2766.96,"gross_charge":3416,"discounted_cash":1011.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2766.96,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBST/LEGS ADD 25SQ","code_information":[{"code":"15272","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3416,"discounted_cash":1011.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2391.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.2,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBST/LEGS/>EQ 100SQ","code_information":[{"code":"15273","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11342.43,"maximum":11342.43,"gross_charge":14003,"discounted_cash":4144.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11342.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11342.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11342.43,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBST/LEGS/>EQ 100SQ","code_information":[{"code":"15273","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11342.43,"gross_charge":14003,"discounted_cash":4144.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11342.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11342.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11342.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9802.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2660.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2800.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2100.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2800.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"EA ADDL 100 SQ CM WOUND LEGS","code_information":[{"code":"15274","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5699.16,"maximum":5699.16,"gross_charge":7036,"discounted_cash":2082.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5699.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5699.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5699.16,"methodology":"fee schedule"}]}]},{"description":"EA ADDL 100 SQ CM WOUND LEGS","code_information":[{"code":"15274","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5699.16,"gross_charge":7036,"discounted_cash":2082.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5699.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5699.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5699.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4925.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1336.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1407.2,"methodology":"fee schedule"}]}]},{"description":"HC APP.SKIN SUB FACE<100SQ CM","code_information":[{"code":"15275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5533.11,"maximum":5533.11,"gross_charge":6831,"discounted_cash":2021.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5533.11,"methodology":"fee schedule"}]}]},{"description":"HC APP.SKIN SUB FACE<100SQ CM","code_information":[{"code":"15275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5533.11,"gross_charge":6831,"discounted_cash":2021.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4781.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"APP/SKIN SUBS/FEET ADD 25SQCM","code_information":[{"code":"15276","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2766.96,"maximum":2766.96,"gross_charge":3416,"discounted_cash":1011.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2766.96,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBS/FEET ADD 25SQCM","code_information":[{"code":"15276","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3416,"discounted_cash":1011.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2391.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.2,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBS/FEET/>SQ 100SQCM","code_information":[{"code":"15277","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5533.11,"maximum":5533.11,"gross_charge":6831,"discounted_cash":2021.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5533.11,"methodology":"fee schedule"}]}]},{"description":"APP/SKIN SUBS/FEET/>SQ 100SQCM","code_information":[{"code":"15277","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5533.11,"gross_charge":6831,"discounted_cash":2021.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5533.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4781.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1024.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"EA ADDL 100 SQ CM WOUND FEET","code_information":[{"code":"15278","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2766.96,"maximum":2766.96,"gross_charge":3416,"discounted_cash":1011.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2766.96,"methodology":"fee schedule"}]}]},{"description":"EA ADDL 100 SQ CM WOUND FEET","code_information":[{"code":"15278","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3416,"discounted_cash":1011.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2766.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2391.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.2,"methodology":"fee schedule"}]}]},{"description":"OTITIS MEDIA AND URI WITHOUT MCC","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"minimum":3827,"maximum":13825.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6397,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4175,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5544,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5198,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13133.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7464,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8898,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7758,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13825.01,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10569,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6563,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6563,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3827,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7680.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8218.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7910.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8064.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8141.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8064.59,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITH MCC","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"minimum":6397,"maximum":24400.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14619,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13820,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8739,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18430,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17279,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23180.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16245,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19368,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16240,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24400.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24152,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14996,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14996,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6397,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13555.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14504.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13962.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14233.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14369.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14233.79,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITH CC","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"minimum":4046,"maximum":16390.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8392,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7934,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5378,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12583,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11797,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15571.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9937,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11847,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9994,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16390.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8609,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8609,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4046,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9106.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9743.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9379.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9561.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9652.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9561.37,"methodology":"case rate"}]}]},{"description":"SKIN PEDICLE FLAP TRUNK","code_information":[{"code":"15570","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN PEDICLE FLAP ARMS/LEGS","code_information":[{"code":"15572","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"PEDCLE FH/CH/CH/M/N/AX/G/H/F","code_information":[{"code":"15574","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"PEDICLE E/N/E/L/NTRORAL","code_information":[{"code":"15576","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"OTHER EAR NOSE MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"minimum":3209,"maximum":13370.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6044,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5714,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3724,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9463,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8872,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12702.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7368,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8785,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6921,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13370.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9986,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6200,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6200,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3209,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7428.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7948.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7650.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7799.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7873.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7799.51,"methodology":"case rate"}]}]},{"description":"DELAY FLAP TRUNK","code_information":[{"code":"15600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"DELAY FLAP ARMS/LEGS","code_information":[{"code":"15610","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DELAY FLAP F/C/C/N/AX/G/H/F","code_information":[{"code":"15620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DELAY FLAP EYE/NOS/EAR/LIP","code_information":[{"code":"15630","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"TRANSFER SKIN PEDICLE FLAP","code_information":[{"code":"15650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH MCC","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":6209,"maximum":25565,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14719,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13915,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9698,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25565,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23969,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18070,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21544,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18023,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24530.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24319,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15099,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15099,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6209,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13627.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14581.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14036.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14309.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14445.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14309.34,"methodology":"case rate"}]}]},{"description":"MDFC FLAP W/PRSRV VASC PEDCL","code_information":[{"code":"15730","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"FOREHEAD FLAP W/VASC PEDICLE","code_information":[{"code":"15731","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"MUSC MYOQ/FSCQ FLP HN PEDCL","code_information":[{"code":"15733","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"MUSCLE-SKIN GRAFT TRUNK","code_information":[{"code":"15734","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"MUSCLE-SKIN GRAFT ARM","code_information":[{"code":"15736","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"HC MUSCLE MYO. FASCFLAP.LOWER","code_information":[{"code":"15738","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2999.43,"maximum":2999.43,"gross_charge":3703,"discounted_cash":1096.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2999.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2999.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2999.43,"methodology":"fee schedule"}]}]},{"description":"HC MUSCLE MYO. FASCFLAP.LOWER","code_information":[{"code":"15738","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"gross_charge":3703,"discounted_cash":1096.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2999.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2999.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2999.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"ISLAND PEDICLE FLAP GRAFT","code_information":[{"code":"15740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"NEUROVASCULAR PEDICLE FLAP","code_information":[{"code":"15750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"FREE MYO/SKIN FLAP MICROVASC","code_information":[{"code":"15756","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FREE SKIN FLAP MICROVASC","code_information":[{"code":"15757","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FREE FASCIAL FLAP MICROVASC","code_information":[{"code":"15758","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMPOSITE SKIN GRAFT","code_information":[{"code":"15760","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"GRFG AUTOL SOFT TISS DIR EXC","code_information":[{"code":"15769","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"DERMA-FAT-FASCIA GRAFT","code_information":[{"code":"15770","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"GRFG AUTOL FAT LIPO 50 CC/<","code_information":[{"code":"15771","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"GRFG AUTOL FAT LIPO EA ADDL","code_information":[{"code":"15772","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GRFG AUTOL FAT LIPO 25 CC/<","code_information":[{"code":"15773","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"GFRG AUTOL FAT LIPO EA ADDL","code_information":[{"code":"15774","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HAIR TRNSPL 1-15 PUNCH GRFTS","code_information":[{"code":"15775","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HAIR TRNSPL >15 PUNCH GRAFTS","code_information":[{"code":"15776","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"ACELLULAR DERM MATRIX IMPLT","code_information":[{"code":"15777","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DERMABRASION TOTAL FACE","code_information":[{"code":"15780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DERMABRASION SEGMENTAL FACE","code_information":[{"code":"15781","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DERMABRASION OTHER THAN FACE","code_information":[{"code":"15782","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DERMABRASION SUPRFL ANY SITE","code_information":[{"code":"15783","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"ABRASION LESION SINGLE","code_information":[{"code":"15786","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"ABRASION LESIONS ADD-ON","code_information":[{"code":"15787","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMICAL PEEL FACE EPIDERM","code_information":[{"code":"15788","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"CHEMICAL PEEL FACE DERMAL","code_information":[{"code":"15789","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CHEMICAL PEEL NONFACIAL","code_information":[{"code":"15792","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"CHEMICAL PEEL NONFACIAL","code_information":[{"code":"15793","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH CC","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":5332,"maximum":16471.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8455,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7993,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5332,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13836,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12973,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15648.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10043,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11973,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9909,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16471.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13969,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8673,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8673,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5496,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9151.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9791.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9425.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9608.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9700.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9608.59,"methodology":"case rate"}]}]},{"description":"PLASTIC SURGERY NECK","code_information":[{"code":"15819","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF LOWER EYELID","code_information":[{"code":"15820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REVISION OF LOWER EYELID","code_information":[{"code":"15821","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REVISION OF UPPER EYELID","code_information":[{"code":"15822","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REVISION OF UPPER EYELID","code_information":[{"code":"15823","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREHEAD WRINKLES","code_information":[{"code":"15824","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NECK WRINKLES","code_information":[{"code":"15825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BROW WRINKLES","code_information":[{"code":"15826","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FACE WRINKLES","code_information":[{"code":"15828","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SKIN WRINKLES","code_information":[{"code":"15829","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"EXC SKIN ABD","code_information":[{"code":"15830","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN THIGH","code_information":[{"code":"15832","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN LEG","code_information":[{"code":"15833","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN HIP","code_information":[{"code":"15834","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN BUTTCK","code_information":[{"code":"15835","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESSIVE SKIN ARM","code_information":[{"code":"15836","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESS SKIN ARM/HAND","code_information":[{"code":"15837","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESS SKIN FAT PAD","code_information":[{"code":"15838","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISE EXCESS SKIN  TISSUE","code_information":[{"code":"15839","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"NERVE PALSY FASCIAL GRAFT","code_information":[{"code":"15840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"NERVE PALSY MUSCLE GRAFT","code_information":[{"code":"15841","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"NERVE PALSY MICROSURG GRAFT","code_information":[{"code":"15842","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SKIN AND MUSCLE REPAIR FACE","code_information":[{"code":"15845","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"EXC SKIN ABD ADD-ON","code_information":[{"code":"15847","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SUTURES SAME SURGEON","code_information":[{"code":"15850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SUTURES DIFF SURGEON","code_information":[{"code":"15851","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DRESSING CHANGE W/ANESTHESIA","code_information":[{"code":"15852","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1660.5,"maximum":1660.5,"gross_charge":2050,"discounted_cash":606.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"}]}]},{"description":"DRESSING CHANGE W/ANESTHESIA","code_information":[{"code":"15852","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2050,"discounted_cash":606.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1435,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"TEST FOR BLOOD FLOW IN GRAFT","code_information":[{"code":"15860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY HEADNECK","code_information":[{"code":"15876","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY TRUNK","code_information":[{"code":"15877","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY UPR EXTREM","code_information":[{"code":"15878","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SUCTION LIPECTOMY LWR EXTREM","code_information":[{"code":"15879","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"DENTAL AND ORAL DISEASES WITHOUT CC/MCC","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"minimum":3836,"maximum":13222.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5929,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5605,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3836,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12032,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11281,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12561.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8106,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9664,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7129,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13222.57,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9796,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6082,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6082,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7345.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7860.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7566.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7713.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7786.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7713.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TAIL BONE ULCER","code_information":[{"code":"15920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TAIL BONE ULCER","code_information":[{"code":"15922","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15931","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15933","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15934","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15935","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15936","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVE SACRUM PRESSURE SORE","code_information":[{"code":"15937","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15940","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15941","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15944","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15945","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVE HIP PRESSURE SORE","code_information":[{"code":"15946","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15950","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15951","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15952","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15953","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15956","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVE THIGH PRESSURE SORE","code_information":[{"code":"15958","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF PRESSURE SORE","code_information":[{"code":"15999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"minimum":6665,"maximum":6665,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6665,"methodology":"case rate"}]}]},{"description":"INITIAL TREATMENT OF BURN(S)","code_information":[{"code":"16000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1601","type":"APR-DRG"}],"standard_charges":[{"minimum":21273,"maximum":21273,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21273,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21273,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21273,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1602","type":"APR-DRG"}],"standard_charges":[{"minimum":31002,"maximum":31002,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31002,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31002,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31002,"methodology":"case rate"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN S","code_information":[{"code":"16020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":891,"maximum":891,"gross_charge":1100,"discounted_cash":325.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891,"methodology":"fee schedule"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN S","code_information":[{"code":"16020","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1100,"discounted_cash":325.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":770,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN M","code_information":[{"code":"16025","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1547.1,"maximum":1547.1,"gross_charge":1910,"discounted_cash":565.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1547.1,"methodology":"fee schedule"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN M","code_information":[{"code":"16025","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"gross_charge":1910,"discounted_cash":565.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":382,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":382,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1603","type":"APR-DRG"}],"standard_charges":[{"minimum":49494,"maximum":49494,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49494,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49494,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49494,"methodology":"case rate"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN L","code_information":[{"code":"16030","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":665.01,"maximum":665.01,"gross_charge":821,"discounted_cash":243.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":665.01,"methodology":"fee schedule"}]}]},{"description":"HC DRESS/DEBRID P-THICK BURN L","code_information":[{"code":"16030","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"gross_charge":821,"discounted_cash":243.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC ESCHAROTOMY INITIAL INCISION","code_information":[{"code":"16035","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1196.37,"maximum":1196.37,"gross_charge":1477,"discounted_cash":437.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1196.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1196.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1196.37,"methodology":"fee schedule"}]}]},{"description":"HC ESCHAROTOMY INITIAL INCISION","code_information":[{"code":"16035","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3073,"gross_charge":1477,"discounted_cash":437.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1196.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1196.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1196.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1033.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"ESCHAROTOMY ADDL INCISION","code_information":[{"code":"16036","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY","code_information":[{"code":"1604","type":"APR-DRG"}],"standard_charges":[{"minimum":80910,"maximum":80910,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80910,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80910,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80910,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"minimum":10563,"maximum":10563,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10563,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1611","type":"APR-DRG"}],"standard_charges":[{"minimum":104007,"maximum":104007,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104007,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104007,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104007,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1612","type":"APR-DRG"}],"standard_charges":[{"minimum":109481,"maximum":109481,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109481,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109481,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109481,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1613","type":"APR-DRG"}],"standard_charges":[{"minimum":173992,"maximum":173992,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":173992,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":173992,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":173992,"methodology":"case rate"}]}]},{"description":"IMPLANTABLE HEART ASSIST SYSTEMS","code_information":[{"code":"1614","type":"APR-DRG"}],"standard_charges":[{"minimum":237665,"maximum":237665,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":237665,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":237665,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":237665,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"minimum":8180,"maximum":8180,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8180,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1621","type":"APR-DRG"}],"standard_charges":[{"minimum":27298,"maximum":27298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27298,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27298,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27298,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1622","type":"APR-DRG"}],"standard_charges":[{"minimum":32599,"maximum":32599,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32599,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32599,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32599,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1623","type":"APR-DRG"}],"standard_charges":[{"minimum":44968,"maximum":44968,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44968,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44968,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44968,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1624","type":"APR-DRG"}],"standard_charges":[{"minimum":84091,"maximum":84091,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84091,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84091,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84091,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITH MCC","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"minimum":26780,"maximum":68452,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41432,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39169,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26780,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67944,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":63702,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":55948.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52356,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62421,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49766,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":58892.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68452,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42501,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42501,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33821,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32718.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35008.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33699.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34354.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34681.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34354.18,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1631","type":"APR-DRG"}],"standard_charges":[{"minimum":34621,"maximum":34621,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34621,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34621,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34621,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1632","type":"APR-DRG"}],"standard_charges":[{"minimum":35627,"maximum":35627,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35627,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35627,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35627,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1633","type":"APR-DRG"}],"standard_charges":[{"minimum":50784,"maximum":50784,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50784,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50784,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50784,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1634","type":"APR-DRG"}],"standard_charges":[{"minimum":81554,"maximum":81554,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81554,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81554,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81554,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITH CC","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"minimum":14490,"maximum":37380,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22625,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21389,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14490,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36432,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34158,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32965.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27916,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33283,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26927,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34700.19,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37380,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23209,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23209,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15686,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19277.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20627.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19856.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20241.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20434.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20241.78,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"minimum":10660,"maximum":27682,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16755,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15840,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10660,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27095,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25404,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25791.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20828,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24832,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19811,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27149.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27682,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17188,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17188,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10700,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15082.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16138.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15535.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15837.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15987.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15837.14,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1651","type":"APR-DRG"}],"standard_charges":[{"minimum":27863,"maximum":27863,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27863,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27863,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27863,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1652","type":"APR-DRG"}],"standard_charges":[{"minimum":31999,"maximum":31999,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31999,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31999,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31999,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1653","type":"APR-DRG"}],"standard_charges":[{"minimum":44264,"maximum":44264,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44264,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44264,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44264,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1654","type":"APR-DRG"}],"standard_charges":[{"minimum":65114,"maximum":65114,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65114,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65114,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65114,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"minimum":23054,"maximum":58374,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34610,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32720,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23054,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58374,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54730,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47611.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39624,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47241,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42842,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":50117.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57181,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35504,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35504,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27843.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29792.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28678.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29235.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29513.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29235.22,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1661","type":"APR-DRG"}],"standard_charges":[{"minimum":27002,"maximum":27002,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27002,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27002,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27002,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1662","type":"APR-DRG"}],"standard_charges":[{"minimum":29433,"maximum":29433,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29433,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29433,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29433,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1663","type":"APR-DRG"}],"standard_charges":[{"minimum":33287,"maximum":33287,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33287,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33287,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33287,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"1664","type":"APR-DRG"}],"standard_charges":[{"minimum":52629,"maximum":52629,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52629,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52629,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52629,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":10339,"maximum":32552,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16425,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15528,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10339,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32552,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30520,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25387.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20549,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24499,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19213,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26723.85,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27136,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16849,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11463,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14846.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15885.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15291.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15588.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15737.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15588.91,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1671","type":"APR-DRG"}],"standard_charges":[{"minimum":22281,"maximum":22281,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22281,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22281,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22281,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1672","type":"APR-DRG"}],"standard_charges":[{"minimum":27401,"maximum":27401,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27401,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27401,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27401,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1673","type":"APR-DRG"}],"standard_charges":[{"minimum":38841,"maximum":38841,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38841,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38841,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38841,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC AND THORACIC VASCULAR PROCEDURES","code_information":[{"code":"1674","type":"APR-DRG"}],"standard_charges":[{"minimum":50814,"maximum":50814,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50814,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50814,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50814,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"minimum":7702,"maximum":24963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12170,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11505,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7702,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24963,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23404,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20188.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15323,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18269,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14313,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21250.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20107,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12484,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12484,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11806.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12632.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12160.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12396.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12514.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12396.39,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"minimum":2630,"maximum":2630,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2630,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1691","type":"APR-DRG"}],"standard_charges":[{"minimum":18847,"maximum":18847,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18847,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18847,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18847,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1692","type":"APR-DRG"}],"standard_charges":[{"minimum":26321,"maximum":26321,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26321,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26321,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26321,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1693","type":"APR-DRG"}],"standard_charges":[{"minimum":35922,"maximum":35922,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35922,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35922,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35922,"methodology":"case rate"}]}]},{"description":"MAJOR ABDOMINAL VASCULAR PROCEDURES","code_information":[{"code":"1694","type":"APR-DRG"}],"standard_charges":[{"minimum":38733,"maximum":38733,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38733,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38733,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38733,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"170","type":"MS-DRG"}],"standard_charges":[{"minimum":3043,"maximum":3043,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3043,"methodology":"case rate"}]}]},{"description":"DESTRUCT PREMALG LESION","code_information":[{"code":"17000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCT PREMALG LES 2-14","code_information":[{"code":"17003","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DESTROY PREMAL LESIONS 15/>","code_information":[{"code":"17004","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1701","type":"APR-DRG"}],"standard_charges":[{"minimum":16223,"maximum":16223,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16223,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16223,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16223,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1702","type":"APR-DRG"}],"standard_charges":[{"minimum":18427,"maximum":18427,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18427,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18427,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18427,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1703","type":"APR-DRG"}],"standard_charges":[{"minimum":19361,"maximum":19361,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19361,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19361,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19361,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1704","type":"APR-DRG"}],"standard_charges":[{"minimum":32860,"maximum":32860,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32860,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32860,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32860,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"minimum":2872,"maximum":2872,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2872,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17106","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17107","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17108","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1711","type":"APR-DRG"}],"standard_charges":[{"minimum":14873,"maximum":14873,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14873,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14873,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14873,"methodology":"case rate"}]}]},{"description":"DESTRUCT B9 LESION 1-14","code_information":[{"code":"17110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCT LESION 15 OR MORE","code_information":[{"code":"17111","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1712","type":"APR-DRG"}],"standard_charges":[{"minimum":17022,"maximum":17022,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17022,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17022,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17022,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1713","type":"APR-DRG"}],"standard_charges":[{"minimum":17022,"maximum":17022,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17022,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17022,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17022,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI HEART FAILURE OR SHOCK","code_information":[{"code":"1714","type":"APR-DRG"}],"standard_charges":[{"minimum":28745,"maximum":28745,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28745,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28745,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28745,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"172","type":"MS-DRG"}],"standard_charges":[{"minimum":4647,"maximum":4647,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4647,"methodology":"case rate"}]}]},{"description":"HC CHEM CAUT GRANULATION TISS","code_information":[{"code":"17250","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":486.81,"maximum":486.81,"gross_charge":601,"discounted_cash":177.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486.81,"methodology":"fee schedule"}]}]},{"description":"HC CHEM CAUT GRANULATION TISS","code_information":[{"code":"17250","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":601,"discounted_cash":177.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":420.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17260","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17261","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17262","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17263","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17264","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17266","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17270","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17271","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17272","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17273","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17274","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17276","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17281","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17282","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17283","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17284","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"DESTRUCTION OF SKIN LESIONS","code_information":[{"code":"17286","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"minimum":6988,"maximum":51472,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27584,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26077,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17470,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51472,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48259,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39024.56,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32466,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41078.49,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45572,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28296,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28296,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6988,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22821.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24418.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23506.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23962.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24190.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23962.45,"methodology":"case rate"}]}]},{"description":"MOHS 1 STAGE H/N/HF/G","code_information":[{"code":"17311","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"MOHS ADDL STAGE","code_information":[{"code":"17312","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOHS 1 STAGE T/A/L","code_information":[{"code":"17313","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"MOHS ADDL STAGE T/A/L","code_information":[{"code":"17314","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOHS SURG ADDL BLOCK","code_information":[{"code":"17315","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRYOTHERAPY OF SKIN","code_information":[{"code":"17340","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"SKIN PEEL THERAPY","code_information":[{"code":"17360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HAIR REMOVAL BY ELECTROLYSIS","code_information":[{"code":"17380","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"minimum":3446,"maximum":3446,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3446,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1741","type":"APR-DRG"}],"standard_charges":[{"minimum":12453,"maximum":12453,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12453,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12453,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12453,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1742","type":"APR-DRG"}],"standard_charges":[{"minimum":14966,"maximum":14966,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14966,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14966,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14966,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1743","type":"APR-DRG"}],"standard_charges":[{"minimum":16996,"maximum":16996,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16996,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16996,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16996,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITH AMI","code_information":[{"code":"1744","type":"APR-DRG"}],"standard_charges":[{"minimum":25281,"maximum":25281,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25281,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25281,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25281,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":7971,"maximum":21889.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12666,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11975,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7971,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21386,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20051,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20794.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15098,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18001,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14813,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21889.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20927,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12993,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9412,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12160.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13011.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12525.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12768.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12890.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12768.73,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1751","type":"APR-DRG"}],"standard_charges":[{"minimum":16797,"maximum":16797,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16797,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16797,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16797,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1752","type":"APR-DRG"}],"standard_charges":[{"minimum":17598,"maximum":17598,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17598,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17598,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17598,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1753","type":"APR-DRG"}],"standard_charges":[{"minimum":24399,"maximum":24399,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24399,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24399,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24399,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI","code_information":[{"code":"1754","type":"APR-DRG"}],"standard_charges":[{"minimum":27112,"maximum":27112,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27112,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27112,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27112,"methodology":"case rate"}]}]},{"description":"PULMONARY EMBOLISM WITHOUT MCC","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":4634,"maximum":15013.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7322,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4634,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13691,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12836,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14263.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8837,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10536,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8611,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15013.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12096,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7511,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7511,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5752,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8340.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8924.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8591.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8758.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8841.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8758.01,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1761","type":"APR-DRG"}],"standard_charges":[{"minimum":10312,"maximum":10312,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10312,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10312,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10312,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1762","type":"APR-DRG"}],"standard_charges":[{"minimum":13140,"maximum":13140,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13140,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13140,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13140,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1763","type":"APR-DRG"}],"standard_charges":[{"minimum":18234,"maximum":18234,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18234,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18234,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18234,"methodology":"case rate"}]}]},{"description":"INSERTION REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES","code_information":[{"code":"1764","type":"APR-DRG"}],"standard_charges":[{"minimum":37735,"maximum":37735,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37735,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37735,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37735,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":9638,"maximum":28408,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14531,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13737,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9638,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26595,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24935,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23073.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19239,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22938,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17911,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24287.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28408,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14906,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14906,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11375,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13493.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14437.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13897.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14167.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14302.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14167.7,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1771","type":"APR-DRG"}],"standard_charges":[{"minimum":9343,"maximum":9343,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9343,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9343,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9343,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1772","type":"APR-DRG"}],"standard_charges":[{"minimum":11582,"maximum":11582,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11582,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11582,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11582,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1773","type":"APR-DRG"}],"standard_charges":[{"minimum":17733,"maximum":17733,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17733,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17733,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17733,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER AND DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT","code_information":[{"code":"1774","type":"APR-DRG"}],"standard_charges":[{"minimum":21935,"maximum":21935,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21935,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21935,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21935,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":5606,"maximum":18565,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8918,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8431,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5606,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16762,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15716,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16213.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11749,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14008,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10418,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17067.35,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18565,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9148,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8761,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9481.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10145.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9766.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9955.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10050.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9955.96,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1781","type":"APR-DRG"}],"standard_charges":[{"minimum":36884,"maximum":36884,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36884,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36884,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36884,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1782","type":"APR-DRG"}],"standard_charges":[{"minimum":40580,"maximum":40580,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40580,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40580,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40580,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1783","type":"APR-DRG"}],"standard_charges":[{"minimum":45027,"maximum":45027,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45027,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45027,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45027,"methodology":"case rate"}]}]},{"description":"EXTERNAL HEART ASSIST SYSTEMS","code_information":[{"code":"1784","type":"APR-DRG"}],"standard_charges":[{"minimum":55154,"maximum":55154,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55154,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55154,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55154,"methodology":"case rate"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"minimum":4322,"maximum":14495.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6919,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6541,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4337,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11985,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11237,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13770.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8489,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10121,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8059,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14495.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13410,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7097,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7097,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4322,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8053.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8616.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8294.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8455.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8536.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8455.82,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1791","type":"APR-DRG"}],"standard_charges":[{"minimum":22519,"maximum":22519,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22519,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22519,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22519,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1792","type":"APR-DRG"}],"standard_charges":[{"minimum":36020,"maximum":36020,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36020,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36020,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36020,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1793","type":"APR-DRG"}],"standard_charges":[{"minimum":36020,"maximum":36020,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36020,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36020,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36020,"methodology":"case rate"}]}]},{"description":"DEFIBRILLATOR IMPLANTS","code_information":[{"code":"1794","type":"APR-DRG"}],"standard_charges":[{"minimum":49423,"maximum":49423,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49423,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49423,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49423,"methodology":"case rate"}]}]},{"description":"UNLISTED PROCEDURE SKIN BX","code_information":[{"code":"17999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":556.47,"maximum":556.47,"gross_charge":687,"discounted_cash":203.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.47,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PROCEDURE SKIN BX","code_information":[{"code":"17999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":687,"discounted_cash":203.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH MCC","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":9875,"maximum":26948,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15711,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14853,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9875,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26948,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25266,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24515.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18309,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21829,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18352,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25805.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16116,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16116,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10592,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14336.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15340.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14766.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15053.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15196.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15053.34,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1801","type":"APR-DRG"}],"standard_charges":[{"minimum":8877,"maximum":8877,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8877,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8877,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8877,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1802","type":"APR-DRG"}],"standard_charges":[{"minimum":9937,"maximum":9937,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9937,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9937,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9937,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1803","type":"APR-DRG"}],"standard_charges":[{"minimum":21584,"maximum":21584,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21584,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21584,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21584,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM PROCEDURES","code_information":[{"code":"1804","type":"APR-DRG"}],"standard_charges":[{"minimum":23328,"maximum":23328,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23328,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23328,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23328,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITH CC","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"minimum":6256,"maximum":18434.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9980,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9435,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6256,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18145,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17012,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17512.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12254,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14610,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11625,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18434.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16489,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10238,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7891,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10241.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10958.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10548.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10753.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10855.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10753.25,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1811","type":"APR-DRG"}],"standard_charges":[{"minimum":11199,"maximum":11199,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11199,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11199,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11199,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1812","type":"APR-DRG"}],"standard_charges":[{"minimum":20180,"maximum":20180,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1813","type":"APR-DRG"}],"standard_charges":[{"minimum":30252,"maximum":30252,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30252,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30252,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30252,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY ARTERIAL PROCEDURES","code_information":[{"code":"1814","type":"APR-DRG"}],"standard_charges":[{"minimum":33645,"maximum":33645,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33645,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33645,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33645,"methodology":"case rate"}]}]},{"description":"RESPIRATORY NEOPLASMS WITHOUT CC/MCC","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"minimum":4502,"maximum":17919,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7528,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7117,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4538,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17919,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16800,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14515.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9593,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11437,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8434,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15279.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12438,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7723,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7723,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4502,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8488.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9082.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8743.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8913.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8998.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8913.15,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1821","type":"APR-DRG"}],"standard_charges":[{"minimum":15667,"maximum":15667,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15667,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15667,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15667,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1822","type":"APR-DRG"}],"standard_charges":[{"minimum":15912,"maximum":15912,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15912,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15912,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15912,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1823","type":"APR-DRG"}],"standard_charges":[{"minimum":26275,"maximum":26275,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26275,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26275,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26275,"methodology":"case rate"}]}]},{"description":"OTHER PERIPHERAL VASCULAR PROCEDURES","code_information":[{"code":"1824","type":"APR-DRG"}],"standard_charges":[{"minimum":49196,"maximum":49196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49196,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49196,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49196,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITH MCC","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"minimum":7801,"maximum":23949.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14268,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13489,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8945,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15000,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14063,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22752.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16237,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19359,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16624,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23949.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23573,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14636,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14636,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7801,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13305.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14236.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13704.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13970.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14103.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13970.73,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1831","type":"APR-DRG"}],"standard_charges":[{"minimum":24316,"maximum":24316,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24316,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24316,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24316,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1832","type":"APR-DRG"}],"standard_charges":[{"minimum":27697,"maximum":27697,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27697,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27697,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27697,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1833","type":"APR-DRG"}],"standard_charges":[{"minimum":46192,"maximum":46192,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46192,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46192,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46192,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES","code_information":[{"code":"1834","type":"APR-DRG"}],"standard_charges":[{"minimum":47175,"maximum":47175,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47175,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47175,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47175,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITH CC","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":4956,"maximum":17946.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9601,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9077,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5976,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11418,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10705,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17048.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11298,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13469,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11106,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17946.17,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15862,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9849,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4956,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9970.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10668,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10269.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10468.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10568.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10468.6,"methodology":"case rate"}]}]},{"description":"MAJOR CHEST TRAUMA WITHOUT CC/MCC","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"minimum":3064,"maximum":14588.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6991,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6609,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4293,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7280,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6825,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13858.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8161,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9730,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7979,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14588.19,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11550,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7171,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7171,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3064,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8104.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8671.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8347.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8509.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8590.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8509.78,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITH MCC","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":8818,"maximum":23865.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14203,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13427,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8818,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22978,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21543,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22672.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16503,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19676,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16387,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23865.41,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23465,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14569,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14569,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9679,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13258.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14186.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13656.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13921.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14054.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13921.49,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITH CC","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"minimum":5660,"maximum":17204.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9025,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8532,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5660,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13433,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12594,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16344.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11305,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13479,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10519,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17204.96,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14910,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9258,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9258,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6896,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9558.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9845.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10036.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10131.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10036.23,"methodology":"case rate"}]}]},{"description":"PLEURAL EFFUSION WITHOUT CC/MCC","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"minimum":3848,"maximum":14085.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6600,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6239,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4241,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11809,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11072,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13380.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7826,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9330,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7882,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14085.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10904,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6770,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6770,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3848,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7825.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8372.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8059.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8216.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8294.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8216.36,"methodology":"case rate"}]}]},{"description":"PULMONARY EDEMA AND RESPIRATORY FAILURE","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":6999,"maximum":22347,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11123,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10515,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6999,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22347,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20951,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18908.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13046,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15555,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13007,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19903.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11410,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11410,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8336,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11057.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11831.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11389.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11610.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11721.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11610.57,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":6261,"maximum":18580.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10095,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9543,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6261,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15253,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14300,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17651.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11733,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13989,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11635,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18580.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16678,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6656,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10322.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11045.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10632.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10838.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10942.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10838.91,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BREAST LESION","code_information":[{"code":"19000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DRAIN BREAST LESION ADD-ON","code_information":[{"code":"19001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1901","type":"APR-DRG"}],"standard_charges":[{"minimum":4963,"maximum":4963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4963,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4963,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4963,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1902","type":"APR-DRG"}],"standard_charges":[{"minimum":6049,"maximum":6049,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6049,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6049,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6049,"methodology":"case rate"}]}]},{"description":"INCISION OF BREAST LESION","code_information":[{"code":"19020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1903","type":"APR-DRG"}],"standard_charges":[{"minimum":9571,"maximum":9571,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9571,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9571,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9571,"methodology":"case rate"}]}]},{"description":"INJECTION FOR BREAST X-RAY","code_information":[{"code":"19030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION","code_information":[{"code":"1904","type":"APR-DRG"}],"standard_charges":[{"minimum":14808,"maximum":14808,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14808,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14808,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14808,"methodology":"case rate"}]}]},{"description":"HC BX BREAST 1ST LESION STRTCTC","code_information":[{"code":"19081","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5177.52,"maximum":5177.52,"gross_charge":6392,"discounted_cash":1892.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5177.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5177.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5177.52,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION STRTCTC","code_information":[{"code":"19081","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5177.52,"gross_charge":6392,"discounted_cash":1892.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5177.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5177.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5177.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4474.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1214.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":958.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BX BREAST ADD LESION STRTCTC","code_information":[{"code":"19082","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2744.28,"maximum":2744.28,"gross_charge":3388,"discounted_cash":1002.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2744.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2744.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2744.28,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST ADD LESION STRTCTC","code_information":[{"code":"19082","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3388,"discounted_cash":1002.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2744.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2744.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2744.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1626.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1897.28,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2371.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":643.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.6,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION US IMAG","code_information":[{"code":"19083","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2967.03,"maximum":2967.03,"gross_charge":3663,"discounted_cash":1084.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2967.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2967.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2967.03,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION US IMAG","code_information":[{"code":"19083","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3663,"discounted_cash":1084.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2967.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2967.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2967.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2564.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BX BREAST ADD LESION US IMAG","code_information":[{"code":"19084","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BX BREAST 1ST LESION MR IMAG","code_information":[{"code":"19085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4785.48,"maximum":4785.48,"gross_charge":5908,"discounted_cash":1748.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4785.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4785.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4785.48,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST 1ST LESION MR IMAG","code_information":[{"code":"19085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4785.48,"gross_charge":5908,"discounted_cash":1748.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4785.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4785.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4785.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4135.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1181.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1181.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BX BREAST MRI BIL - 19085","code_information":[{"code":"19085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7176.6,"maximum":7176.6,"gross_charge":8860,"discounted_cash":2622.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7176.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7176.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7176.6,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST MRI BIL - 19085","code_information":[{"code":"19085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7176.6,"gross_charge":8860,"discounted_cash":2622.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7176.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7176.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7176.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6202,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1683.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1329,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1772,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BX BREAST ADD LESION MR IMAG","code_information":[{"code":"19086","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":4823,"maximum":15529.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7722,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7301,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4823,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10865,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10187,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14752.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9341,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11137,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8964,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15529.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12759,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7922,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5328,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8627.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9231.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8886.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9058.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9145.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9058.85,"methodology":"case rate"}]}]},{"description":"BX BREAST PERCUT W/O IMAGE","code_information":[{"code":"19100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"UNDER BREAST BIOPSY","code_information":[{"code":"19101","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9807.48,"maximum":9807.48,"gross_charge":12108,"discounted_cash":3583.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9807.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9807.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9807.48,"methodology":"fee schedule"}]}]},{"description":"UNDER BREAST BIOPSY","code_information":[{"code":"19101","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9807.48,"gross_charge":12108,"discounted_cash":3583.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9807.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9807.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9807.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2300.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2421.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2421.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"CRYOSURG ABLATE FA EACH","code_information":[{"code":"19105","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1911","type":"APR-DRG"}],"standard_charges":[{"minimum":6290,"maximum":6290,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6290,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6290,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6290,"methodology":"case rate"}]}]},{"description":"NIPPLE EXPLORATION","code_information":[{"code":"19110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"EXCISE BREAST DUCT FISTULA","code_information":[{"code":"19112","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1912","type":"APR-DRG"}],"standard_charges":[{"minimum":8439,"maximum":8439,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8439,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8439,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8439,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BREAST LESION","code_information":[{"code":"19120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"EXCISION BREAST LESION","code_information":[{"code":"19125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"EXCISION ADDL BREAST LESION","code_information":[{"code":"19126","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1913","type":"APR-DRG"}],"standard_charges":[{"minimum":9802,"maximum":9802,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9802,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9802,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9802,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE","code_information":[{"code":"1914","type":"APR-DRG"}],"standard_charges":[{"minimum":13755,"maximum":13755,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13755,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13755,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13755,"methodology":"case rate"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"minimum":3646,"maximum":13079.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5818,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5500,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3646,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8087,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7582,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12425.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7049,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8404,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6776,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13079.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9612,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5968,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5968,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4180,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7266.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7774.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7484.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7629.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7702.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7629.53,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1921","type":"APR-DRG"}],"standard_charges":[{"minimum":7995,"maximum":7995,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7995,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7995,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7995,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1922","type":"APR-DRG"}],"standard_charges":[{"minimum":10640,"maximum":10640,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10640,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10640,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10640,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1923","type":"APR-DRG"}],"standard_charges":[{"minimum":15821,"maximum":15821,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15821,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15821,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15821,"methodology":"case rate"}]}]},{"description":"CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS","code_information":[{"code":"1924","type":"APR-DRG"}],"standard_charges":[{"minimum":26262,"maximum":26262,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26262,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26262,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26262,"methodology":"case rate"}]}]},{"description":"PERQ DEVICE BREAST 1ST IMAG","code_information":[{"code":"19281","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"PERQ DEVICE BREAST EA IMAG","code_information":[{"code":"19282","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PERQ DEV BREAST 1ST STRTCTC","code_information":[{"code":"19283","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1972.35,"maximum":1972.35,"gross_charge":2435,"discounted_cash":720.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1972.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1972.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1972.35,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST 1ST STRTCTC","code_information":[{"code":"19283","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2435,"discounted_cash":720.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1972.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1972.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1972.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1704.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":487,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":365.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":487,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"PERQ DEV BREAST ADD STRTCTC","code_information":[{"code":"19284","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PERQ DEV BREAST 1ST US IMAG","code_information":[{"code":"19285","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3541.32,"maximum":3541.32,"gross_charge":4372,"discounted_cash":1294.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3541.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3541.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3541.32,"methodology":"fee schedule"}]}]},{"description":"HC PERQ DEV BREAST 1ST US IMAG","code_information":[{"code":"19285","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3541.32,"gross_charge":4372,"discounted_cash":1294.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3541.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3541.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3541.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3060.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"PERQ DEV BREAST ADD US IMAG","code_information":[{"code":"19286","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ DEV BREAST 1ST MR GUIDE","code_information":[{"code":"19287","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"PERQ DEV BREAST ADD MR GUIDE","code_information":[{"code":"19288","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP TUM CAV IORT PRTL MAST","code_information":[{"code":"19294","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLACE PO BREAST CATH FOR RAD","code_information":[{"code":"19296","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20949.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20949.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20949.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13753.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14629.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8555.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9153.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8811.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8982.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9410.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9068.42,"methodology":"case rate"}]}]},{"description":"PLACE BREAST CATH FOR RAD","code_information":[{"code":"19297","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLACE BREAST RAD TUBE/CATHS","code_information":[{"code":"19298","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH MCC","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":7537,"maximum":20832.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11845,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11198,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7537,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17378,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19790.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14038,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16736,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14006,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20832.36,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19569,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12151,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12151,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7985,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11573.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12383.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11920.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12152.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12267.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12152.21,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BREAST TISSUE","code_information":[{"code":"19300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"PARTIAL MASTECTOMY","code_information":[{"code":"19301","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"P-MASTECTOMY W/LN REMOVAL","code_information":[{"code":"19302","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"MAST SIMPLE COMPLETE","code_information":[{"code":"19303","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"MAST RADICAL","code_information":[{"code":"19305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAST RAD URBAN TYPE","code_information":[{"code":"19306","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAST MOD RAD","code_information":[{"code":"19307","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1931","type":"APR-DRG"}],"standard_charges":[{"minimum":5645,"maximum":5645,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"}]}]},{"description":"SUSPENSION OF BREAST","code_information":[{"code":"19316","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"BREAST REDUCTION","code_information":[{"code":"19318","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1932","type":"APR-DRG"}],"standard_charges":[{"minimum":6733,"maximum":6733,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6733,"methodology":"case rate"}]}]},{"description":"ENLARGE BREAST","code_information":[{"code":"19324","type":"CPT"}],"standard_charges":[{"minimum":2371,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST AUGMENTATION W/IMPLT","code_information":[{"code":"19325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20949.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20949.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20949.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13753.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14629.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8555.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9153.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8811.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8982.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9410.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9068.42,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BREAST IMPLANT","code_information":[{"code":"19328","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1933","type":"APR-DRG"}],"standard_charges":[{"minimum":8943,"maximum":8943,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8943,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8943,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8943,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IMPLANT MATERIAL","code_information":[{"code":"19330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS","code_information":[{"code":"1934","type":"APR-DRG"}],"standard_charges":[{"minimum":13687,"maximum":13687,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13687,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13687,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13687,"methodology":"case rate"}]}]},{"description":"IMMEDIATE BREAST PROSTHESIS","code_information":[{"code":"19340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"DELAYED BREAST PROSTHESIS","code_information":[{"code":"19342","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20949.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20949.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20949.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13753.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14629.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8555.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9153.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8811.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8982.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9410.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9068.42,"methodology":"case rate"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"CORRECT INVERTED NIPPLE(S)","code_information":[{"code":"19355","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19357","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":38090.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38090.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38090.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25710.92,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26598.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15554.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16643.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16021.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16332.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17110.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16488.11,"methodology":"case rate"}]}]},{"description":"BREAST RECONSTR W/LAT FLAP","code_information":[{"code":"19361","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19364","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19366","type":"CPT"}],"standard_charges":[{"minimum":2704,"maximum":3964.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19367","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19368","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST RECONSTRUCTION","code_information":[{"code":"19369","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVJ PERI-IMPLT CAPSULE BRST","code_information":[{"code":"19370","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"PERI-IMPLT CAPSLC BRST COMPL","code_information":[{"code":"19371","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"REVISE BREAST RECONSTRUCTION","code_information":[{"code":"19380","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"DESIGN CUSTOM BREAST IMPLANT","code_information":[{"code":"19396","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH CC","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":4671,"maximum":15077.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6968,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10253,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9613,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14323.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9082,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10828,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8681,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15077.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12178,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7561,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7561,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5527,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8376.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8962.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8627.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8795.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8878.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8795.11,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1941","type":"APR-DRG"}],"standard_charges":[{"minimum":4258,"maximum":4258,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4258,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4258,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4258,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1942","type":"APR-DRG"}],"standard_charges":[{"minimum":6344,"maximum":6344,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6344,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6344,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6344,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1943","type":"APR-DRG"}],"standard_charges":[{"minimum":9347,"maximum":9347,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9347,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9347,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9347,"methodology":"case rate"}]}]},{"description":"HEART FAILURE","code_information":[{"code":"1944","type":"APR-DRG"}],"standard_charges":[{"minimum":18020,"maximum":18020,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18020,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18020,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18020,"methodology":"case rate"}]}]},{"description":"BREAST SURGERY PROCEDURE","code_information":[{"code":"19499","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":3554,"maximum":12795.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5597,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5292,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3554,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7199,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6750,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12156.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6937,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8271,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6605,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12795.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9248,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5742,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5742,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4166,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7108.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7606.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7322.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7464.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7535.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7464.27,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":7723,"maximum":27981,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16936,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16011,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10768,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22484,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21080,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26012.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18783,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22394,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20012,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27381.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27981,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17373,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17373,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7723,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15212.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16276.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15668.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15972.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16124.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15972.72,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1961","type":"APR-DRG"}],"standard_charges":[{"minimum":2778,"maximum":2778,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2778,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2778,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2778,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1962","type":"APR-DRG"}],"standard_charges":[{"minimum":3517,"maximum":3517,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3517,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3517,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1963","type":"APR-DRG"}],"standard_charges":[{"minimum":7680,"maximum":7680,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7680,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7680,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7680,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST AND SHOCK","code_information":[{"code":"1964","type":"APR-DRG"}],"standard_charges":[{"minimum":11328,"maximum":11328,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11328,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11328,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11328,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH CC","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"minimum":5667,"maximum":17166,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8899,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8413,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5667,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17166,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16094,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16190.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10632,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12676,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10532,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17043.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14703,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9129,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9129,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6073,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9468.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10131.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9752.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9941.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10036.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9941.79,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1971","type":"APR-DRG"}],"standard_charges":[{"minimum":5384,"maximum":5384,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5384,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5384,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5384,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1972","type":"APR-DRG"}],"standard_charges":[{"minimum":6466,"maximum":6466,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6466,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6466,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6466,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1973","type":"APR-DRG"}],"standard_charges":[{"minimum":10224,"maximum":10224,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10224,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10224,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10224,"methodology":"case rate"}]}]},{"description":"PERIPHERAL AND OTHER VASCULAR DISORDERS","code_information":[{"code":"1974","type":"APR-DRG"}],"standard_charges":[{"minimum":12194,"maximum":12194,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12194,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12194,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12194,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"minimum":4030,"maximum":14697,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6296,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5952,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4421,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14697,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13779,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13009.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7684,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9161,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8216,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13694.35,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10402,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6458,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6458,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4030,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7607.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8140.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7836.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7988.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8064.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7988.37,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1981","type":"APR-DRG"}],"standard_charges":[{"minimum":3722,"maximum":3722,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3722,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3722,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3722,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1982","type":"APR-DRG"}],"standard_charges":[{"minimum":4815,"maximum":4815,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4815,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1983","type":"APR-DRG"}],"standard_charges":[{"minimum":5145,"maximum":5145,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5145,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5145,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5145,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS","code_information":[{"code":"1984","type":"APR-DRG"}],"standard_charges":[{"minimum":9658,"maximum":9658,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9658,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9658,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9658,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITH MCC","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":8997,"maximum":26217,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15868,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15002,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20468,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19191,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24707.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19009,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22663,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18731,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26008.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26217,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16278,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16278,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8997,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14448.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15460.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14882.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15171.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15315.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15171.38,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1991","type":"APR-DRG"}],"standard_charges":[{"minimum":4785,"maximum":4785,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4785,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4785,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4785,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1992","type":"APR-DRG"}],"standard_charges":[{"minimum":5354,"maximum":5354,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5354,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5354,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5354,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1993","type":"APR-DRG"}],"standard_charges":[{"minimum":7656,"maximum":7656,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656,"methodology":"case rate"}]}]},{"description":"HYPERTENSION","code_information":[{"code":"1994","type":"APR-DRG"}],"standard_charges":[{"minimum":7656,"maximum":7656,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7656,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITH CC","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"minimum":4530,"maximum":18401.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9955,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9412,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6119,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12532,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11750,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17481.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11587,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13815,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11371,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18401.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16448,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10212,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10212,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4530,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10223.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10938.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10529.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10734.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10836.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10734.36,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2001","type":"APR-DRG"}],"standard_charges":[{"minimum":4541,"maximum":4541,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2002","type":"APR-DRG"}],"standard_charges":[{"minimum":4541,"maximum":4541,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2003","type":"APR-DRG"}],"standard_charges":[{"minimum":6634,"maximum":6634,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6634,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6634,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6634,"methodology":"case rate"}]}]},{"description":"CARDIAC STRUCTURAL AND VALVULAR DISORDERS","code_information":[{"code":"2004","type":"APR-DRG"}],"standard_charges":[{"minimum":8115,"maximum":8115,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"}]}]},{"description":"PNEUMOTHORAX WITHOUT CC/MCC","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"minimum":3663,"maximum":13424.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6086,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5754,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4012,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9722,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9115,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12753.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7868,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9380,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7455,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13424.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10056,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6244,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6244,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3663,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7458.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7980.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7682.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7831.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7905.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7831.21,"methodology":"case rate"}]}]},{"description":"EXPLORE WOUND NECK","code_information":[{"code":"20100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"EXPLORE WOUND CHEST","code_information":[{"code":"20101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"EXPLORE WOUND ABDOMEN","code_information":[{"code":"20102","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"EXPLORE WOUND EXTREMITY","code_information":[{"code":"20103","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2011","type":"APR-DRG"}],"standard_charges":[{"minimum":4441,"maximum":4441,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4441,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4441,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4441,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2012","type":"APR-DRG"}],"standard_charges":[{"minimum":6080,"maximum":6080,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6080,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6080,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6080,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2013","type":"APR-DRG"}],"standard_charges":[{"minimum":9214,"maximum":9214,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9214,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9214,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9214,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS","code_information":[{"code":"2014","type":"APR-DRG"}],"standard_charges":[{"minimum":14576,"maximum":14576,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14576,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14576,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14576,"methodology":"case rate"}]}]},{"description":"EXCISE EPIPHYSEAL BAR","code_information":[{"code":"20150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"BRONCHITIS AND ASTHMA WITH CC/MCC","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":5140,"maximum":16773.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8690,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8215,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5440,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8299,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7781,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15934.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10007,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11931,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10109,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16773.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14357,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8914,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8914,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5140,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9318.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9598.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9784.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9877.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9784.63,"methodology":"case rate"}]}]},{"description":"MUSCLE BIOPSY","code_information":[{"code":"20200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"DEEP MUSCLE BIOPSY","code_information":[{"code":"20205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"HC BIOPSY MUSCLE NEEDLE","code_information":[{"code":"20206","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2117.34,"maximum":2117.34,"gross_charge":2614,"discounted_cash":773.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY MUSCLE NEEDLE","code_information":[{"code":"20206","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":2614,"discounted_cash":773.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2117.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BIOPSY BONE TROCR NDLE","code_information":[{"code":"20220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1266.03,"maximum":1266.03,"gross_charge":1563,"discounted_cash":462.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1266.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1266.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1266.03,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY BONE TROCR NDLE","code_information":[{"code":"20220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":1563,"discounted_cash":462.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1266.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1266.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1266.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BIOPSY BONE TROCR/NDLE DEEP","code_information":[{"code":"20225","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3248.91,"maximum":3248.91,"gross_charge":4011,"discounted_cash":1187.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3248.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3248.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3248.91,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY BONE TROCR/NDLE DEEP","code_information":[{"code":"20225","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":4011,"discounted_cash":1187.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3248.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3248.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3248.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":802.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BONE BIOPSY OPEN SUPERFICIAL","code_information":[{"code":"20240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"BONE BIOPSY OPEN DEEP","code_information":[{"code":"20245","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"OPEN BONE BIOPSY","code_information":[{"code":"20250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OPEN BONE BIOPSY","code_information":[{"code":"20251","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"BRONCHITIS AND ASTHMA WITHOUT CC/MCC","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":3685,"maximum":13650.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6262,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3948,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5618,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5267,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12967.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7211,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8597,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7337,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13650.41,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6423,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6423,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3685,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7583.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8114.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7811.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7962.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8038.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7962.74,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2031","type":"APR-DRG"}],"standard_charges":[{"minimum":3796,"maximum":3796,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3796,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2032","type":"APR-DRG"}],"standard_charges":[{"minimum":5234,"maximum":5234,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5234,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5234,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5234,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2033","type":"APR-DRG"}],"standard_charges":[{"minimum":5234,"maximum":5234,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5234,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5234,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5234,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"2034","type":"APR-DRG"}],"standard_charges":[{"minimum":7815,"maximum":7815,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7815,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7815,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7815,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SIGNS AND SYMPTOMS","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"minimum":4675,"maximum":14973.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7290,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6892,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4675,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7871,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7379,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14224.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8749,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10431,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8688,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14973.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12044,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7478,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7478,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4736,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8318.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8900.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8568.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8734.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8817.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8734.4,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2041","type":"APR-DRG"}],"standard_charges":[{"minimum":4652,"maximum":4652,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4652,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4652,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4652,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2042","type":"APR-DRG"}],"standard_charges":[{"minimum":5306,"maximum":5306,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5306,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5306,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5306,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2043","type":"APR-DRG"}],"standard_charges":[{"minimum":9449,"maximum":9449,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9449,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9449,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9449,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"2044","type":"APR-DRG"}],"standard_charges":[{"minimum":9449,"maximum":9449,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9449,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9449,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9449,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"minimum":6959,"maximum":28036,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16969,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16043,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10285,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16317,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15299,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26053.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19251,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22952,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19113,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27424.59,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28036,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17407,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6959,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15235.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16302.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15692.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15997.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16150.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15997.68,"methodology":"case rate"}]}]},{"description":"HC SINUS TRACT INJECTION","code_information":[{"code":"20500","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":794.61,"maximum":794.61,"gross_charge":981,"discounted_cash":290.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":794.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":794.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":794.61,"methodology":"fee schedule"}]}]},{"description":"HC SINUS TRACT INJECTION","code_information":[{"code":"20500","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"gross_charge":981,"discounted_cash":290.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":794.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":794.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":794.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":686.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"HC INJECT SINUS TRACT FOR X-RAY","code_information":[{"code":"20501","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC INJECT SINUS TRACT FOR X-RAY","code_information":[{"code":"20501","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":68.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":79.52,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2051","type":"APR-DRG"}],"standard_charges":[{"minimum":3694,"maximum":3694,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3694,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3694,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3694,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2052","type":"APR-DRG"}],"standard_charges":[{"minimum":4847,"maximum":4847,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4847,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4847,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4847,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREIGN BODY","code_information":[{"code":"20520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREIGN BODY","code_information":[{"code":"20525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"THER INJECTION CARP TUNNEL","code_information":[{"code":"20526","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INJ DUPUYTREN CORD W/ENZYME","code_information":[{"code":"20527","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2053","type":"APR-DRG"}],"standard_charges":[{"minimum":7900,"maximum":7900,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7900,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7900,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7900,"methodology":"case rate"}]}]},{"description":"CARDIOMYOPATHY","code_information":[{"code":"2054","type":"APR-DRG"}],"standard_charges":[{"minimum":12246,"maximum":12246,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12246,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12246,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12246,"methodology":"case rate"}]}]},{"description":"HC INJ TENDON SHTH/LIG SGL","code_information":[{"code":"20550","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":827.82,"maximum":827.82,"gross_charge":1022,"discounted_cash":302.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.82,"methodology":"fee schedule"}]}]},{"description":"HC INJ TENDON SHTH/LIG SGL","code_information":[{"code":"20550","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1022,"discounted_cash":302.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":715.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INJ TENDON ORIGIN/INSERTION","code_information":[{"code":"20551","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INJ TRIGGER POINT 1/2 MUSCL","code_information":[{"code":"20552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INJECT TRIGGER POINTS 3/>","code_information":[{"code":"20553","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"PLACE NDL MUSC/TIS FOR RT","code_information":[{"code":"20555","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"NDL INSJ W/O NJX 1 OR 2 MUSC","code_information":[{"code":"20560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"NDL INSJ W/O NJX 3+ MUSC","code_information":[{"code":"20561","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"minimum":4084,"maximum":16069.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8142,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7697,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5190,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10931,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10248,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15265.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9657,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11513,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9645,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16069.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13452,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8352,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8352,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4084,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8927.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9195.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9373.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9463.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9373.85,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ JOINT SMALL","code_information":[{"code":"20600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1022.22,"maximum":1022.22,"gross_charge":1262,"discounted_cash":373.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1022.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1022.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1022.22,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ JOINT SMALL","code_information":[{"code":"20600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1262,"discounted_cash":373.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1022.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1022.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1022.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":883.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"DRAIN/INJ JOINT/BURSA W/US","code_information":[{"code":"20604","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ JOINT INTERM","code_information":[{"code":"20605","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":355.59,"maximum":355.59,"gross_charge":439,"discounted_cash":129.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":355.59,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ JOINT INTERM","code_information":[{"code":"20605","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":439,"discounted_cash":129.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":307.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US INTRMDT","code_information":[{"code":"20606","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2238.03,"maximum":2238.03,"gross_charge":2763,"discounted_cash":817.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2238.03,"methodology":"fee schedule"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US INTRMDT","code_information":[{"code":"20606","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2763,"discounted_cash":817.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2061","type":"APR-DRG"}],"standard_charges":[{"minimum":5792,"maximum":5792,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5792,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5792,"methodology":"case rate"}]}]},{"description":"HC ASPIR/INJ JOINT MAJOR","code_information":[{"code":"20610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1076.49,"maximum":1076.49,"gross_charge":1329,"discounted_cash":393.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.49,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR/INJ JOINT MAJOR","code_information":[{"code":"20610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1329,"discounted_cash":393.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":930.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC ASPIRATION MAJOR JOINT","code_information":[{"code":"20610","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1076.49,"maximum":1076.49,"gross_charge":1329,"discounted_cash":393.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.49,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION MAJOR JOINT","code_information":[{"code":"20610","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1329,"discounted_cash":393.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":930.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC HIP INJ UNILATERAL PM","code_information":[{"code":"20610","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1076.49,"maximum":1076.49,"gross_charge":1329,"discounted_cash":393.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.49,"methodology":"fee schedule"}]}]},{"description":"HC HIP INJ UNILATERAL PM","code_information":[{"code":"20610","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":1329,"discounted_cash":393.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":930.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US MAJOR","code_information":[{"code":"20611","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":893.43,"maximum":893.43,"gross_charge":1103,"discounted_cash":326.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":893.43,"methodology":"fee schedule"}]}]},{"description":"HC DRAIN/INJ JOINT/BURSA W/US MAJOR","code_information":[{"code":"20611","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1103,"discounted_cash":326.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"ASPIRATE/INJ GANGLION CYST","code_information":[{"code":"20612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"TREATMENT OF BONE CYST","code_information":[{"code":"20615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2062","type":"APR-DRG"}],"standard_charges":[{"minimum":8502,"maximum":8502,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2063","type":"APR-DRG"}],"standard_charges":[{"minimum":12457,"maximum":12457,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12457,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12457,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12457,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF CARDIAC OR VASCULAR DEVICE OR PROCEDURE","code_information":[{"code":"2064","type":"APR-DRG"}],"standard_charges":[{"minimum":13641,"maximum":13641,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13641,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13641,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13641,"methodology":"case rate"}]}]},{"description":"INSERT AND REMOVE BONE PIN","code_information":[{"code":"20650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"APPLY REM FIXATION DEVICE","code_information":[{"code":"20660","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"APPLICATION OF HEAD BRACE","code_information":[{"code":"20661","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPLICATION OF PELVIS BRACE","code_information":[{"code":"20662","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"APPLICATION OF THIGH BRACE","code_information":[{"code":"20663","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"APPLICATION OF HALO","code_information":[{"code":"20664","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF FIXATION DEVICE","code_information":[{"code":"20665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SUPPORT IMPLANT","code_information":[{"code":"20670","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IMPLANT","code_information":[{"code":"20680","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7494.12,"maximum":7494.12,"gross_charge":9252,"discounted_cash":2738.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7494.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7494.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7494.12,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF IMPLANT","code_information":[{"code":"20680","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7494.12,"gross_charge":9252,"discounted_cash":2738.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7494.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7494.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7494.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1757.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1387.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"APPLY BONE FIXATION DEVICE","code_information":[{"code":"20690","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"APPLY BONE FIXATION DEVICE","code_information":[{"code":"20692","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"ADJUST BONE FIXATION DEVICE","code_information":[{"code":"20693","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE BONE FIXATION DEVICE","code_information":[{"code":"20694","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"COMP MULTIPLANE EXT FIXATION","code_information":[{"code":"20696","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"COMP EXT FIXATE STRUT CHANGE","code_information":[{"code":"20697","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"minimum":39247,"maximum":100242,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58134,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":54958,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39247,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":100242,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":93984,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":76358.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70971,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":84615,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72935,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":80377.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":59634,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":59634,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41513,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44654.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":47779.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45993.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":46886.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47333.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46886.84,"methodology":"case rate"}]}]},{"description":"MNL PREPINSJ DP RX DLVR DEV","code_information":[{"code":"20700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL DEEP RX DELIVERY DEVICE","code_information":[{"code":"20701","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MNL PREPINSJ IMED RX DEV","code_information":[{"code":"20702","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL IMED RX DELIVERY DEVICE","code_information":[{"code":"20703","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MNL PREPINSJ I-ARTIC RX DEV","code_information":[{"code":"20704","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL I-ARTIC RX DELIVERY DEV","code_information":[{"code":"20705","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2071","type":"APR-DRG"}],"standard_charges":[{"minimum":4716,"maximum":4716,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4716,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4716,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4716,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2072","type":"APR-DRG"}],"standard_charges":[{"minimum":6340,"maximum":6340,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6340,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6340,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6340,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2073","type":"APR-DRG"}],"standard_charges":[{"minimum":11531,"maximum":11531,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES","code_information":[{"code":"2074","type":"APR-DRG"}],"standard_charges":[{"minimum":11531,"maximum":11531,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11531,"methodology":"case rate"}]}]},{"description":"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"minimum":12634,"maximum":42964,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24125,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22807,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15361,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42964,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40282,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34797.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28104,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33507,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28547,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36628.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39857,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24747,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24747,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20349.41,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21773.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20959.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21366.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21570.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21366.89,"methodology":"case rate"}]}]},{"description":"REPLANTATION ARM COMPLETE","code_information":[{"code":"20802","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLANT FOREARM COMPLETE","code_information":[{"code":"20805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLANTATION HAND COMPLETE","code_information":[{"code":"20808","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLANTATION DIGIT COMPLETE","code_information":[{"code":"20816","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLANTATION DIGIT COMPLETE","code_information":[{"code":"20822","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPLANTATION THUMB COMPLETE","code_information":[{"code":"20824","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLANTATION THUMB COMPLETE","code_information":[{"code":"20827","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLANTATION FOOT COMPLETE","code_information":[{"code":"20838","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"minimum":2468,"maximum":2468,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2468,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE FOR GRAFT","code_information":[{"code":"20900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE FOR GRAFT","code_information":[{"code":"20902","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE CARTILAGE FOR GRAFT","code_information":[{"code":"20910","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"REMOVE CARTILAGE FOR GRAFT","code_information":[{"code":"20912","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FASCIA FOR GRAFT","code_information":[{"code":"20920","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FASCIA FOR GRAFT","code_information":[{"code":"20922","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TENDON FOR GRAFT","code_information":[{"code":"20924","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SP BONE ALGRFT MORSEL ADD-ON","code_information":[{"code":"20930","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SP BONE ALGRFT STRUCT ADD-ON","code_information":[{"code":"20931","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OSTEOART ALGRFT W/SURF  B1","code_information":[{"code":"20932","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEMICRT INTRCLRY ALGRFT PRTL","code_information":[{"code":"20933","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTERCALARY ALGRFT COMPL","code_information":[{"code":"20934","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SP BONE AGRFT LOCAL ADD-ON","code_information":[{"code":"20936","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SP BONE AGRFT MORSEL ADD-ON","code_information":[{"code":"20937","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SP BONE AGRFT STRUCT ADD-ON","code_information":[{"code":"20938","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BONE MARROW ASPIR BONE GRFG","code_information":[{"code":"20939","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FLUID PRESSURE MUSCLE","code_information":[{"code":"20950","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"FIBULA BONE GRAFT MICROVASC","code_information":[{"code":"20955","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ILIAC BONE GRAFT MICROVASC","code_information":[{"code":"20956","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MT BONE GRAFT MICROVASC","code_information":[{"code":"20957","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER BONE GRAFT MICROVASC","code_information":[{"code":"20962","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BONE/SKIN GRAFT MICROVASC","code_information":[{"code":"20969","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BONE/SKIN GRAFT ILIAC CREST","code_information":[{"code":"20970","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BONE/SKIN GRAFT METATARSAL","code_information":[{"code":"20972","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"BONE/SKIN GRAFT GREAT TOE","code_information":[{"code":"20973","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ELECTRICAL BONE STIMULATION","code_information":[{"code":"20974","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":133.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":77.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":80.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":81.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":85.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":82.53,"methodology":"fee schedule"}]}]},{"description":"ELECTRICAL BONE STIMULATION","code_information":[{"code":"20975","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5362,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5362,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"US BONE STIMULATION","code_information":[{"code":"20979","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"HC RF ABLATE BONE TUMOR(S)W IMG","code_information":[{"code":"20982","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4539.24,"maximum":4539.24,"gross_charge":5604,"discounted_cash":1658.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4539.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4539.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4539.24,"methodology":"fee schedule"}]}]},{"description":"HC RF ABLATE BONE TUMOR(S)W IMG","code_information":[{"code":"20982","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"gross_charge":5604,"discounted_cash":1658.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4539.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4539.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4539.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3922.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"ABLATE BONE TUMOR(S) PERQ","code_information":[{"code":"20983","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CPTR-ASST DIR MS PX","code_information":[{"code":"20985","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MUSCULOSKELETAL SURGERY","code_information":[{"code":"20999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"minimum":4726,"maximum":4726,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4726,"methodology":"case rate"}]}]},{"description":"INCISION OF JAW JOINT","code_information":[{"code":"21010","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXC FACE LES SC <2 CM","code_information":[{"code":"21011","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC FACE LES SBQ 2 CM/>","code_information":[{"code":"21012","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC FACE TUM DEEP < 2 CM","code_information":[{"code":"21013","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC FACE TUM DEEP 2 CM/>","code_information":[{"code":"21014","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT FACE/SCALP TUM < 2 CM","code_information":[{"code":"21015","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT FACE/SCALP TUM 2 CM/>","code_information":[{"code":"21016","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXCISION OF BONE LOWER JAW","code_information":[{"code":"21025","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISION OF FACIAL BONE(S)","code_information":[{"code":"21026","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CONTOUR OF FACE BONE LESION","code_information":[{"code":"21029","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISE MAX/ZYGOMA B9 TUMOR","code_information":[{"code":"21030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE EXOSTOSIS MANDIBLE","code_information":[{"code":"21031","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVE EXOSTOSIS MAXILLA","code_information":[{"code":"21032","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISE MAX/ZYGOMA MAL TUMOR","code_information":[{"code":"21034","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE MANDIBLE LESION","code_information":[{"code":"21040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF JAW BONE LESION","code_information":[{"code":"21044","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXTENSIVE JAW SURGERY","code_information":[{"code":"21045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE MANDIBLE CYST COMPLEX","code_information":[{"code":"21046","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE LWR JAW CYST W/REPAIR","code_information":[{"code":"21047","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE MAXILLA CYST COMPLEX","code_information":[{"code":"21048","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCIS UPPR JAW CYST W/REPAIR","code_information":[{"code":"21049","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF JAW JOINT","code_information":[{"code":"21050","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE JAW JOINT CARTILAGE","code_information":[{"code":"21060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE CORONOID PROCESS","code_information":[{"code":"21070","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MNPJ OF TMJ W/ANESTH","code_information":[{"code":"21073","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21076","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21077","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21079","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21080","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21081","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21082","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21083","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21084","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21085","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21086","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21087","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21088","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PREPARE FACE/ORAL PROSTHESIS","code_information":[{"code":"21089","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"minimum":5006,"maximum":5006,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5006,"methodology":"case rate"}]}]},{"description":"MAXILLOFACIAL FIXATION","code_information":[{"code":"21100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"INTERDENTAL FIXATION","code_information":[{"code":"21110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"INJECTION JAW JOINT X-RAY","code_information":[{"code":"21116","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21121","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21122","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF CHIN","code_information":[{"code":"21123","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"AUGMENTATION LOWER JAW BONE","code_information":[{"code":"21125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"AUGMENTATION LOWER JAW BONE","code_information":[{"code":"21127","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21137","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21138","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FOREHEAD","code_information":[{"code":"21139","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LEFORT I-1 PIECE W/O GRAFT","code_information":[{"code":"21141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LEFORT I-2 PIECE W/O GRAFT","code_information":[{"code":"21142","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LEFORT I-3/> PIECE W/O GRAFT","code_information":[{"code":"21143","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LEFORT I-1 PIECE W/ GRAFT","code_information":[{"code":"21145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT I-2 PIECE W/ GRAFT","code_information":[{"code":"21146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT I-3/> PIECE W/ GRAFT","code_information":[{"code":"21147","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT II ANTERIOR INTRUSION","code_information":[{"code":"21150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LEFORT II W/BONE GRAFTS","code_information":[{"code":"21151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT III W/O LEFORT I","code_information":[{"code":"21154","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT III W/ LEFORT I","code_information":[{"code":"21155","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT III W/FHDW/O LEFORT I","code_information":[{"code":"21159","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEFORT III W/FHD W/ LEFORT I","code_information":[{"code":"21160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT ORBIT/FOREHEAD","code_information":[{"code":"21172","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ORBIT/FOREHEAD","code_information":[{"code":"21175","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ENTIRE FOREHEAD","code_information":[{"code":"21179","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT ENTIRE FOREHEAD","code_information":[{"code":"21180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONTOUR CRANIAL BONE LESION","code_information":[{"code":"21181","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21182","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21183","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT CRANIAL BONE","code_information":[{"code":"21184","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCTION OF MIDFACE","code_information":[{"code":"21188","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONST LWR JAW W/O GRAFT","code_information":[{"code":"21193","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONST LWR JAW W/GRAFT","code_information":[{"code":"21194","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONST LWR JAW W/O FIXATION","code_information":[{"code":"21195","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONST LWR JAW W/FIXATION","code_information":[{"code":"21196","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTR LWR JAW SEGMENT","code_information":[{"code":"21198","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTR LWR JAW W/ADVANCE","code_information":[{"code":"21199","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"minimum":3249,"maximum":180291,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97925,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":92576,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":61192,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":180291,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":169035,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":124986.33,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":113717,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":131564.56,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161786,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":100453,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":100453,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3249,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":73091.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":78207.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":75284.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":76746,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77476.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":76746,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT UPPER JAW BONE","code_information":[{"code":"21206","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"AUGMENTATION OF FACIAL BONES","code_information":[{"code":"21208","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REDUCTION OF FACIAL BONES","code_information":[{"code":"21209","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"FACE BONE GRAFT","code_information":[{"code":"21210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LOWER JAW BONE GRAFT","code_information":[{"code":"21215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RIB CARTILAGE GRAFT","code_information":[{"code":"21230","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EAR CARTILAGE GRAFT","code_information":[{"code":"21235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21242","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW JOINT","code_information":[{"code":"21243","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF LOWER JAW","code_information":[{"code":"21244","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21245","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21246","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT LOWER JAW BONE","code_information":[{"code":"21247","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21248","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF JAW","code_information":[{"code":"21249","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT LOWER JAW BONE","code_information":[{"code":"21255","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF ORBIT","code_information":[{"code":"21256","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21260","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21261","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21263","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21267","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKETS","code_information":[{"code":"21268","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AUGMENTATION CHEEK BONE","code_information":[{"code":"21270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION ORBITOFACIAL BONES","code_information":[{"code":"21275","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"21280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"21282","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REVISION OF JAW MUSCLE/BONE","code_information":[{"code":"21295","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REVISION OF JAW MUSCLE/BONE","code_information":[{"code":"21296","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"CRANIO/MAXILLOFACIAL SURGERY","code_information":[{"code":"21299","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"minimum":10090,"maximum":10090,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10090,"methodology":"case rate"}]}]},{"description":"CLOSED TX NOSE FX W/O MANJ","code_information":[{"code":"21310","type":"CPT"}],"standard_charges":[{"minimum":1791.86,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSED TX NOSE FX W/O STABLJ","code_information":[{"code":"21315","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"CLOSED TX NOSE FX W/ STABLJ","code_information":[{"code":"21320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OPEN TX NOSE FX UNCOMPLICATD","code_information":[{"code":"21325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OPEN TX NOSE FX W/SKELE FIXJ","code_information":[{"code":"21330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPEN TX NOSE  SEPTAL FX","code_information":[{"code":"21335","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OPEN TX SEPTAL FX W/WO STABJ","code_information":[{"code":"21336","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CLOSED TX SEPTALNOSE FX","code_information":[{"code":"21337","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OPEN NASOETHMOID FX W/O FIXJ","code_information":[{"code":"21338","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPEN NASOETHMOID FX W/ FIXJ","code_information":[{"code":"21339","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PERQ TX NASOETHMOID FX","code_information":[{"code":"21340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OPEN TX DPRSD FRONT SINUS FX","code_information":[{"code":"21343","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN TX COMPL FRONT SINUS FX","code_information":[{"code":"21344","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSED TX NOSE/JAW FX","code_information":[{"code":"21345","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"OPN TX NASOMAX FX W/FIXJ","code_information":[{"code":"21346","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX NASOMAX FX MULTPLE","code_information":[{"code":"21347","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX NASOMAX FX W/GRAFT","code_information":[{"code":"21348","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ TX MALAR FRACTURE","code_information":[{"code":"21355","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OPN TX DPRSD ZYGOMATIC ARCH","code_information":[{"code":"21356","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX DPRSD MALAR FRACTURE","code_information":[{"code":"21360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX COMPLX MALAR FX","code_information":[{"code":"21365","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX COMPLX MALAR W/GRFT","code_information":[{"code":"21366","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX TRANSANTRAL","code_information":[{"code":"21385","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX PERIORBITAL","code_information":[{"code":"21386","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX COMBINED","code_information":[{"code":"21387","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT PERIORBTL IMPLT","code_information":[{"code":"21390","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT PERIORBT W/GRFT","code_information":[{"code":"21395","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"minimum":4860,"maximum":4860,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"}]}]},{"description":"CLOSED TX ORBIT W/O MANIPULJ","code_information":[{"code":"21400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"CLOSED TX ORBIT W/MANIPULJ","code_information":[{"code":"21401","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX W/O IMPLANT","code_information":[{"code":"21406","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX W/IMPLANT","code_information":[{"code":"21407","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OPN TX ORBIT FX W/BONE GRFT","code_information":[{"code":"21408","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21421","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21422","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT MOUTH ROOF FRACTURE","code_information":[{"code":"21423","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21431","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21432","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21433","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21435","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT CRANIOFACIAL FRACTURE","code_information":[{"code":"21436","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT DENTAL RIDGE FRACTURE","code_information":[{"code":"21440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TREAT DENTAL RIDGE FRACTURE","code_information":[{"code":"21445","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21451","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21452","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21453","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21454","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21461","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21462","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21465","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREAT LOWER JAW FRACTURE","code_information":[{"code":"21470","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RESET DISLOCATED JAW","code_information":[{"code":"21480","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"RESET DISLOCATED JAW","code_information":[{"code":"21485","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REPAIR DISLOCATED JAW","code_information":[{"code":"21490","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"INTERDENTAL WIRING","code_information":[{"code":"21497","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"HEAD SURGERY PROCEDURE","code_information":[{"code":"21499","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"OTHER HEART ASSIST SYSTEM IMPLANT","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"minimum":58034,"maximum":200895,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95236,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":90035,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58034,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":200895,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":188353,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":121700.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":111367,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":132777,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":107848,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":128105.99,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157344,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":97695,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":97695,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":76254,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":71169.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":76151.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":73305.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":74728.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":75440.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74728.49,"methodology":"case rate"}]}]},{"description":"DRAIN NECK/CHEST LESION","code_information":[{"code":"21501","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAIN CHEST LESION","code_information":[{"code":"21502","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"21510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSY OF NECK/CHEST","code_information":[{"code":"21550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC NECK LES SC 3 CM/>","code_information":[{"code":"21552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC NECK TUM DEEP 5 CM/>","code_information":[{"code":"21554","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC NECK LES SC < 3 CM","code_information":[{"code":"21555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC NECK TUM DEEP < 5 CM","code_information":[{"code":"21556","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT NECK THORAX TUMOR<5CM","code_information":[{"code":"21557","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT NECK TUMOR 5 CM/>","code_information":[{"code":"21558","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"minimum":55139,"maximum":164600,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86754,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":82015,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55139,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":164600,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":154324,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":111334.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":105300,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":125544,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":102469,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":117193.74,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143329,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":88993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":88993,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63805,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65107.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":69665.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":67060.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68363.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69014.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":68363.02,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RIB","code_information":[{"code":"21600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXC CHEST WALL TUMOR W/RIBS","code_information":[{"code":"21601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC CH WAL TUM W/O LYMPHADEC","code_information":[{"code":"21602","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXC CH WAL TUM W/LYMPHADEC","code_information":[{"code":"21603","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF RIB","code_information":[{"code":"21610","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF RIB","code_information":[{"code":"21615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF RIB AND NERVES","code_information":[{"code":"21616","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OSTECTOMY STERNUM;PARTIAL","code_information":[{"code":"21620","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":19456.2,"maximum":19456.2,"gross_charge":24020,"discounted_cash":7109.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19456.2,"methodology":"fee schedule"}]}]},{"description":"OSTECTOMY STERNUM;PARTIAL","code_information":[{"code":"21620","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19456.2,"gross_charge":24020,"discounted_cash":7109.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16814,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4563.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4804,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3603,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4804,"methodology":"fee schedule"}]}]},{"description":"STERNAL DEBRIDEMENT","code_information":[{"code":"21627","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE STERNUM SURGERY","code_information":[{"code":"21630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE STERNUM SURGERY","code_information":[{"code":"21632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HYOID MYOTOMY  SUSPENSION","code_information":[{"code":"21685","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"minimum":36163,"maximum":105529,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58050,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":54879,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":36163,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":105529,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":98941,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":76256.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":68624,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":81817,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67205,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":80269.89,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95907,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":59548,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":59548,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37365,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44594.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":47715.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45932.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":46824.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47270.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46824.1,"methodology":"case rate"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF NECK MUSCLE/RIB","code_information":[{"code":"21705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF NECK MUSCLE","code_information":[{"code":"21725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF STERNUM","code_information":[{"code":"21740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR STERN/NUSS W/O SCOPE","code_information":[{"code":"21742","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR STERNUM/NUSS W/SCOPE","code_information":[{"code":"21743","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF STERNUM SEPARATION","code_information":[{"code":"21750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"minimum":29807,"maximum":95936,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53478,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":50557,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32365,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":95936,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":89947,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70669.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64191,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":76532,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60146,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":74388.82,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88353,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":54858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54858,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29807,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41327.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44220.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42566.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43393.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":43806.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43393.48,"methodology":"case rate"}]}]},{"description":"OPTX OF RIB FX W/FIXJ SCOPE","code_information":[{"code":"21811","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RIB FRACTURE","code_information":[{"code":"21812","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RIB FRACTURE","code_information":[{"code":"21813","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT STERNUM FRACTURE","code_information":[{"code":"21820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT STERNUM FRACTURE","code_information":[{"code":"21825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NECK/CHEST SURGERY PROCEDURE","code_information":[{"code":"21899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"minimum":41294,"maximum":182112,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69552,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":65753,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43810,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":182112,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":170743,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90312.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":87859,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104749,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81415,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":95066.25,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114910,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":71347,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":71347,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41294,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":52814.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56511.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54399.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55455.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":55983.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":55455.31,"methodology":"case rate"}]}]},{"description":"BIOPSY OF BACK-SUPERFICIAL","code_information":[{"code":"21920","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4371.57,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"}]}]},{"description":"BIOPSY OF BACK-SUPERFICIAL","code_information":[{"code":"21920","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3777.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BIOPSY SOFT TISSUE OF BACK","code_information":[{"code":"21925","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC BACK LES SC < 3 CM","code_information":[{"code":"21930","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4371.57,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"}]}]},{"description":"EXC BACK LES SC < 3 CM","code_information":[{"code":"21930","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC BACK LES SC 3 CM/>","code_information":[{"code":"21931","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC BACK TUM DEEP < 5 CM","code_information":[{"code":"21932","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC BACK TUM DEEP 5 CM/>","code_information":[{"code":"21933","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT BACK TUM < 5 CM","code_information":[{"code":"21935","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT BACK TUM 5 CM/>","code_information":[{"code":"21936","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"minimum":29796,"maximum":94947,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47612,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":45011,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29796,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":94947,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":89020,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":63500.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58748,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70042,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55372,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":66842.63,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78662,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":48841,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":48841,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33007,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37134.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39734.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38248.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38991.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":39362.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38991.53,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2201","type":"APR-DRG"}],"standard_charges":[{"minimum":11126,"maximum":11126,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11126,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11126,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11126,"methodology":"case rate"}]}]},{"description":"ID P-SPINE C/T/CERV-THOR","code_information":[{"code":"22010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ID ABSCESS P-SPINE L/S/LS","code_information":[{"code":"22015","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2202","type":"APR-DRG"}],"standard_charges":[{"minimum":15822,"maximum":15822,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15822,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15822,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15822,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2203","type":"APR-DRG"}],"standard_charges":[{"minimum":29369,"maximum":29369,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29369,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29369,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29369,"methodology":"case rate"}]}]},{"description":"MAJOR STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2204","type":"APR-DRG"}],"standard_charges":[{"minimum":52229,"maximum":52229,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52229,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52229,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52229,"methodology":"case rate"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"minimum":26410,"maximum":72133,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41283,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39028,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26410,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72133,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67630,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":55765.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51144,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60976,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49080,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":58700.92,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68205,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42348,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42348,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32369,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32611.62,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34894.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33589.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34242.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34568.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34242.21,"methodology":"case rate"}]}]},{"description":"REMOVE PART OF NECK VERTEBRA","code_information":[{"code":"22100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE PART THORAX VERTEBRA","code_information":[{"code":"22101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE PART LUMBAR VERTEBRA","code_information":[{"code":"22102","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE EXTRA SPINE SEGMENT","code_information":[{"code":"22103","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PART OF NECK VERTEBRA","code_information":[{"code":"22110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PART THORAX VERTEBRA","code_information":[{"code":"22112","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PART LUMBAR VERTEBRA","code_information":[{"code":"22114","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE EXTRA SPINE SEGMENT","code_information":[{"code":"22116","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"minimum":39039,"maximum":98671,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":82760,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":98671,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39039,"methodology":"case rate"}]}]},{"description":"INCIS SPINE 3 COLUMN THORAC","code_information":[{"code":"22206","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS SPINE 3 COLUMN LUMBAR","code_information":[{"code":"22207","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS SPINE 3 COLUMN ADL SEG","code_information":[{"code":"22208","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2221","type":"APR-DRG"}],"standard_charges":[{"minimum":4777,"maximum":4777,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4777,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4777,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4777,"methodology":"case rate"}]}]},{"description":"INCIS 1 VERTEBRAL SEG CERV","code_information":[{"code":"22210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS 1 VERTEBRAL SEG THORAC","code_information":[{"code":"22212","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS 1 VERTEBRAL SEG LUMBAR","code_information":[{"code":"22214","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS ADDL SPINE SEGMENT","code_information":[{"code":"22216","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2222","type":"APR-DRG"}],"standard_charges":[{"minimum":14870,"maximum":14870,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870,"methodology":"case rate"}]}]},{"description":"INCIS W/DISCECTOMY CERVICAL","code_information":[{"code":"22220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS W/DISCECTOMY THORACIC","code_information":[{"code":"22222","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCIS W/DISCECTOMY LUMBAR","code_information":[{"code":"22224","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE EXTRA SPINE SEGMENT","code_information":[{"code":"22226","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2223","type":"APR-DRG"}],"standard_charges":[{"minimum":14870,"maximum":14870,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870,"methodology":"case rate"}]}]},{"description":"OTHER STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES","code_information":[{"code":"2224","type":"APR-DRG"}],"standard_charges":[{"minimum":25726,"maximum":25726,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25726,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25726,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25726,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"minimum":27506,"maximum":67253,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56409,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67253,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27506,"methodology":"case rate"}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2231","type":"APR-DRG"}],"standard_charges":[{"minimum":6966,"maximum":6966,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6966,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6966,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6966,"methodology":"case rate"}]}]},{"description":"CLOSED TX VERT FX W/O MANJ","code_information":[{"code":"22310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CLOSED TX VERT FX W/MANJ","code_information":[{"code":"22315","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT ODONTOID FX W/O GRAFT","code_information":[{"code":"22318","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT ODONTOID FX W/GRAFT","code_information":[{"code":"22319","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2232","type":"APR-DRG"}],"standard_charges":[{"minimum":11558,"maximum":11558,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11558,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11558,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11558,"methodology":"case rate"}]}]},{"description":"TREAT SPINE FRACTURE","code_information":[{"code":"22325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT NECK SPINE FRACTURE","code_information":[{"code":"22326","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THORAX SPINE FRACTURE","code_information":[{"code":"22327","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT EACH ADD SPINE FX","code_information":[{"code":"22328","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2233","type":"APR-DRG"}],"standard_charges":[{"minimum":13566,"maximum":13566,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13566,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13566,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13566,"methodology":"case rate"}]}]},{"description":"OTHER SMALL AND LARGE BOWEL PROCEDURES","code_information":[{"code":"2234","type":"APR-DRG"}],"standard_charges":[{"minimum":31307,"maximum":31307,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31307,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31307,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31307,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"minimum":31790,"maximum":91359,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76627,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":91359,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31790,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2241","type":"APR-DRG"}],"standard_charges":[{"minimum":10476,"maximum":10476,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10476,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10476,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10476,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2242","type":"APR-DRG"}],"standard_charges":[{"minimum":11543,"maximum":11543,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11543,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11543,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11543,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2243","type":"APR-DRG"}],"standard_charges":[{"minimum":16618,"maximum":16618,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16618,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16618,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16618,"methodology":"case rate"}]}]},{"description":"PERITONEAL ADHESIOLYSIS","code_information":[{"code":"2244","type":"APR-DRG"}],"standard_charges":[{"minimum":24395,"maximum":24395,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24395,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24395,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24395,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"minimum":25971,"maximum":65179,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54669,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65179,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25971,"methodology":"case rate"}]}]},{"description":"MANIPULATION OF SPINE","code_information":[{"code":"22505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"PERCUT VERTBRPLSTY CER/THORAC","code_information":[{"code":"22510","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8526.87,"maximum":8526.87,"gross_charge":10527,"discounted_cash":3116,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8526.87,"methodology":"fee schedule"}]}]},{"description":"PERCUT VERTBRPLSTY CER/THORAC","code_information":[{"code":"22510","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8526.87,"gross_charge":10527,"discounted_cash":3116,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2000.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2105.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2105.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PERCUT VERTBRPLSTY LUMBAR","code_information":[{"code":"22511","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8526.87,"maximum":8526.87,"gross_charge":10527,"discounted_cash":3116,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8526.87,"methodology":"fee schedule"}]}]},{"description":"PERCUT VERTBRPLSTY LUMBAR","code_information":[{"code":"22511","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8526.87,"gross_charge":10527,"discounted_cash":3116,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8526.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2000.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2105.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1579.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2105.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EA ADDL CER/THORA/LUMBAR BODY","code_information":[{"code":"22512","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4263.03,"maximum":4263.03,"gross_charge":5263,"discounted_cash":1557.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4263.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4263.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4263.03,"methodology":"fee schedule"}]}]},{"description":"EA ADDL CER/THORA/LUMBAR BODY","code_information":[{"code":"22512","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"gross_charge":5263,"discounted_cash":1557.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4263.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4263.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4263.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.6,"methodology":"fee schedule"}]}]},{"description":"HC PERC KYPHOPLASTY THOR 1 V","code_information":[{"code":"22513","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8730.18,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"}]}]},{"description":"HC PERC KYPHOPLASTY THOR 1 V","code_information":[{"code":"22513","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"gross_charge":10778,"discounted_cash":3190.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"KYPHOPLASTY THORACIC","code_information":[{"code":"22513","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8730.18,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"}]}]},{"description":"KYPHOPLASTY THORACIC","code_information":[{"code":"22513","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"gross_charge":10778,"discounted_cash":3190.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HC PERC KYPHOPLASTY LUMB 1 V","code_information":[{"code":"22514","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8730.18,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"}]}]},{"description":"HC PERC KYPHOPLASTY LUMB 1 V","code_information":[{"code":"22514","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"gross_charge":10778,"discounted_cash":3190.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"KYPHOPLASTY LUMBAR","code_information":[{"code":"22514","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8730.18,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"}]}]},{"description":"KYPHOPLASTY LUMBAR","code_information":[{"code":"22514","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"gross_charge":10778,"discounted_cash":3190.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HC PERC KYPHOPLASTY EA ADD VRT","code_information":[{"code":"22515","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8730.18,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"}]}]},{"description":"HC PERC KYPHOPLASTY EA ADD VRT","code_information":[{"code":"22515","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"}]}]},{"description":"KYPHO EA ADDL THORACIC/LUMBAR","code_information":[{"code":"22515","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8730.18,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"}]}]},{"description":"KYPHO EA ADDL THORACIC/LUMBAR","code_information":[{"code":"22515","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8730.18,"gross_charge":10778,"discounted_cash":3190.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8730.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2047.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.6,"methodology":"fee schedule"}]}]},{"description":"IDET SINGLE LEVEL","code_information":[{"code":"22526","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IDET 1 OR MORE LEVELS","code_information":[{"code":"22527","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAT THORAX SPINE FUSION","code_information":[{"code":"22532","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAT LUMBAR SPINE FUSION","code_information":[{"code":"22533","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAT THOR/LUMB ADDL SEG","code_information":[{"code":"22534","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NECK SPINE FUSION","code_information":[{"code":"22548","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NECK SPINE FUSEREMOV BEL C2","code_information":[{"code":"22551","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"ADDL NECK SPINE FUSION","code_information":[{"code":"22552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NECK SPINE FUSION","code_information":[{"code":"22554","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"THORAX SPINE FUSION","code_information":[{"code":"22556","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUMBAR SPINE FUSION","code_information":[{"code":"22558","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ADDITIONAL SPINAL FUSION","code_information":[{"code":"22585","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRESCRL FUSE W/ INSTR L5-S1","code_information":[{"code":"22586","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPINE  SKULL SPINAL FUSION","code_information":[{"code":"22590","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NECK SPINAL FUSION","code_information":[{"code":"22595","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"minimum":39048,"maximum":82488,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69187,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":82488,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39048,"methodology":"case rate"}]}]},{"description":"NECK SPINE FUSION","code_information":[{"code":"22600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2261","type":"APR-DRG"}],"standard_charges":[{"minimum":6397,"maximum":6397,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6397,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6397,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6397,"methodology":"case rate"}]}]},{"description":"THORAX SPINE FUSION","code_information":[{"code":"22610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUMBAR SPINE FUSION","code_information":[{"code":"22612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22614","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2262","type":"APR-DRG"}],"standard_charges":[{"minimum":8454,"maximum":8454,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8454,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8454,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8454,"methodology":"case rate"}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2263","type":"APR-DRG"}],"standard_charges":[{"minimum":11679,"maximum":11679,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11679,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11679,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11679,"methodology":"case rate"}]}]},{"description":"LUMBAR SPINE FUSION","code_information":[{"code":"22630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUMBAR SPINE FUSION COMBINED","code_information":[{"code":"22633","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"SPINE FUSION EXTRA SEGMENT","code_information":[{"code":"22634","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANAL PROCEDURES","code_information":[{"code":"2264","type":"APR-DRG"}],"standard_charges":[{"minimum":15592,"maximum":15592,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15592,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15592,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15592,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"minimum":30938,"maximum":64702,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54269,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64702,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30938,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2271","type":"APR-DRG"}],"standard_charges":[{"minimum":8196,"maximum":8196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2272","type":"APR-DRG"}],"standard_charges":[{"minimum":14404,"maximum":14404,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14404,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14404,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14404,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2273","type":"APR-DRG"}],"standard_charges":[{"minimum":17634,"maximum":17634,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17634,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17634,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17634,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL FEMORAL AND UMBILICAL","code_information":[{"code":"2274","type":"APR-DRG"}],"standard_charges":[{"minimum":25742,"maximum":25742,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25742,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25742,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25742,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITH MCC","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"minimum":28627,"maximum":122576,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44795,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42348,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28627,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":122576,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":114924,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60057.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53270,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63511,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53199,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":63218.69,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74007,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":45951,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45951,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33913,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35121.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37580,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36175.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36877.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37228.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":36877.57,"methodology":"case rate"}]}]},{"description":"POST FUSION </6 VERT SEG","code_information":[{"code":"22800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POST FUSION 7-12 VERT SEG","code_information":[{"code":"22802","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POST FUSION 13/> VERT SEG","code_information":[{"code":"22804","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANT FUSION 2-3 VERT SEG","code_information":[{"code":"22808","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2281","type":"APR-DRG"}],"standard_charges":[{"minimum":5057,"maximum":5057,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"}]}]},{"description":"ANT FUSION 4-7 VERT SEG","code_information":[{"code":"22810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANT FUSION 8/> VERT SEG","code_information":[{"code":"22812","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KYPHECTOMY 1-2 SEGMENTS","code_information":[{"code":"22818","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KYPHECTOMY 3 OR MORE","code_information":[{"code":"22819","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2282","type":"APR-DRG"}],"standard_charges":[{"minimum":8512,"maximum":8512,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8512,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8512,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8512,"methodology":"case rate"}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2283","type":"APR-DRG"}],"standard_charges":[{"minimum":11064,"maximum":11064,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11064,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11064,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11064,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF SPINAL FUSION","code_information":[{"code":"22830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INGUINAL FEMORAL AND UMBILICAL HERNIA PROCEDURES","code_information":[{"code":"2284","type":"APR-DRG"}],"standard_charges":[{"minimum":24049,"maximum":24049,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24049,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24049,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24049,"methodology":"case rate"}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22841","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22842","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22843","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22844","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22846","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT SPINE FIXATION DEVICE","code_information":[{"code":"22847","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT PELV FIXATION DEVICE","code_information":[{"code":"22848","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REINSERT SPINAL FIXATION","code_information":[{"code":"22849","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SPINE FIXATION DEVICE","code_information":[{"code":"22850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SPINE FIXATION DEVICE","code_information":[{"code":"22852","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSJ BIOMECHANICAL DEVICE","code_information":[{"code":"22853","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSJ BIOMECHANICAL DEVICE","code_information":[{"code":"22854","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SPINE FIXATION DEVICE","code_information":[{"code":"22855","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CERV ARTIFIC DISKECTOMY","code_information":[{"code":"22856","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"LUMBAR ARTIF DISKECTOMY","code_information":[{"code":"22857","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SECOND LEVEL CER DISKECTOMY","code_information":[{"code":"22858","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSJ BIOMECHANICAL DEVICE","code_information":[{"code":"22859","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE CERV ARTIFIC DISC","code_information":[{"code":"22861","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE LUMBAR ARTIF DISC","code_information":[{"code":"22862","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE CERV ARTIF DISC","code_information":[{"code":"22864","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE LUMB ARTIF DISC","code_information":[{"code":"22865","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSJ STABLJ DEV W/DCMPRN","code_information":[{"code":"22867","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"INSJ STABLJ DEV W/DCMPRN","code_information":[{"code":"22868","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSJ STABLJ DEV W/O DCMPRN","code_information":[{"code":"22869","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"INSJ STABLJ DEV W/O DCMPRN","code_information":[{"code":"22870","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPINE SURGERY PROCEDURE","code_information":[{"code":"22899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"minimum":18064,"maximum":80682,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26397,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18064,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":80682,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75645,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39438.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35679,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42539,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33570,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41514.43,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46132,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28643,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28643,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21699,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23063.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24678.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23755.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24216.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24447.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24216.75,"methodology":"case rate"}]}]},{"description":"EXC ABDL TUM DEEP < 5 CM","code_information":[{"code":"22900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC ABDL TUM DEEP 5 CM/>","code_information":[{"code":"22901","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC ABD LES SC < 3 CM","code_information":[{"code":"22902","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC ABD LES SC 3 CM/>","code_information":[{"code":"22903","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RADICAL RESECT ABD TUMOR<5CM","code_information":[{"code":"22904","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RAD RESECT ABD TUMOR 5 CM/>","code_information":[{"code":"22905","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2291","type":"APR-DRG"}],"standard_charges":[{"minimum":10527,"maximum":10527,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10527,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10527,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10527,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2292","type":"APR-DRG"}],"standard_charges":[{"minimum":11014,"maximum":11014,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11014,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11014,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11014,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2293","type":"APR-DRG"}],"standard_charges":[{"minimum":18469,"maximum":18469,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18469,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18469,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18469,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES","code_information":[{"code":"2294","type":"APR-DRG"}],"standard_charges":[{"minimum":26040,"maximum":26040,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26040,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26040,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26040,"methodology":"case rate"}]}]},{"description":"ABDOMEN SURGERY PROCEDURE","code_information":[{"code":"22999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"minimum":5573,"maximum":8182,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"}]}]},{"description":"REMOVAL OF CALCIUM DEPOSITS","code_information":[{"code":"23000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2301","type":"APR-DRG"}],"standard_charges":[{"minimum":13449,"maximum":13449,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13449,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13449,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13449,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2302","type":"APR-DRG"}],"standard_charges":[{"minimum":16531,"maximum":16531,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16531,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16531,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16531,"methodology":"case rate"}]}]},{"description":"RELEASE SHOULDER JOINT","code_information":[{"code":"23020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2303","type":"APR-DRG"}],"standard_charges":[{"minimum":27067,"maximum":27067,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27067,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27067,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27067,"methodology":"case rate"}]}]},{"description":"DRAIN SHOULDER LESION","code_information":[{"code":"23030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAIN SHOULDER BURSA","code_information":[{"code":"23031","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAIN SHOULDER BONE LESION","code_information":[{"code":"23035","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL BOWEL PROCEDURES","code_information":[{"code":"2304","type":"APR-DRG"}],"standard_charges":[{"minimum":40373,"maximum":40373,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40373,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40373,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40373,"methodology":"case rate"}]}]},{"description":"EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"23040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORATORY SHOULDER SURGERY","code_information":[{"code":"23044","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"BIOPSY SHOULDER TISSUES","code_information":[{"code":"23065","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BIOPSY SHOULDER TISSUES","code_information":[{"code":"23066","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER LES SC 3 CM/>","code_information":[{"code":"23071","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER TUM DEEP 5 CM/>","code_information":[{"code":"23073","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER LES SC < 3 CM","code_information":[{"code":"23075","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC SHOULDER TUM DEEP < 5 CM","code_information":[{"code":"23076","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT SHOULDER TUMOR < 5 CM","code_information":[{"code":"23077","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT SHOULDER TUMOR 5 CM/>","code_information":[{"code":"23078","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH PTCA WITH MCC","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"minimum":39106,"maximum":125846,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76172,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":72011,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":46105,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":101666,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":95319,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":98402.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":90722,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":108163,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85680,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":103581.45,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":78138,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78138,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39106,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":57545.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":61573.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":59271.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":60422.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":60997.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":60422.52,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SHOULDER JOINT","code_information":[{"code":"23100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHOULDER JOINT SURGERY","code_information":[{"code":"23101","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER JOINT LINING","code_information":[{"code":"23105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF COLLARBONE JOINT","code_information":[{"code":"23106","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORE TREAT SHOULDER JOINT","code_information":[{"code":"23107","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2311","type":"APR-DRG"}],"standard_charges":[{"minimum":12056,"maximum":12056,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12056,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12056,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12056,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2312","type":"APR-DRG"}],"standard_charges":[{"minimum":15834,"maximum":15834,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15834,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15834,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15834,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL COLLAR BONE","code_information":[{"code":"23120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF COLLAR BONE","code_information":[{"code":"23125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2313","type":"APR-DRG"}],"standard_charges":[{"minimum":19664,"maximum":19664,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19664,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19664,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19664,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER BONE PART","code_information":[{"code":"23130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR LARGE BOWEL PROCEDURES","code_information":[{"code":"2314","type":"APR-DRG"}],"standard_charges":[{"minimum":37677,"maximum":37677,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37677,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37677,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37677,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BONE LESION","code_information":[{"code":"23146","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23155","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HUMERUS LESION","code_information":[{"code":"23156","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE COLLAR BONE LESION","code_information":[{"code":"23170","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER BLADE LESION","code_information":[{"code":"23172","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"23174","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE COLLAR BONE LESION","code_information":[{"code":"23180","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER BLADE LESION","code_information":[{"code":"23182","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"23184","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF SCAPULA","code_information":[{"code":"23190","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEAD OF HUMERUS","code_information":[{"code":"23195","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH PTCA WITHOUT MCC","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"minimum":33069,"maximum":90721,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54911,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51912,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33796,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76455,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71682,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":72420.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63317,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75489,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62805,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":76232,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90721,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":56328,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56328,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33069,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42351.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45315.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43621.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44468.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44892.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44468.67,"methodology":"case rate"}]}]},{"description":"RESECT CLAVICLE TUMOR","code_information":[{"code":"23200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2321","type":"APR-DRG"}],"standard_charges":[{"minimum":5652,"maximum":5652,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5652,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5652,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5652,"methodology":"case rate"}]}]},{"description":"RESECT SCAPULA TUMOR","code_information":[{"code":"23210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2322","type":"APR-DRG"}],"standard_charges":[{"minimum":10456,"maximum":10456,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10456,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10456,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10456,"methodology":"case rate"}]}]},{"description":"RESECT PROX HUMERUS TUMOR","code_information":[{"code":"23220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2323","type":"APR-DRG"}],"standard_charges":[{"minimum":13821,"maximum":13821,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13821,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13821,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13821,"methodology":"case rate"}]}]},{"description":"GASTRIC FUNDOPLICATION","code_information":[{"code":"2324","type":"APR-DRG"}],"standard_charges":[{"minimum":30330,"maximum":30330,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30330,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30330,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30330,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"minimum":38685,"maximum":116082,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70261,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":66424,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44312,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":87319,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81868,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":91179.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":83715,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99809,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":82348,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":95978.6,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116082,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":72075,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72075,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38685,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53321.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":57053.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54921.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55987.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":56520.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":55987.52,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2331","type":"APR-DRG"}],"standard_charges":[{"minimum":9498,"maximum":9498,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9498,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9498,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9498,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2332","type":"APR-DRG"}],"standard_charges":[{"minimum":11362,"maximum":11362,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11362,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11362,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11362,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2333","type":"APR-DRG"}],"standard_charges":[{"minimum":13306,"maximum":13306,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13306,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13306,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13306,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER FOREIGN BODY","code_information":[{"code":"23330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVE SHOULDER FB DEEP","code_information":[{"code":"23333","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"SHOULDER PROSTHESIS REMOVAL","code_information":[{"code":"23334","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"SHOULDER PROSTHESIS REMOVAL","code_information":[{"code":"23335","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2334","type":"APR-DRG"}],"standard_charges":[{"minimum":21427,"maximum":21427,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21427,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21427,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21427,"methodology":"case rate"}]}]},{"description":"HC INJECTION FOR SHOULDER ARTH","code_information":[{"code":"23350","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":747.63,"maximum":747.63,"gross_charge":923,"discounted_cash":273.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":747.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":747.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":747.63,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION FOR SHOULDER ARTH","code_information":[{"code":"23350","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":923,"discounted_cash":273.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":747.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":747.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":747.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":443.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":516.88,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":646.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.6,"methodology":"fee schedule"}]}]},{"description":"MUSCLE TRANSFER SHOULDER/ARM","code_information":[{"code":"23395","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"MUSCLE TRANSFERS","code_information":[{"code":"23397","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"minimum":26883,"maximum":79011,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47823,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":45211,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29531,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59194,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55499,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":63758.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56059,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66836,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54879,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":67114.35,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79011,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49058,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49058,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26883,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37285.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39895.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38404.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39150.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":39522.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39150.04,"methodology":"case rate"}]}]},{"description":"FIXATION OF SHOULDER BLADE","code_information":[{"code":"23400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF TENDON  MUSCLE","code_information":[{"code":"23405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISE TENDON(S)  MUSCLE(S)","code_information":[{"code":"23406","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2341","type":"APR-DRG"}],"standard_charges":[{"minimum":5429,"maximum":5429,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5429,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5429,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5429,"methodology":"case rate"}]}]},{"description":"REPAIR ROTATOR CUFF ACUTE","code_information":[{"code":"23410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR ROTATOR CUFF CHRONIC","code_information":[{"code":"23412","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RELEASE OF SHOULDER LIGAMENT","code_information":[{"code":"23415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2342","type":"APR-DRG"}],"standard_charges":[{"minimum":6711,"maximum":6711,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6711,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6711,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6711,"methodology":"case rate"}]}]},{"description":"REPAIR OF SHOULDER","code_information":[{"code":"23420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2343","type":"APR-DRG"}],"standard_charges":[{"minimum":11094,"maximum":11094,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11094,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11094,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11094,"methodology":"case rate"}]}]},{"description":"REPAIR BICEPS TENDON","code_information":[{"code":"23430","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS","code_information":[{"code":"2344","type":"APR-DRG"}],"standard_charges":[{"minimum":19750,"maximum":19750,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19750,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19750,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19750,"methodology":"case rate"}]}]},{"description":"REMOVE/TRANSPLANT TENDON","code_information":[{"code":"23440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23455","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23460","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23462","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23465","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR SHOULDER CAPSULE","code_information":[{"code":"23466","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT SHOULDER JOINT","code_information":[{"code":"23470","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT SHOULDER JOINT","code_information":[{"code":"23472","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"REVIS RECONST SHOULDER JOINT","code_information":[{"code":"23473","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVIS RECONST SHOULDER JOINT","code_information":[{"code":"23474","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF COLLAR BONE","code_information":[{"code":"23480","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF COLLAR BONE","code_information":[{"code":"23485","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REINFORCE CLAVICLE","code_information":[{"code":"23490","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REINFORCE SHOULDER BONES","code_information":[{"code":"23491","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"minimum":31908,"maximum":87387,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52893,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":50004,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33410,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":80168,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75163,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":69954.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64746,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":77193,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62087,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":73636.04,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87387,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":54258,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":54258,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31908,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":40908.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":43772.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42136.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":42954.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":43363.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":42954.36,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE FRACTURE","code_information":[{"code":"23515","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23525","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23532","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT CLAVICLE DISLOCATION","code_information":[{"code":"23552","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT SHOULDER BLADE FX","code_information":[{"code":"23570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT SHOULDER BLADE FX","code_information":[{"code":"23575","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT SCAPULA FRACTURE","code_information":[{"code":"23585","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"minimum":22959,"maximum":61069,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36964,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":34945,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22959,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53597,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50251,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50487.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44083,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52558,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42667,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":53144.77,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61069,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37918,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37918,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23111,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29524.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31591.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30410.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31001.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31296.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31001.12,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CLOSE TX PROX HUM FX W/MANIP","code_information":[{"code":"23605","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4346.46,"maximum":4346.46,"gross_charge":5366,"discounted_cash":1588.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4346.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4346.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4346.46,"methodology":"fee schedule"}]}]},{"description":"CLOSE TX PROX HUM FX W/MANIP","code_information":[{"code":"23605","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4346.46,"gross_charge":5366,"discounted_cash":1588.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4346.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4346.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4346.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23615","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23616","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23625","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"23630","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HC CL TX SHLDR DISL WO ANES","code_information":[{"code":"23650","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":660.15,"maximum":660.15,"gross_charge":815,"discounted_cash":241.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":660.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":660.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":660.15,"methodology":"fee schedule"}]}]},{"description":"HC CL TX SHLDR DISL WO ANES","code_information":[{"code":"23650","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"gross_charge":815,"discounted_cash":241.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":660.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":660.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":660.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":163,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":163,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT SHOULDER DISLOCATION","code_information":[{"code":"23655","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT SHOULDER DISLOCATION","code_information":[{"code":"23660","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HC CL TX SHLDR DISLOC & FX GT W MAN","code_information":[{"code":"23665","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1082.16,"maximum":1082.16,"gross_charge":1336,"discounted_cash":395.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1082.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1082.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1082.16,"methodology":"fee schedule"}]}]},{"description":"HC CL TX SHLDR DISLOC & FX GT W MAN","code_information":[{"code":"23665","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"gross_charge":1336,"discounted_cash":395.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1082.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1082.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1082.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23670","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23675","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT DISLOCATION/FRACTURE","code_information":[{"code":"23680","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"minimum":5573,"maximum":8182,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"}]}]},{"description":"HC MANIP/FIX OF SHOULDER/W ANES","code_information":[{"code":"23700","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":4337.55,"maximum":4337.55,"gross_charge":5355,"discounted_cash":1585.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4337.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4337.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4337.55,"methodology":"fee schedule"}]}]},{"description":"HC MANIP/FIX OF SHOULDER/W ANES","code_information":[{"code":"23700","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4337.55,"gross_charge":5355,"discounted_cash":1585.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4337.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4337.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4337.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"minimum":5573,"maximum":8182,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"}]}]},{"description":"FUSION OF SHOULDER JOINT","code_information":[{"code":"23800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF SHOULDER JOINT","code_information":[{"code":"23802","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"minimum":27309,"maximum":117066,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45277,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42804,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27309,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":117066,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":109758,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60646.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50263,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59926,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50750,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":63838.48,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74803,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46445,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32919,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35465.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37948.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36529.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37239.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37593.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37239.12,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF ARM  GIRDLE","code_information":[{"code":"23900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION AT SHOULDER JOINT","code_information":[{"code":"23920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"23921","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"SHOULDER SURGERY PROCEDURE","code_information":[{"code":"23929","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF ARM LESION","code_information":[{"code":"23930","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF ARM BURSA","code_information":[{"code":"23931","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"DRAIN ARM/ELBOW BONE LESION","code_information":[{"code":"23935","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"minimum":15960,"maximum":50189,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26178,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24748,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15960,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50189,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47055,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37306.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29338,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34978,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29660,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39269.99,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43249,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26853,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26853,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15968,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21816.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23343.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22471.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22907.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23125.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22907.5,"methodology":"case rate"}]}]},{"description":"EXPLORATORY ELBOW SURGERY","code_information":[{"code":"24000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE ELBOW JOINT","code_information":[{"code":"24006","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2401","type":"APR-DRG"}],"standard_charges":[{"minimum":5572,"maximum":5572,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5572,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5572,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5572,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2402","type":"APR-DRG"}],"standard_charges":[{"minimum":7953,"maximum":7953,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7953,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7953,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7953,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2403","type":"APR-DRG"}],"standard_charges":[{"minimum":13584,"maximum":13584,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13584,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13584,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13584,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY","code_information":[{"code":"2404","type":"APR-DRG"}],"standard_charges":[{"minimum":13584,"maximum":13584,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13584,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13584,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13584,"methodology":"case rate"}]}]},{"description":"BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"24065","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BIOPSY ARM/ELBOW SOFT TISSUE","code_information":[{"code":"24066","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC ARM/ELBOW LES SC 3 CM/>","code_information":[{"code":"24071","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EX ARM/ELBOW TUM DEEP 5 CM/>","code_information":[{"code":"24073","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC ARM/ELBOW LES SC < 3 CM","code_information":[{"code":"24075","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EX ARM/ELBOW TUM DEEP < 5 CM","code_information":[{"code":"24076","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT ARM/ELBOW TUM < 5 CM","code_information":[{"code":"24077","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT ARM/ELBOW TUM 5 CM/>","code_information":[{"code":"24079","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"minimum":6722,"maximum":41360,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13572,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12831,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7920,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41360,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38778,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21902.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16742,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19961,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14718,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23054.82,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22424,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13923,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6722,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12808.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13704.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13192.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13448.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13576.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13448.65,"methodology":"case rate"}]}]},{"description":"BIOPSY ELBOW JOINT LINING","code_information":[{"code":"24100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT ELBOW JOINT","code_information":[{"code":"24101","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW JOINT LINING","code_information":[{"code":"24102","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ELBOW BURSA","code_information":[{"code":"24105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2411","type":"APR-DRG"}],"standard_charges":[{"minimum":4760,"maximum":4760,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4760,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4760,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4760,"methodology":"case rate"}]}]},{"description":"REMOVE HUMERUS LESION","code_information":[{"code":"24110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24116","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2412","type":"APR-DRG"}],"standard_charges":[{"minimum":6246,"maximum":6246,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6246,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6246,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6246,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW LESION","code_information":[{"code":"24120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"24126","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2413","type":"APR-DRG"}],"standard_charges":[{"minimum":9258,"maximum":9258,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9258,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9258,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9258,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEAD OF RADIUS","code_information":[{"code":"24130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARM BONE LESION","code_information":[{"code":"24134","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE RADIUS BONE LESION","code_information":[{"code":"24136","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW BONE LESION","code_information":[{"code":"24138","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PEPTIC ULCER AND GASTRITIS","code_information":[{"code":"2414","type":"APR-DRG"}],"standard_charges":[{"minimum":13862,"maximum":13862,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13862,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13862,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13862,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ARM BONE","code_information":[{"code":"24140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"24145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ELBOW","code_information":[{"code":"24147","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RADICAL RESECTION OF ELBOW","code_information":[{"code":"24149","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RESECT DISTAL HUMERUS TUMOR","code_information":[{"code":"24150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RESECT RADIUS TUMOR","code_information":[{"code":"24152","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ELBOW JOINT","code_information":[{"code":"24155","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE ELBOW JOINT IMPLANT","code_information":[{"code":"24160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE RADIUS HEAD IMPLANT","code_information":[{"code":"24164","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"minimum":19630,"maximum":84016,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30491,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28825,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19630,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84016,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":78771,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42577.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37545,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44763,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36479,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":44818.06,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50375,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31278,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31278,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25276,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24898.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26641.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25645.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26143.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26392.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26143.87,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARM FOREIGN BODY","code_information":[{"code":"24200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARM FOREIGN BODY","code_information":[{"code":"24201","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2421","type":"APR-DRG"}],"standard_charges":[{"minimum":3714,"maximum":3714,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3714,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3714,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3714,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2422","type":"APR-DRG"}],"standard_charges":[{"minimum":5844,"maximum":5844,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5844,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5844,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5844,"methodology":"case rate"}]}]},{"description":"HC INJECTION FOR ELBOW XRAY","code_information":[{"code":"24220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":538.65,"maximum":538.65,"gross_charge":665,"discounted_cash":196.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.65,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION FOR ELBOW XRAY","code_information":[{"code":"24220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":665,"discounted_cash":196.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":319.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":372.4,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2423","type":"APR-DRG"}],"standard_charges":[{"minimum":11030,"maximum":11030,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11030,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11030,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11030,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS","code_information":[{"code":"2424","type":"APR-DRG"}],"standard_charges":[{"minimum":14716,"maximum":14716,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14716,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14716,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14716,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"minimum":12940,"maximum":68642,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20250,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19144,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12940,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68642,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64356,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30062.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25336,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30207,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24047,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31645.17,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33456,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20773,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20773,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16224,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17580.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18811.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18108.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18459.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18635.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18459.69,"methodology":"case rate"}]}]},{"description":"MANIPULATE ELBOW W/ANESTH","code_information":[{"code":"24300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"MUSCLE/TENDON TRANSFER","code_information":[{"code":"24301","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ARM TENDON LENGTHENING","code_information":[{"code":"24305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2431","type":"APR-DRG"}],"standard_charges":[{"minimum":3204,"maximum":3204,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM TENDON","code_information":[{"code":"24310","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2432","type":"APR-DRG"}],"standard_charges":[{"minimum":5769,"maximum":5769,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5769,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5769,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5769,"methodology":"case rate"}]}]},{"description":"REPAIR OF ARM TENDON","code_information":[{"code":"24320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2433","type":"APR-DRG"}],"standard_charges":[{"minimum":8950,"maximum":8950,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8950,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8950,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8950,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM MUSCLES","code_information":[{"code":"24330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM MUSCLES","code_information":[{"code":"24331","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TENOLYSIS TRICEPS","code_information":[{"code":"24332","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER ESOPHAGEAL DISORDERS","code_information":[{"code":"2434","type":"APR-DRG"}],"standard_charges":[{"minimum":14955,"maximum":14955,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14955,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14955,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14955,"methodology":"case rate"}]}]},{"description":"REPAIR OF BICEPS TENDON","code_information":[{"code":"24340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR ARM TENDON/MUSCLE","code_information":[{"code":"24341","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF RUPTURED TENDON","code_information":[{"code":"24342","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPR ELBOW LAT LIGMNT W/TISS","code_information":[{"code":"24343","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW LAT LIGMNT","code_information":[{"code":"24344","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPR ELBW MED LIGMNT W/TISSU","code_information":[{"code":"24345","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW MED LIGMNT","code_information":[{"code":"24346","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REPAIR ELBOW PERC","code_information":[{"code":"24357","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR ELBOW W/DEB OPEN","code_information":[{"code":"24358","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR ELBOW DEB/ATTCH OPEN","code_information":[{"code":"24359","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24361","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ELBOW JOINT","code_information":[{"code":"24362","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REPLACE ELBOW JOINT","code_information":[{"code":"24363","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT HEAD OF RADIUS","code_information":[{"code":"24365","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT HEAD OF RADIUS","code_information":[{"code":"24366","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISE RECONST ELBOW JOINT","code_information":[{"code":"24370","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISE RECONST ELBOW JOINT","code_information":[{"code":"24371","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"minimum":10394,"maximum":45358,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16222,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15336,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10394,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45358,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42526,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25140.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20549,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24499,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19316,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26463.68,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26802,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16641,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16641,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12573,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14702.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15731.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15143.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15437.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15584.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15437.15,"methodology":"case rate"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2441","type":"APR-DRG"}],"standard_charges":[{"minimum":4329,"maximum":4329,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4329,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4329,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4329,"methodology":"case rate"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2442","type":"APR-DRG"}],"standard_charges":[{"minimum":5748,"maximum":5748,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5748,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5748,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5748,"methodology":"case rate"}]}]},{"description":"REVISION OF HUMERUS","code_information":[{"code":"24420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2443","type":"APR-DRG"}],"standard_charges":[{"minimum":10139,"maximum":10139,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10139,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10139,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10139,"methodology":"case rate"}]}]},{"description":"REPAIR OF HUMERUS","code_information":[{"code":"24430","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REPAIR HUMERUS WITH GRAFT","code_information":[{"code":"24435","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"DIVERTICULITIS AND DIVERTICULOSIS","code_information":[{"code":"2444","type":"APR-DRG"}],"standard_charges":[{"minimum":12743,"maximum":12743,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12743,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12743,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12743,"methodology":"case rate"}]}]},{"description":"REVISION OF ELBOW JOINT","code_information":[{"code":"24470","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC DECOMP FAS; FOREARM W/ BRACH ART","code_information":[{"code":"24495","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":19109.52,"maximum":19109.52,"gross_charge":23592,"discounted_cash":6983.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19109.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19109.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19109.52,"methodology":"fee schedule"}]}]},{"description":"HC DECOMP FAS; FOREARM W/ BRACH ART","code_information":[{"code":"24495","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19109.52,"gross_charge":23592,"discounted_cash":6983.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19109.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19109.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19109.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4482.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4718.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3538.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4718.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REINFORCE HUMERUS","code_information":[{"code":"24498","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"AICD GENERATOR PROCEDURES","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"minimum":25744,"maximum":76003,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43927,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":41528,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25744,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76003,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71259,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":58997.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52705,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62837,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47843,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":62102.83,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72574,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":45061,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45061,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29435,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":34501.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36916.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":35536.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36226.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36571.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":36226.65,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2451","type":"APR-DRG"}],"standard_charges":[{"minimum":5074,"maximum":5074,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5074,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5074,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5074,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24515","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24516","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2452","type":"APR-DRG"}],"standard_charges":[{"minimum":7037,"maximum":7037,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7037,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7037,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7037,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2453","type":"APR-DRG"}],"standard_charges":[{"minimum":9529,"maximum":9529,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9529,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9529,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9529,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24538","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE","code_information":[{"code":"2454","type":"APR-DRG"}],"standard_charges":[{"minimum":12453,"maximum":12453,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12453,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12453,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12453,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24546","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24565","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24566","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24575","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24576","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24577","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24579","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT HUMERUS FRACTURE","code_information":[{"code":"24582","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24586","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24587","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"minimum":18130,"maximum":38602,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32377,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38602,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18130,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2461","type":"APR-DRG"}],"standard_charges":[{"minimum":4361,"maximum":4361,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4361,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4361,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4361,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24615","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2462","type":"APR-DRG"}],"standard_charges":[{"minimum":5136,"maximum":5136,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5136,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5136,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5136,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2463","type":"APR-DRG"}],"standard_charges":[{"minimum":6698,"maximum":6698,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6698,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6698,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6698,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW FRACTURE","code_information":[{"code":"24635","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL VASCULAR INSUFFICIENCY","code_information":[{"code":"2464","type":"APR-DRG"}],"standard_charges":[{"minimum":9808,"maximum":9808,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9808,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9808,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9808,"methodology":"case rate"}]}]},{"description":"TREAT ELBOW DISLOCATION","code_information":[{"code":"24640","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24655","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT RADIUS FRACTURE","code_information":[{"code":"24666","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24670","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24675","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT ULNAR FRACTURE","code_information":[{"code":"24685","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"minimum":13215,"maximum":24608,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20640,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24608,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13215,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2471","type":"APR-DRG"}],"standard_charges":[{"minimum":3020,"maximum":3020,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3020,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3020,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3020,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2472","type":"APR-DRG"}],"standard_charges":[{"minimum":5052,"maximum":5052,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5052,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5052,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5052,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2473","type":"APR-DRG"}],"standard_charges":[{"minimum":9051,"maximum":9051,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9051,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9051,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9051,"methodology":"case rate"}]}]},{"description":"INTESTINAL OBSTRUCTION","code_information":[{"code":"2474","type":"APR-DRG"}],"standard_charges":[{"minimum":11487,"maximum":11487,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11487,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11487,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11487,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"minimum":17654,"maximum":38787,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32533,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38787,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17654,"methodology":"case rate"}]}]},{"description":"FUSION OF ELBOW JOINT","code_information":[{"code":"24800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION/GRAFT OF ELBOW JOINT","code_information":[{"code":"24802","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2481","type":"APR-DRG"}],"standard_charges":[{"minimum":4724,"maximum":4724,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4724,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4724,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4724,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2482","type":"APR-DRG"}],"standard_charges":[{"minimum":7145,"maximum":7145,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7145,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7145,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7145,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2483","type":"APR-DRG"}],"standard_charges":[{"minimum":12855,"maximum":12855,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12855,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12855,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12855,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL AND PERITONEAL INFECTIONS","code_information":[{"code":"2484","type":"APR-DRG"}],"standard_charges":[{"minimum":14191,"maximum":14191,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14191,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14191,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14191,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"minimum":12202,"maximum":23412,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19637,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23412,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12202,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF UPPER ARM","code_information":[{"code":"24900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2491","type":"APR-DRG"}],"standard_charges":[{"minimum":3207,"maximum":3207,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3207,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3207,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3207,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2492","type":"APR-DRG"}],"standard_charges":[{"minimum":4327,"maximum":4327,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4327,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4327,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4327,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF UPPER ARM","code_information":[{"code":"24920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"24925","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2493","type":"APR-DRG"}],"standard_charges":[{"minimum":9361,"maximum":9361,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9361,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9361,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9361,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"24930","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATE UPPER ARM  IMPLANT","code_information":[{"code":"24931","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF AMPUTATION","code_information":[{"code":"24935","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER GASTROENTERITIS NAUSEA AND VOMITING","code_information":[{"code":"2494","type":"APR-DRG"}],"standard_charges":[{"minimum":10574,"maximum":10574,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10574,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10574,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10574,"methodology":"case rate"}]}]},{"description":"REVISION OF UPPER ARM","code_information":[{"code":"24940","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UPPER ARM/ELBOW SURGERY","code_information":[{"code":"24999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"minimum":13356,"maximum":80195,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20788,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19652,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13356,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":80195,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75188,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30719.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26155,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31183,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24820,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32336.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21324,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21324,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14489,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17964.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19222.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18503.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18863.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19042.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18863.06,"methodology":"case rate"}]}]},{"description":"INCISION OF TENDON SHEATH","code_information":[{"code":"25000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISE FLEXOR CARPI RADIALIS","code_information":[{"code":"25001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 1 SPACE","code_information":[{"code":"25020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 1 SPACE","code_information":[{"code":"25023","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 2 SPACES","code_information":[{"code":"25024","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FOREARM 2 SPACES","code_information":[{"code":"25025","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF FOREARM LESION","code_information":[{"code":"25028","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF FOREARM BURSA","code_information":[{"code":"25031","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT FOREARM BONE LESION","code_information":[{"code":"25035","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT WRIST JOINT","code_information":[{"code":"25040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"BIOPSY FOREARM SOFT TISSUES","code_information":[{"code":"25065","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BIOPSY FOREARM SOFT TISSUES","code_information":[{"code":"25066","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC FOREARM LES SC 3 CM/>","code_information":[{"code":"25071","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC FOREARM TUM DEEP 3 CM/>","code_information":[{"code":"25073","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC FOREARM LES SC < 3 CM","code_information":[{"code":"25075","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC FOREARM TUM DEEP < 3 CM","code_information":[{"code":"25076","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"RESECT FOREARM/WRIST TUM<3CM","code_information":[{"code":"25077","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT FORARM/WRIST TUM 3CM>","code_information":[{"code":"25078","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"INCISION OF WRIST CAPSULE","code_information":[{"code":"25085","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"minimum":8865,"maximum":42981,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14046,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13279,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9016,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42981,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40297,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22481,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17568,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20945,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16754,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23664.21,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23206,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14409,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14409,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8865,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13146.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14067.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13541.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13804.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13935.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13804.12,"methodology":"case rate"}]}]},{"description":"BIOPSY OF WRIST JOINT","code_information":[{"code":"25100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT WRIST JOINT","code_information":[{"code":"25101","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST JOINT LINING","code_information":[{"code":"25105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST JOINT CARTILAGE","code_information":[{"code":"25107","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXCISE TENDON FOREARM/WRIST","code_information":[{"code":"25109","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2511","type":"APR-DRG"}],"standard_charges":[{"minimum":3466,"maximum":3466,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3466,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3466,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3466,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST TENDON LESION","code_information":[{"code":"25110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST TENDON LESION","code_information":[{"code":"25111","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REREMOVE WRIST TENDON LESION","code_information":[{"code":"25112","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST/FOREARM LESION","code_information":[{"code":"25115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST/FOREARM LESION","code_information":[{"code":"25116","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXCISE WRIST TENDON SHEATH","code_information":[{"code":"25118","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25119","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2512","type":"APR-DRG"}],"standard_charges":[{"minimum":4655,"maximum":4655,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREARM LESION","code_information":[{"code":"25120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOREARM LESION","code_information":[{"code":"25125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOREARM LESION","code_information":[{"code":"25126","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2513","type":"APR-DRG"}],"standard_charges":[{"minimum":6035,"maximum":6035,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6035,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6035,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6035,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST LESION","code_information":[{"code":"25130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE  GRAFT WRIST LESION","code_information":[{"code":"25135","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE  GRAFT WRIST LESION","code_information":[{"code":"25136","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ABDOMINAL PAIN","code_information":[{"code":"2514","type":"APR-DRG"}],"standard_charges":[{"minimum":10036,"maximum":10036,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10036,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10036,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10036,"methodology":"case rate"}]}]},{"description":"REMOVE FOREARM BONE LESION","code_information":[{"code":"25145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"25151","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT RADIUS/ULNAR TUMOR","code_information":[{"code":"25170","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITH MCC","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"minimum":19054,"maximum":73958,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30836,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29152,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19054,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73958,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":69341,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42998.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36138,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43085,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35409,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45262.08,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50945,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31632,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31632,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20200,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25145.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26905.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25899.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26402.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26654.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26402.88,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2521","type":"APR-DRG"}],"standard_charges":[{"minimum":5006,"maximum":5006,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5006,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5006,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5006,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST BONE","code_information":[{"code":"25210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST BONES","code_information":[{"code":"25215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2522","type":"APR-DRG"}],"standard_charges":[{"minimum":7874,"maximum":7874,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7874,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7874,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7874,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2523","type":"APR-DRG"}],"standard_charges":[{"minimum":10783,"maximum":10783,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10783,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10783,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10783,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF RADIUS","code_information":[{"code":"25230","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION AND COMPLICATION OF GASTROINTESTINAL DEVICE OR PROCEDURE","code_information":[{"code":"2524","type":"APR-DRG"}],"standard_charges":[{"minimum":14158,"maximum":14158,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14158,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14158,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14158,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF ULNA","code_information":[{"code":"25240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC INJ FOR WRIST X-RAY","code_information":[{"code":"25246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":620.46,"maximum":620.46,"gross_charge":766,"discounted_cash":226.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":620.46,"methodology":"fee schedule"}]}]},{"description":"HC INJ FOR WRIST X-RAY","code_information":[{"code":"25246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":766,"discounted_cash":226.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":367.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":428.96,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":536.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.2,"methodology":"fee schedule"}]}]},{"description":"REMOVE FOREARM FOREIGN BODY","code_information":[{"code":"25248","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST PROSTHESIS","code_information":[{"code":"25250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF WRIST PROSTHESIS","code_information":[{"code":"25251","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MANIPULATE WRIST W/ANESTHES","code_information":[{"code":"25259","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25263","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25265","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25272","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON/MUSCLE","code_information":[{"code":"25274","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FOREARM TENDON SHEATH","code_information":[{"code":"25275","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE WRIST/FOREARM TENDON","code_information":[{"code":"25280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISE WRIST/FOREARM TENDON","code_information":[{"code":"25290","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE WRIST/FOREARM TENDON","code_information":[{"code":"25295","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITH CC","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"minimum":14494,"maximum":42393,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22949,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21695,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14494,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42393,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39747,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33360.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28903,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34460,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26935,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35116.47,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37915,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23541,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23541,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17095,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19509.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20874.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20094.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20484.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20679.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20484.61,"methodology":"case rate"}]}]},{"description":"FUSION OF TENDONS AT WRIST","code_information":[{"code":"25300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF TENDONS AT WRIST","code_information":[{"code":"25301","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2531","type":"APR-DRG"}],"standard_charges":[{"minimum":4633,"maximum":4633,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4633,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4633,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4633,"methodology":"case rate"}]}]},{"description":"TRANSPLANT FOREARM TENDON","code_information":[{"code":"25310","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSPLANT FOREARM TENDON","code_information":[{"code":"25312","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE PALSY HAND TENDON(S)","code_information":[{"code":"25315","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE PALSY HAND TENDON(S)","code_information":[{"code":"25316","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2532","type":"APR-DRG"}],"standard_charges":[{"minimum":6134,"maximum":6134,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6134,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6134,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6134,"methodology":"case rate"}]}]},{"description":"REPAIR/REVISE WRIST JOINT","code_information":[{"code":"25320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2533","type":"APR-DRG"}],"standard_charges":[{"minimum":9955,"maximum":9955,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9955,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9955,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9955,"methodology":"case rate"}]}]},{"description":"REVISE WRIST JOINT","code_information":[{"code":"25332","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REALIGNMENT OF HAND","code_information":[{"code":"25335","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ULNA/RADIOULNAR","code_information":[{"code":"25337","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE","code_information":[{"code":"2534","type":"APR-DRG"}],"standard_charges":[{"minimum":12278,"maximum":12278,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12278,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12278,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12278,"methodology":"case rate"}]}]},{"description":"REVISION OF RADIUS","code_information":[{"code":"25350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF RADIUS","code_information":[{"code":"25355","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF ULNA","code_information":[{"code":"25360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE RADIUS  ULNA","code_information":[{"code":"25365","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISE RADIUS OR ULNA","code_information":[{"code":"25370","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE RADIUS  ULNA","code_information":[{"code":"25375","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHORTEN RADIUS OR ULNA","code_information":[{"code":"25390","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LENGTHEN RADIUS OR ULNA","code_information":[{"code":"25391","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"SHORTEN RADIUS  ULNA","code_information":[{"code":"25392","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LENGTHEN RADIUS  ULNA","code_information":[{"code":"25393","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR CARPAL BONE SHORTEN","code_information":[{"code":"25394","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"minimum":9858,"maximum":30130,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15725,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14866,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9858,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30130,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28249,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24533.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19764,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23564,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18319,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25824.23,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25980,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16131,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16131,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11239,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14346.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15351.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14777.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15064.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15207.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15064.13,"methodology":"case rate"}]}]},{"description":"REPAIR RADIUS OR ULNA","code_information":[{"code":"25400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT RADIUS OR ULNA","code_information":[{"code":"25405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2541","type":"APR-DRG"}],"standard_charges":[{"minimum":3856,"maximum":3856,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3856,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3856,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3856,"methodology":"case rate"}]}]},{"description":"REPAIR RADIUS  ULNA","code_information":[{"code":"25415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2542","type":"APR-DRG"}],"standard_charges":[{"minimum":6489,"maximum":6489,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6489,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6489,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6489,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT RADIUS  ULNA","code_information":[{"code":"25420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT RADIUS OR ULNA","code_information":[{"code":"25425","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT RADIUS  ULNA","code_information":[{"code":"25426","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2543","type":"APR-DRG"}],"standard_charges":[{"minimum":10715,"maximum":10715,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10715,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10715,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10715,"methodology":"case rate"}]}]},{"description":"VASC GRAFT INTO CARPAL BONE","code_information":[{"code":"25430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR NONUNION CARPAL BONE","code_information":[{"code":"25431","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES","code_information":[{"code":"2544","type":"APR-DRG"}],"standard_charges":[{"minimum":11173,"maximum":11173,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11173,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11173,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11173,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT WRIST BONE","code_information":[{"code":"25440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25441","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25442","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25443","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25444","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT WRIST JOINT","code_information":[{"code":"25445","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"WRIST REPLACEMENT","code_information":[{"code":"25446","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"REPAIR WRIST JOINTS","code_information":[{"code":"25447","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST JOINT IMPLANT","code_information":[{"code":"25449","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF WRIST JOINT","code_information":[{"code":"25450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF WRIST JOINT","code_information":[{"code":"25455","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REINFORCE RADIUS","code_information":[{"code":"25490","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REINFORCE ULNA","code_information":[{"code":"25491","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REINFORCE RADIUS AND ULNA","code_information":[{"code":"25492","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"minimum":8976,"maximum":77110,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23520,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22235,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15609,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77110,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":72296,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34058.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27732,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33063,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29007,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35850.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38858,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24127,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24127,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8976,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19917.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21311.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20514.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20912.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21112.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20912.94,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25515","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF RADIUS","code_information":[{"code":"25526","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF ULNA","code_information":[{"code":"25530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF ULNA","code_information":[{"code":"25535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE OF ULNA","code_information":[{"code":"25545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE RADIUS  ULNA","code_information":[{"code":"25560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE RADIUS  ULNA","code_information":[{"code":"25565","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE RADIUS  ULNA","code_information":[{"code":"25574","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE RADIUS/ULNA","code_information":[{"code":"25575","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"minimum":8771,"maximum":47316,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15225,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14393,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9316,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47316,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44362,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23921.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17642,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21034,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17312,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25180.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25153,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15618,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15618,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8771,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13988.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14968.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14408.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14688.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14828.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14688.42,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE RADIUS/ULNA","code_information":[{"code":"25600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"HC CL TX COLLES FX W/MNP","code_information":[{"code":"25605","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1807.11,"maximum":1807.11,"gross_charge":2231,"discounted_cash":660.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.11,"methodology":"fee schedule"}]}]},{"description":"HC CL TX COLLES FX W/MNP","code_information":[{"code":"25605","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"gross_charge":2231,"discounted_cash":660.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT FX DISTAL RADIAL","code_information":[{"code":"25606","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FX RAD EXTRA-ARTICUL","code_information":[{"code":"25607","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FX RAD INTRA-ARTICUL","code_information":[{"code":"25608","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FX RADIAL 3+ FRAG","code_information":[{"code":"25609","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25622","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25624","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25628","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25635","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25645","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT WRIST BONE FRACTURE","code_information":[{"code":"25650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"PIN ULNAR STYLOID FRACTURE","code_information":[{"code":"25651","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FRACTURE ULNAR STYLOID","code_information":[{"code":"25652","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25670","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PIN RADIOULNAR DISLOCATION","code_information":[{"code":"25671","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25675","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25676","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT WRIST FRACTURE","code_information":[{"code":"25680","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT WRIST FRACTURE","code_information":[{"code":"25685","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25690","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT WRIST DISLOCATION","code_information":[{"code":"25695","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"minimum":4483,"maximum":34424,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8017,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7579,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5630,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34424,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32275,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15113.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11335,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13515,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10463,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15908.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13246,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8224,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8224,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4483,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8838.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9456.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9103.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9280.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9368.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9280.09,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"minimum":12656,"maximum":41665,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25219,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23841,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15388,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38376,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35980,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36134.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30820,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36745,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28597,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38036.2,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41665,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25870,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25870,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12656,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21131.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22610.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21765.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22187.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22399.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22187.79,"methodology":"case rate"}]}]},{"description":"FUSION OF WRIST JOINT","code_information":[{"code":"25800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION/GRAFT OF WRIST JOINT","code_information":[{"code":"25805","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION/GRAFT OF WRIST JOINT","code_information":[{"code":"25810","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"FUSION OF HAND BONES","code_information":[{"code":"25820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSE HAND BONES WITH GRAFT","code_information":[{"code":"25825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION RADIOULNAR JNT/ULNA","code_information":[{"code":"25830","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"minimum":8856,"maximum":33984,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15800,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14937,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10605,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33984,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31862,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24624.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21554,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25698,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19708,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25920.2,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26104,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16208,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16208,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8856,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14400.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15408.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14832.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15120.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15264.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15120.12,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF FOREARM","code_information":[{"code":"25900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF FOREARM","code_information":[{"code":"25905","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25907","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25909","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF FOREARM","code_information":[{"code":"25915","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATE HAND AT WRIST","code_information":[{"code":"25920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATE HAND AT WRIST","code_information":[{"code":"25922","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25924","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF HAND","code_information":[{"code":"25927","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25929","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"25931","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FOREARM OR WRIST SURGERY","code_information":[{"code":"25999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"minimum":16932,"maximum":93551,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30618,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28946,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18835,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93551,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":87711,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42733.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37816,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45086,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35002,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":44982.26,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50586,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31409,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31409,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16932,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24990.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26739.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25739.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26239.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26489.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26239.65,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2601","type":"APR-DRG"}],"standard_charges":[{"minimum":11900,"maximum":11900,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11900,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11900,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11900,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF FINGER ABSCESS","code_information":[{"code":"26010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF FINGER ABSCESS","code_information":[{"code":"26011","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2602","type":"APR-DRG"}],"standard_charges":[{"minimum":19419,"maximum":19419,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19419,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19419,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19419,"methodology":"case rate"}]}]},{"description":"DRAIN HAND TENDON SHEATH","code_information":[{"code":"26020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PALM BURSA","code_information":[{"code":"26025","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2603","type":"APR-DRG"}],"standard_charges":[{"minimum":21598,"maximum":21598,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21598,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21598,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21598,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PALM BURSAS","code_information":[{"code":"26030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT HAND BONE LESION","code_information":[{"code":"26034","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FINGERS/HAND","code_information":[{"code":"26035","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESS FINGERS/HAND","code_information":[{"code":"26037","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR PANCREAS LIVER AND SHUNT PROCEDURES","code_information":[{"code":"2604","type":"APR-DRG"}],"standard_charges":[{"minimum":41743,"maximum":41743,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41743,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41743,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41743,"methodology":"case rate"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26045","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC INCISE FINGER TENDON SHEATH","code_information":[{"code":"26055","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4511.7,"maximum":4511.7,"gross_charge":5570,"discounted_cash":1648.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4511.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4511.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4511.7,"methodology":"fee schedule"}]}]},{"description":"HC INCISE FINGER TENDON SHEATH","code_information":[{"code":"26055","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4511.7,"gross_charge":5570,"discounted_cash":1648.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4511.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4511.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4511.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISION OF FINGER TENDON","code_information":[{"code":"26060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT HAND JOINT","code_information":[{"code":"26070","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT FINGER JOINT","code_information":[{"code":"26075","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT FINGER JOINT","code_information":[{"code":"26080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"minimum":8799,"maximum":60910,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17057,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16126,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10691,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60910,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57107,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26161,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20654,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24624,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19868,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27537.9,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28181,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17498,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17498,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8799,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15298.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16369.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15757.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16063.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16216.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16063.78,"methodology":"case rate"}]}]},{"description":"BIOPSY HAND JOINT LINING","code_information":[{"code":"26100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"BIOPSY FINGER JOINT LINING","code_information":[{"code":"26105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2611","type":"APR-DRG"}],"standard_charges":[{"minimum":8997,"maximum":8997,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8997,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8997,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8997,"methodology":"case rate"}]}]},{"description":"BIOPSY FINGER JOINT LINING","code_information":[{"code":"26110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"EXC HAND LES SC 1.5 CM/>","code_information":[{"code":"26111","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC HAND TUM DEEP 1.5 CM/>","code_information":[{"code":"26113","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC HAND LES SC < 1.5 CM","code_information":[{"code":"26115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC HAND TUM DEEP < 1.5 CM","code_information":[{"code":"26116","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"RAD RESECT HAND TUMOR < 3 CM","code_information":[{"code":"26117","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RAD RESECT HAND TUMOR 3 CM/>","code_information":[{"code":"26118","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2612","type":"APR-DRG"}],"standard_charges":[{"minimum":15215,"maximum":15215,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15215,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15215,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15215,"methodology":"case rate"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26121","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26123","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE PALM CONTRACTURE","code_information":[{"code":"26125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2613","type":"APR-DRG"}],"standard_charges":[{"minimum":15305,"maximum":15305,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15305,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15305,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15305,"methodology":"case rate"}]}]},{"description":"REMOVE WRIST JOINT LINING","code_information":[{"code":"26130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE FINGER JOINT EACH","code_information":[{"code":"26135","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MAJOR BILIARY TRACT PROCEDURES","code_information":[{"code":"2614","type":"APR-DRG"}],"standard_charges":[{"minimum":37739,"maximum":37739,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37739,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37739,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37739,"methodology":"case rate"}]}]},{"description":"REVISE FINGER JOINT EACH","code_information":[{"code":"26140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TENDON EXCISION PALM/FINGER","code_information":[{"code":"26145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE TENDON SHEATH LESION","code_information":[{"code":"26160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF PALM TENDON EACH","code_information":[{"code":"26170","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FINGER TENDON","code_information":[{"code":"26180","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE FINGER BONE","code_information":[{"code":"26185","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"minimum":8014,"maximum":49876,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13643,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12898,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9348,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49876,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46762,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21988.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18125,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21609,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17371,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23146.17,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22541,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13996,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13996,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8014,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12858.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13759.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13244.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13501.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13630.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13501.93,"methodology":"case rate"}]}]},{"description":"REMOVE HAND BONE LESION","code_information":[{"code":"26200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT BONE LESION","code_information":[{"code":"26205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FINGER LESION","code_information":[{"code":"26210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FINGER LESION","code_information":[{"code":"26215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF HAND BONE","code_information":[{"code":"26230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL FINGER BONE","code_information":[{"code":"26235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL FINGER BONE","code_information":[{"code":"26236","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"EXTENSIVE HAND SURGERY","code_information":[{"code":"26250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT PROX FINGER TUMOR","code_information":[{"code":"26260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT DISTAL FINGER TUMOR","code_information":[{"code":"26262","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"VEIN LIGATION AND STRIPPING","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"minimum":15631,"maximum":39832,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24109,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22792,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37032,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34720,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34778.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30114,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35903,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29828,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36609.29,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39832,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24732,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24732,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15631,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20338.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21762.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20948.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21355.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21558.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21355.42,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2631","type":"APR-DRG"}],"standard_charges":[{"minimum":7621,"maximum":7621,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7621,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7621,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7621,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2632","type":"APR-DRG"}],"standard_charges":[{"minimum":9614,"maximum":9614,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9614,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9614,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9614,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IMPLANT FROM HAND","code_information":[{"code":"26320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2633","type":"APR-DRG"}],"standard_charges":[{"minimum":13894,"maximum":13894,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13894,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13894,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13894,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY","code_information":[{"code":"2634","type":"APR-DRG"}],"standard_charges":[{"minimum":21178,"maximum":21178,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21178,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21178,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21178,"methodology":"case rate"}]}]},{"description":"MANIPULATE FINGER W/ANESTH","code_information":[{"code":"26340","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"MANIPULAT PALM CORD POST INJ","code_information":[{"code":"26341","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26352","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26356","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26357","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26358","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26370","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26372","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26373","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE HAND/FINGER TENDON","code_information":[{"code":"26390","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26392","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM O.R. PROCEDURES","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"minimum":16283,"maximum":52324,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31417,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29701,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18555,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52324,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49058,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43709.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35775,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42652,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34482,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46010.24,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51906,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32228,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32228,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16283,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25561.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27350.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26328.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26839.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27094.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26839.31,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2641","type":"APR-DRG"}],"standard_charges":[{"minimum":9065,"maximum":9065,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9065,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9065,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9065,"methodology":"case rate"}]}]},{"description":"REPAIR HAND TENDON","code_information":[{"code":"26410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT HAND TENDON","code_information":[{"code":"26412","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXCISION HAND/FINGER TENDON","code_information":[{"code":"26415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"GRAFT HAND OR FINGER TENDON","code_information":[{"code":"26416","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER TENDON","code_information":[{"code":"26418","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2642","type":"APR-DRG"}],"standard_charges":[{"minimum":11139,"maximum":11139,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11139,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11139,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11139,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT FINGER TENDON","code_information":[{"code":"26420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER/HAND TENDON","code_information":[{"code":"26426","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT FINGER TENDON","code_information":[{"code":"26428","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2643","type":"APR-DRG"}],"standard_charges":[{"minimum":15125,"maximum":15125,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15125,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15125,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15125,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER TENDON","code_information":[{"code":"26432","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER TENDON","code_information":[{"code":"26433","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT FINGER TENDON","code_information":[{"code":"26434","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REALIGNMENT OF TENDONS","code_information":[{"code":"26437","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY PANCREAS AND ABDOMINAL PROCEDURES","code_information":[{"code":"2644","type":"APR-DRG"}],"standard_charges":[{"minimum":31714,"maximum":31714,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31714,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31714,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31714,"methodology":"case rate"}]}]},{"description":"RELEASE PALM/FINGER TENDON","code_information":[{"code":"26440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RELEASE PALM  FINGER TENDON","code_information":[{"code":"26442","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE HAND/FINGER TENDON","code_information":[{"code":"26445","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE FOREARM/HAND TENDON","code_information":[{"code":"26449","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF PALM TENDON","code_information":[{"code":"26450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF FINGER TENDON","code_information":[{"code":"26455","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISE HAND/FINGER TENDON","code_information":[{"code":"26460","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"FUSION OF FINGER TENDONS","code_information":[{"code":"26471","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF FINGER TENDONS","code_information":[{"code":"26474","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TENDON LENGTHENING","code_information":[{"code":"26476","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TENDON SHORTENING","code_information":[{"code":"26477","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"LENGTHENING OF HAND TENDON","code_information":[{"code":"26478","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHORTENING OF HAND TENDON","code_information":[{"code":"26479","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSPLANT HAND TENDON","code_information":[{"code":"26480","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSPLANT/GRAFT HAND TENDON","code_information":[{"code":"26483","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSPLANT PALM TENDON","code_information":[{"code":"26485","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSPLANT/GRAFT PALM TENDON","code_information":[{"code":"26489","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE THUMB TENDON","code_information":[{"code":"26490","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TENDON TRANSFER WITH GRAFT","code_information":[{"code":"26492","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HAND TENDON/MUSCLE TRANSFER","code_information":[{"code":"26494","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE THUMB TENDON","code_information":[{"code":"26496","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FINGER TENDON TRANSFER","code_information":[{"code":"26497","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FINGER TENDON TRANSFER","code_information":[{"code":"26498","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF FINGER","code_information":[{"code":"26499","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"AICD LEAD PROCEDURES","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"minimum":14869,"maximum":52977,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32065,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30314,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20078,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36983,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34674,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44501.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36557,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43585,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37313,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46843.94,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52977,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32893,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32893,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14869,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26024.41,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27846.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26805.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27325.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27585.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27325.64,"methodology":"case rate"}]}]},{"description":"HAND TENDON RECONSTRUCTION","code_information":[{"code":"26500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HAND TENDON RECONSTRUCTION","code_information":[{"code":"26502","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE THUMB CONTRACTURE","code_information":[{"code":"26508","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"THUMB TENDON TRANSFER","code_information":[{"code":"26510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF KNUCKLE JOINT","code_information":[{"code":"26516","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF KNUCKLE JOINTS","code_information":[{"code":"26517","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF KNUCKLE JOINTS","code_information":[{"code":"26518","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RELEASE KNUCKLE CONTRACTURE","code_information":[{"code":"26520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE FINGER CONTRACTURE","code_information":[{"code":"26525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REVISE KNUCKLE JOINT","code_information":[{"code":"26530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE KNUCKLE WITH IMPLANT","code_information":[{"code":"26531","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE FINGER JOINT","code_information":[{"code":"26535","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE/IMPLANT FINGER JOINT","code_information":[{"code":"26536","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR HAND JOINT","code_information":[{"code":"26540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR HAND JOINT WITH GRAFT","code_information":[{"code":"26541","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR HAND JOINT WITH GRAFT","code_information":[{"code":"26542","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT FINGER JOINT","code_information":[{"code":"26545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR NONUNION HAND","code_information":[{"code":"26546","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT FINGER JOINT","code_information":[{"code":"26548","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CONSTRUCT THUMB REPLACEMENT","code_information":[{"code":"26550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"GREAT TOE-HAND TRANSFER","code_information":[{"code":"26551","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SINGLE TRANSFER TOE-HAND","code_information":[{"code":"26553","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DOUBLE TRANSFER TOE-HAND","code_information":[{"code":"26554","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POSITIONAL CHANGE OF FINGER","code_information":[{"code":"26555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TOE JOINT TRANSFER","code_information":[{"code":"26556","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF WEB FINGER","code_information":[{"code":"26560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPAIR OF WEB FINGER","code_information":[{"code":"26561","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF WEB FINGER","code_information":[{"code":"26562","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRECT METACARPAL FLAW","code_information":[{"code":"26565","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRECT FINGER DEFORMITY","code_information":[{"code":"26567","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"LENGTHEN METACARPAL/FINGER","code_information":[{"code":"26568","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR HAND DEFORMITY","code_information":[{"code":"26580","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT EXTRA FINGER","code_information":[{"code":"26587","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FINGER DEFORMITY","code_information":[{"code":"26590","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3964.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPAIR MUSCLES OF HAND","code_information":[{"code":"26591","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE MUSCLES OF HAND","code_information":[{"code":"26593","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXCISION CONSTRICTING TISSUE","code_information":[{"code":"26596","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"minimum":28643,"maximum":150517,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53851,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":50910,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35486,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":150517,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":141120,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":71125.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":71347,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85063,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65946,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":74868.68,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88970,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":55241,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":55241,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28643,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41593.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44505.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42841.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43673.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44089.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43673.4,"methodology":"case rate"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26607","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26608","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT METACARPAL FRACTURE","code_information":[{"code":"26615","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT THUMB DISLOCATION","code_information":[{"code":"26641","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT THUMB FRACTURE","code_information":[{"code":"26645","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT THUMB FRACTURE","code_information":[{"code":"26650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT THUMB FRACTURE","code_information":[{"code":"26665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26670","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26675","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"PIN HAND DISLOCATION","code_information":[{"code":"26676","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26685","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT HAND DISLOCATION","code_information":[{"code":"26686","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"minimum":3270,"maximum":113017,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6095,"methodology":"per diem"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42290,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39980,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27726,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":113017,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105961,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":56997.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55781,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66505,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51525,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":59997.17,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":8182,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69870,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":43382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43382,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3270,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33331.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35664.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34331.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34998.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35331.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34998.35,"methodology":"case rate"}]}]},{"description":"TREAT KNUCKLE DISLOCATION","code_information":[{"code":"26700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNUCKLE DISLOCATION","code_information":[{"code":"26705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"PIN KNUCKLE DISLOCATION","code_information":[{"code":"26706","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT KNUCKLE DISLOCATION","code_information":[{"code":"26715","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26727","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26735","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26742","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26746","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26755","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"PIN FINGER FRACTURE EACH","code_information":[{"code":"26756","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER FRACTURE EACH","code_information":[{"code":"26765","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER DISLOCATION","code_information":[{"code":"26770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FINGER DISLOCATION","code_information":[{"code":"26775","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"PIN FINGER DISLOCATION","code_information":[{"code":"26776","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FINGER DISLOCATION","code_information":[{"code":"26785","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"minimum":15794,"maximum":105133,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59935,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":56661,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38944,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":105133,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":98569,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":78559.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":74807,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":89188,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72372,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":82694.7,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99021,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":61482,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61482,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15794,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":45941.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49157.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47319.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48238.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48697.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":48238.58,"methodology":"case rate"}]}]},{"description":"THUMB FUSION WITH GRAFT","code_information":[{"code":"26820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF THUMB","code_information":[{"code":"26841","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"THUMB FUSION WITH GRAFT","code_information":[{"code":"26842","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF HAND JOINT","code_information":[{"code":"26843","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION/GRAFT OF HAND JOINT","code_information":[{"code":"26844","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF KNUCKLE","code_information":[{"code":"26850","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF KNUCKLE WITH GRAFT","code_information":[{"code":"26852","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF FINGER JOINT","code_information":[{"code":"26860","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF FINGER JNT ADD-ON","code_information":[{"code":"26861","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION/GRAFT OF FINGER JOINT","code_information":[{"code":"26862","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSE/GRAFT ADDED JOINT","code_information":[{"code":"26863","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"minimum":2663,"maximum":65351,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37400,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":35358,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23626,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65351,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61271,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":51021.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46223,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55109,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43906,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":53706.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38366,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38366,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2663,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29837.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31925.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30732.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31328.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31627.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31328.94,"methodology":"case rate"}]}]},{"description":"AMPUTATION FINGER/THUMB","code_information":[{"code":"26910","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8797.41,"maximum":8797.41,"gross_charge":10861,"discounted_cash":3214.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8797.41,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FINGER/THUMB","code_information":[{"code":"26910","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8797.41,"gross_charge":10861,"discounted_cash":3214.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2063.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC AMP- JOINT OR PHALANX HAND","code_information":[{"code":"26951","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3651.48,"maximum":3651.48,"gross_charge":4508,"discounted_cash":1334.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"}]}]},{"description":"HC AMP- JOINT OR PHALANX HAND","code_information":[{"code":"26951","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"gross_charge":4508,"discounted_cash":1334.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3651.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":901.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF FINGER/THUMB","code_information":[{"code":"26952","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HAND/FINGER SURGERY","code_information":[{"code":"26989","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"HC I&D PELVIS/HIP JOINT AREA","code_information":[{"code":"26990","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9152.19,"maximum":9152.19,"gross_charge":11299,"discounted_cash":3344.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9152.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9152.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9152.19,"methodology":"fee schedule"}]}]},{"description":"HC I&D PELVIS/HIP JOINT AREA","code_information":[{"code":"26990","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9152.19,"gross_charge":11299,"discounted_cash":3344.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9152.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9152.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9152.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2146.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2259.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1694.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2259.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PELVIS BURSA","code_information":[{"code":"26991","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"26992","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"minimum":1699,"maximum":79257,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46140,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":43620,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28730,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79257,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":74310,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61702.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55262,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65886,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53391,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":64949.71,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76230,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":47331,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47331,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1699,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36083.17,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38609,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":37165.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37887.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38248.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37887.33,"methodology":"case rate"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27001","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27003","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF HIP TENDON","code_information":[{"code":"27005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF HIP TENDONS","code_information":[{"code":"27006","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF HIP/THIGH FASCIA","code_information":[{"code":"27025","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BUTTOCK FASCIOTOMY","code_information":[{"code":"27027","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF HIP JOINT","code_information":[{"code":"27030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION OF HIP JOINT","code_information":[{"code":"27033","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DENERVATION OF HIP JOINT","code_information":[{"code":"27035","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXCISION OF HIP JOINT/MUSCLE","code_information":[{"code":"27036","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL","code_information":[{"code":"27040","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4548.15,"maximum":4548.15,"gross_charge":5615,"discounted_cash":1662.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4548.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4548.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4548.15,"methodology":"fee schedule"}]}]},{"description":"BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL","code_information":[{"code":"27040","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4548.15,"gross_charge":5615,"discounted_cash":1662.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4548.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4548.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4548.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SOFT TISSUES","code_information":[{"code":"27041","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC HIP PELVIS LES SC 3 CM/>","code_information":[{"code":"27043","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC HIP/PELV TUM DEEP 5 CM/>","code_information":[{"code":"27045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC HIP/PELVIS LES SC < 3 CM","code_information":[{"code":"27047","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC HIP/PELV TUM DEEP < 5 CM","code_information":[{"code":"27048","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT HIP/PELV TUM < 5 CM","code_information":[{"code":"27049","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SACROILIAC JOINT","code_information":[{"code":"27050","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"BIOPSY OF HIP JOINT","code_information":[{"code":"27052","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HIP JOINT LINING","code_information":[{"code":"27054","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BUTTOCK FASCIOTOMY W/DBRDMT","code_information":[{"code":"27057","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RESECT HIP/PELV TUM 5 CM/>","code_information":[{"code":"27059","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ISCHIAL BURSA","code_information":[{"code":"27060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE FEMUR LESION/BURSA","code_information":[{"code":"27062","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE HIP BONE LES SUPER","code_information":[{"code":"27065","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE HIP BONE LES DEEP","code_information":[{"code":"27066","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT HIP BONE LESION","code_information":[{"code":"27067","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PART REMOVE HIP BONE SUPER","code_information":[{"code":"27070","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PART REMOVAL HIP BONE DEEP","code_information":[{"code":"27071","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT HIP TUMOR","code_information":[{"code":"27075","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT HIP TUM INCL ACETABUL","code_information":[{"code":"27076","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT HIP TUM W/INNOM BONE","code_information":[{"code":"27077","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RSECT HIP TUM INCL FEMUR","code_information":[{"code":"27078","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF TAIL BONE","code_information":[{"code":"27080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE HIP FOREIGN BODY","code_information":[{"code":"27086","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE HIP FOREIGN BODY","code_information":[{"code":"27087","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HIP PROSTHESIS","code_information":[{"code":"27090","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF HIP PROSTHESIS","code_information":[{"code":"27091","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INJ FOR HIP X-RAY","code_information":[{"code":"27093","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":765.45,"maximum":765.45,"gross_charge":945,"discounted_cash":279.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":765.45,"methodology":"fee schedule"}]}]},{"description":"HC INJ FOR HIP X-RAY","code_information":[{"code":"27093","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":945,"discounted_cash":279.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":529.2,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":661.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR HIP X-RAY","code_information":[{"code":"27095","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INJECT SACROILIAC JOINT","code_information":[{"code":"27096","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HIP TENDON","code_information":[{"code":"27097","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSFER TENDON TO PELVIS","code_information":[{"code":"27098","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"minimum":3191,"maximum":52604,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30962,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29270,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19636,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52604,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49320,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43152.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37656,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44896,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36491,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45423.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51153,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31761,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31761,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3191,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25235.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27002.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25992.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26497.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26749.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26497.32,"methodology":"case rate"}]}]},{"description":"TRANSFER OF ABDOMINAL MUSCLE","code_information":[{"code":"27100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TRANSFER OF SPINAL MUSCLE","code_information":[{"code":"27105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSFER OF ILIOPSOAS MUSCLE","code_information":[{"code":"27110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TRANSFER OF ILIOPSOAS MUSCLE","code_information":[{"code":"27111","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF HIP SOCKET","code_information":[{"code":"27120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCTION OF HIP SOCKET","code_information":[{"code":"27122","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL HIP REPLACEMENT","code_information":[{"code":"27125","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TOTAL HIP ARTHROPLASTY","code_information":[{"code":"27130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TOTAL HIP ARTHROPLASTY","code_information":[{"code":"27132","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"27134","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"27137","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE HIP JOINT REPLACEMENT","code_information":[{"code":"27138","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANT FEMUR RIDGE","code_information":[{"code":"27140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF HIP BONE","code_information":[{"code":"27146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HIP BONE","code_information":[{"code":"27147","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF HIP BONES","code_information":[{"code":"27151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HIP BONES","code_information":[{"code":"27156","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF PELVIS","code_information":[{"code":"27158","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF NECK OF FEMUR","code_information":[{"code":"27161","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION/FIXATION OF FEMUR","code_information":[{"code":"27165","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR/GRAFT FEMUR HEAD/NECK","code_information":[{"code":"27170","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27175","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27176","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27177","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27178","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE HEAD/NECK OF FEMUR","code_information":[{"code":"27179","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT SLIPPED EPIPHYSIS","code_information":[{"code":"27181","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF FEMUR EPIPHYSIS","code_information":[{"code":"27185","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REINFORCE HIP BONES","code_information":[{"code":"27187","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLSD TX PELVIC RING FX","code_information":[{"code":"27197","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CLSD TX PELVIC RING FX","code_information":[{"code":"27198","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"minimum":13860,"maximum":37676,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22492,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21264,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13860,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37676,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35324,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32802.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28064,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33460,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25756,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34529.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37160,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23073,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23073,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19182.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20525.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19758.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20141.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20333.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20141.96,"methodology":"case rate"}]}]},{"description":"TREAT TAIL BONE FRACTURE","code_information":[{"code":"27200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT TAIL BONE FRACTURE","code_information":[{"code":"27202","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT PELVIC FRACTURE(S)","code_information":[{"code":"27215","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT PELVIC RING FRACTURE","code_information":[{"code":"27216","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT PELVIC RING FRACTURE","code_information":[{"code":"27217","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT PELVIC RING FRACTURE","code_information":[{"code":"27218","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP SOCKET FRACTURE","code_information":[{"code":"27220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HIP SOCKET FRACTURE","code_information":[{"code":"27222","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP WALL FRACTURE","code_information":[{"code":"27226","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP FRACTURE(S)","code_information":[{"code":"27227","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP FRACTURE(S)","code_information":[{"code":"27228","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27232","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27235","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27236","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27238","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27244","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27245","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27246","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT THIGH FRACTURE","code_information":[{"code":"27248","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27250","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27252","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27253","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27254","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27256","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27257","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27258","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27259","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27265","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT HIP DISLOCATION","code_information":[{"code":"27266","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"CLTX THIGH FX","code_information":[{"code":"27267","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CLTX THIGH FX W/MNPJ","code_information":[{"code":"27268","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPTX THIGH FX","code_information":[{"code":"27269","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC MANIPULATION HIP JOINT","code_information":[{"code":"27275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4400.73,"maximum":4400.73,"gross_charge":5433,"discounted_cash":1608.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4400.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4400.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4400.73,"methodology":"fee schedule"}]}]},{"description":"HC MANIPULATION HIP JOINT","code_information":[{"code":"27275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4400.73,"gross_charge":5433,"discounted_cash":1608.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4400.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4400.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4400.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":814.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1086.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"ARTHRODESIS SACROILIAC JOINT","code_information":[{"code":"27279","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"FUSION OF SACROILIAC JOINT","code_information":[{"code":"27280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF PUBIC BONES","code_information":[{"code":"27282","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF HIP JOINT","code_information":[{"code":"27284","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF HIP JOINT","code_information":[{"code":"27286","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF LEG AT HIP","code_information":[{"code":"27290","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF LEG AT HIP","code_information":[{"code":"27295","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PELVIS/HIP JOINT SURGERY","code_information":[{"code":"27299","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"minimum":22140,"maximum":59422,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35150,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33230,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22140,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59422,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55712,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48270.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43377,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51716,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41145,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":50811.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58072,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36057,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36057,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23145,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28228.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30204.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29075.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29639.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29922.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29639.93,"methodology":"case rate"}]}]},{"description":"HC I&D THIGH OR KNEE","code_information":[{"code":"27301","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":7975.26,"maximum":7975.26,"gross_charge":9846,"discounted_cash":2914.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7975.26,"methodology":"fee schedule"}]}]},{"description":"HC I&D THIGH OR KNEE","code_information":[{"code":"27301","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7975.26,"gross_charge":9846,"discounted_cash":2914.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1870.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1969.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1969.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"INCIS/DRAIN THIGH/KNEE/ABSCDEP","code_information":[{"code":"27301","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7975.26,"maximum":7975.26,"gross_charge":9846,"discounted_cash":2914.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7975.26,"methodology":"fee schedule"}]}]},{"description":"INCIS/DRAIN THIGH/KNEE/ABSCDEP","code_information":[{"code":"27301","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7975.26,"gross_charge":9846,"discounted_cash":2914.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7975.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1870.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1969.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1969.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BONE LESION","code_information":[{"code":"27303","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE THIGH TENDON  FASCIA","code_information":[{"code":"27305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF THIGH TENDON","code_information":[{"code":"27306","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF THIGH TENDONS","code_information":[{"code":"27307","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF KNEE JOINT","code_information":[{"code":"27310","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC BIO/SOFT TISSUPP LEG SUPERFIC","code_information":[{"code":"27323","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1398.87,"maximum":1398.87,"gross_charge":1727,"discounted_cash":511.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1398.87,"methodology":"fee schedule"}]}]},{"description":"HC BIO/SOFT TISSUPP LEG SUPERFIC","code_information":[{"code":"27323","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"gross_charge":1727,"discounted_cash":511.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BIO/SOFT TISSUPP LEG DEEP","code_information":[{"code":"27324","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3373.65,"maximum":3373.65,"gross_charge":4165,"discounted_cash":1232.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3373.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3373.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3373.65,"methodology":"fee schedule"}]}]},{"description":"HC BIO/SOFT TISSUPP LEG DEEP","code_information":[{"code":"27324","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4165,"discounted_cash":1232.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3373.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3373.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3373.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":833,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":624.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":833,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"NEURECTOMY HAMSTRING","code_information":[{"code":"27325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"NEURECTOMY POPLITEAL","code_information":[{"code":"27326","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"EXC THIGH/KNEE LES SC < 3 CM","code_information":[{"code":"27327","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC THIGH/KNEE TUM DEEP <5CM","code_information":[{"code":"27328","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT THIGH/KNEE TUM < 5 CM","code_information":[{"code":"27329","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"BIOPSY KNEE JOINT LINING","code_information":[{"code":"27330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT KNEE JOINT","code_information":[{"code":"27331","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KNEE CARTILAGE","code_information":[{"code":"27332","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KNEE CARTILAGE","code_information":[{"code":"27333","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE KNEE JOINT LINING","code_information":[{"code":"27334","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE KNEE JOINT LINING","code_information":[{"code":"27335","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXC THIGH/KNEE LES SC 3 CM/>","code_information":[{"code":"27337","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC THIGH/KNEE TUM DEP 5CM/>","code_information":[{"code":"27339","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KNEECAP BURSA","code_information":[{"code":"27340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KNEE CYST","code_information":[{"code":"27345","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE KNEE CYST","code_information":[{"code":"27347","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KNEECAP","code_information":[{"code":"27350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE FEMUR LESION","code_information":[{"code":"27355","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE FEMUR LESION/GRAFT","code_information":[{"code":"27356","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REMOVE FEMUR LESION/GRAFT","code_information":[{"code":"27357","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE FEMUR LESION/FIXATION","code_information":[{"code":"27358","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3964.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL LEG BONE(S)","code_information":[{"code":"27360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT THIGH/KNEE TUM 5 CM/>","code_information":[{"code":"27364","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT FEMUR/KNEE TUMOR","code_information":[{"code":"27365","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FL KNEE ARTHROGRAM","code_information":[{"code":"27369","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":813.24,"maximum":813.24,"gross_charge":1004,"discounted_cash":297.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":813.24,"methodology":"fee schedule"}]}]},{"description":"FL KNEE ARTHROGRAM","code_information":[{"code":"27369","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1004,"discounted_cash":297.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.8,"methodology":"fee schedule"}]}]},{"description":"HC ARTHROGRAM KNEE INJ UNILATERAL","code_information":[{"code":"27369","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":520.83,"maximum":520.83,"gross_charge":643,"discounted_cash":190.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":520.83,"methodology":"fee schedule"}]}]},{"description":"HC ARTHROGRAM KNEE INJ UNILATERAL","code_information":[{"code":"27369","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":643,"discounted_cash":190.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.6,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREIGN BODY","code_information":[{"code":"27372","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REPAIR OF KNEECAP TENDON","code_information":[{"code":"27380","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT KNEECAP TENDON","code_information":[{"code":"27381","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF THIGH MUSCLE","code_information":[{"code":"27385","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT OF THIGH MUSCLE","code_information":[{"code":"27386","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF THIGH TENDON","code_information":[{"code":"27390","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF THIGH TENDONS","code_information":[{"code":"27391","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF THIGH TENDONS","code_information":[{"code":"27392","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"LENGTHENING OF THIGH TENDON","code_information":[{"code":"27393","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LENGTHENING OF THIGH TENDONS","code_information":[{"code":"27394","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LENGTHENING OF THIGH TENDONS","code_information":[{"code":"27395","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TRANSPLANT OF THIGH TENDON","code_information":[{"code":"27396","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TRANSPLANTS OF THIGH TENDONS","code_information":[{"code":"27397","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"minimum":12299,"maximum":46350,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28055,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26522,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18412,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40503,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37975,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39600.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36313,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43294,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34216,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41684.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28779,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28779,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12299,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23158,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24779.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23852.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24315.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24547.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24315.9,"methodology":"case rate"}]}]},{"description":"REVISE THIGH MUSCLES/TENDONS","code_information":[{"code":"27400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF KNEE CARTILAGE","code_information":[{"code":"27403","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF KNEE LIGAMENT","code_information":[{"code":"27405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF KNEE LIGAMENT","code_information":[{"code":"27407","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF KNEE LIGAMENTS","code_information":[{"code":"27409","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"AUTOCHONDROCYTE IMPLANT KNEE","code_information":[{"code":"27412","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OSTEOCHONDRAL KNEE ALLOGRAFT","code_information":[{"code":"27415","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"OSTEOCHONDRAL KNEE AUTOGRAFT","code_information":[{"code":"27416","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR DEGENERATED KNEECAP","code_information":[{"code":"27418","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF UNSTABLE KNEECAP","code_information":[{"code":"27420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF UNSTABLE KNEECAP","code_information":[{"code":"27422","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION/REMOVAL OF KNEECAP","code_information":[{"code":"27424","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LAT RETINACULAR RELEASE OPEN","code_information":[{"code":"27425","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION KNEE","code_information":[{"code":"27427","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION KNEE","code_information":[{"code":"27428","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION KNEE","code_information":[{"code":"27429","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF THIGH MUSCLES","code_information":[{"code":"27430","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF KNEE JOINT","code_information":[{"code":"27435","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE KNEECAP","code_information":[{"code":"27437","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE KNEECAP WITH IMPLANT","code_information":[{"code":"27438","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27441","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27442","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27443","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27445","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF KNEE JOINT","code_information":[{"code":"27446","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TOTAL KNEE ARTHROPLASTY","code_information":[{"code":"27447","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"INCISION OF THIGH","code_information":[{"code":"27448","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF THIGH","code_information":[{"code":"27450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REALIGNMENT OF THIGH BONE","code_information":[{"code":"27454","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REALIGNMENT OF KNEE","code_information":[{"code":"27455","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REALIGNMENT OF KNEE","code_information":[{"code":"27457","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SHORTENING OF THIGH BONE","code_information":[{"code":"27465","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LENGTHENING OF THIGH BONE","code_information":[{"code":"27466","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SHORTEN/LENGTHEN THIGHS","code_information":[{"code":"27468","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF THIGH","code_information":[{"code":"27470","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR/GRAFT OF THIGH","code_information":[{"code":"27472","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27475","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27477","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27479","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SURGERY TO STOP LEG GROWTH","code_information":[{"code":"27485","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE/REPLACE KNEE JOINT","code_information":[{"code":"27486","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE/REPLACE KNEE JOINT","code_information":[{"code":"27487","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KNEE PROSTHESIS","code_information":[{"code":"27488","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REINFORCE THIGH","code_information":[{"code":"27495","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27496","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27497","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27498","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF THIGH/KNEE","code_information":[{"code":"27499","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"minimum":29745,"maximum":117772,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63525,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":60055,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39973,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":117772,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110420,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":82947.44,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":74284,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":87313.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104952,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":65165,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65165,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29745,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":48507.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51902.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49962.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50932.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":51417.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50932.64,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27502","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27503","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27506","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27507","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27508","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27509","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27511","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27513","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREATMENT OF THIGH FRACTURE","code_information":[{"code":"27514","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT THIGH FX GROWTH PLATE","code_information":[{"code":"27516","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT THIGH FX GROWTH PLATE","code_information":[{"code":"27517","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT THIGH FX GROWTH PLATE","code_information":[{"code":"27519","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT KNEECAP FRACTURE","code_information":[{"code":"27520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNEECAP FRACTURE","code_information":[{"code":"27524","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27532","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27535","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27536","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT KNEE FRACTURE(S)","code_information":[{"code":"27538","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNEE FRACTURE","code_information":[{"code":"27540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27552","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27556","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27557","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT KNEE DISLOCATION","code_information":[{"code":"27558","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CL TX PATELLR WO ANES","code_information":[{"code":"27560","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":712.8,"maximum":712.8,"gross_charge":880,"discounted_cash":260.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":712.8,"methodology":"fee schedule"}]}]},{"description":"HC CL TX PATELLR WO ANES","code_information":[{"code":"27560","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"gross_charge":880,"discounted_cash":260.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":176,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":132,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":176,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNEECAP DISLOCATION","code_information":[{"code":"27562","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT KNEECAP DISLOCATION","code_information":[{"code":"27566","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HC FIXATION OF KNEE JOINT","code_information":[{"code":"27570","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2310.12,"maximum":2310.12,"gross_charge":2852,"discounted_cash":844.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2310.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2310.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2310.12,"methodology":"fee schedule"}]}]},{"description":"HC FIXATION OF KNEE JOINT","code_information":[{"code":"27570","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"gross_charge":2852,"discounted_cash":844.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2310.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2310.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2310.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"FUSION OF KNEE","code_information":[{"code":"27580","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC AMPUTATION THIGH THRU FEMUR","code_information":[{"code":"27590","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9244.53,"maximum":9244.53,"gross_charge":11413,"discounted_cash":3378.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9244.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9244.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9244.53,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATION THIGH THRU FEMUR","code_information":[{"code":"27590","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"gross_charge":11413,"discounted_cash":3378.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9244.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9244.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9244.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7989.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2168.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2282.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1711.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2282.6,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE LEG AT THIGH","code_information":[{"code":"27591","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATE LEG AT THIGH","code_information":[{"code":"27592","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION FOLLOW-UP SURGERY","code_information":[{"code":"27594","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC AMPTHIGHTHRU FEMREAMP","code_information":[{"code":"27596","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9387.9,"maximum":9387.9,"gross_charge":11590,"discounted_cash":3430.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9387.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9387.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9387.9,"methodology":"fee schedule"}]}]},{"description":"HC AMPTHIGHTHRU FEMREAMP","code_information":[{"code":"27596","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9387.9,"gross_charge":11590,"discounted_cash":3430.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9387.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9387.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9387.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8113,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2202.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2318,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1738.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2318,"methodology":"fee schedule"}]}]},{"description":"AMPUTATE LOWER LEG AT KNEE","code_information":[{"code":"27598","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEG SURGERY PROCEDURE","code_information":[{"code":"27599","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"minimum":21257,"maximum":103953,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55681,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":52640,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35282,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":103953,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":97463,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73361.83,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65567,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":77222.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":57119,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57119,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21257,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42901.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45904.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44188.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45046.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45475.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45046.74,"methodology":"case rate"}]}]},{"description":"HC FASCIOTOMY-ANTLAT ONLY","code_information":[{"code":"27600","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8237.7,"maximum":8237.7,"gross_charge":10170,"discounted_cash":3010.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8237.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8237.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8237.7,"methodology":"fee schedule"}]}]},{"description":"HC FASCIOTOMY-ANTLAT ONLY","code_information":[{"code":"27600","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8237.7,"gross_charge":10170,"discounted_cash":3010.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8237.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8237.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8237.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1932.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1525.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2034,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC FASCIOTOMY-POSTERIOR","code_information":[{"code":"27601","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8797.41,"maximum":8797.41,"gross_charge":10861,"discounted_cash":3214.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8797.41,"methodology":"fee schedule"}]}]},{"description":"HC FASCIOTOMY-POSTERIOR","code_information":[{"code":"27601","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8797.41,"gross_charge":10861,"discounted_cash":3214.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8797.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2063.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2172.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC FASCIOTOMY - ANT LAT POST","code_information":[{"code":"27602","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4448.52,"maximum":4448.52,"gross_charge":5492,"discounted_cash":1625.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4448.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4448.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4448.52,"methodology":"fee schedule"}]}]},{"description":"HC FASCIOTOMY - ANT LAT POST","code_information":[{"code":"27602","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"gross_charge":5492,"discounted_cash":1625.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4448.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4448.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4448.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1043.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC I&D LEG/ANK DEEP ABSC/HEMAT","code_information":[{"code":"27603","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3574.53,"maximum":3574.53,"gross_charge":4413,"discounted_cash":1306.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3574.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3574.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3574.53,"methodology":"fee schedule"}]}]},{"description":"HC I&D LEG/ANK DEEP ABSC/HEMAT","code_information":[{"code":"27603","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4413,"discounted_cash":1306.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3574.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3574.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3574.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAIN LOWER LEG BURSA","code_information":[{"code":"27604","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF ACHILLES TENDON","code_information":[{"code":"27605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISION OF ACHILLES TENDON","code_information":[{"code":"27606","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG BONE LESION","code_information":[{"code":"27607","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT ANKLE JOINT","code_information":[{"code":"27610","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF ANKLE JOINT","code_information":[{"code":"27612","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC BIO/SOFT TISSLWR LEG SUPERFIC","code_information":[{"code":"27613","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2716.74,"maximum":2716.74,"gross_charge":3354,"discounted_cash":992.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2716.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2716.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2716.74,"methodology":"fee schedule"}]}]},{"description":"HC BIO/SOFT TISSLWR LEG SUPERFIC","code_information":[{"code":"27613","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":3354,"discounted_cash":992.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2716.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2716.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2716.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2347.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BIO SOFT TISSUE LL DEEP","code_information":[{"code":"27614","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3395.52,"maximum":3395.52,"gross_charge":4192,"discounted_cash":1240.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3395.52,"methodology":"fee schedule"}]}]},{"description":"HC BIO SOFT TISSUE LL DEEP","code_information":[{"code":"27614","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4192,"discounted_cash":1240.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"HC BIOPSY SOFT TISSUE LOWR LEG","code_information":[{"code":"27614","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3395.52,"maximum":3395.52,"gross_charge":4192,"discounted_cash":1240.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3395.52,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY SOFT TISSUE LOWR LEG","code_information":[{"code":"27614","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"gross_charge":4192,"discounted_cash":1240.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3395.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":628.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT LEG/ANKLE TUM < 5 CM","code_information":[{"code":"27615","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT LEG/ANKLE TUM 5 CM/>","code_information":[{"code":"27616","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC LEG/ANKLE TUM < 3 CM","code_information":[{"code":"27618","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC LEG/ANKLE TUM DEEP <5 CM","code_information":[{"code":"27619","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT ANKLE JOINT","code_information":[{"code":"27620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE ANKLE JOINT LINING","code_information":[{"code":"27625","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE ANKLE JOINT LINING","code_information":[{"code":"27626","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TENDON LESION","code_information":[{"code":"27630","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXC LEG/ANKLE LES SC 3 CM/>","code_information":[{"code":"27632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC LEG/ANKLE TUM DEP 5 CM/>","code_information":[{"code":"27634","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"REMOVE LOWER LEG BONE LESION","code_information":[{"code":"27635","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT LEG BONE LESION","code_information":[{"code":"27637","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT LEG BONE LESION","code_information":[{"code":"27638","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TIBIA","code_information":[{"code":"27640","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF FIBULA","code_information":[{"code":"27641","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT TIBIA TUMOR","code_information":[{"code":"27645","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT FIBULA TUMOR","code_information":[{"code":"27646","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT TALUS/CALCANEUS TUM","code_information":[{"code":"27647","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INJECTION FOR ANKLE X-RAY","code_information":[{"code":"27648","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ACHILLES TENDON","code_information":[{"code":"27650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT ACHILLES TENDON","code_information":[{"code":"27652","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF ACHILLES TENDON","code_information":[{"code":"27654","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR LEG FASCIA DEFECT","code_information":[{"code":"27656","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27658","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27659","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27664","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF LEG TENDON EACH","code_information":[{"code":"27665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR LOWER LEG TENDONS","code_information":[{"code":"27675","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR LOWER LEG TENDONS","code_information":[{"code":"27676","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RELEASE OF LOWER LEG TENDON","code_information":[{"code":"27680","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE OF LOWER LEG TENDONS","code_information":[{"code":"27681","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF LOWER LEG TENDON","code_information":[{"code":"27685","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE LOWER LEG TENDONS","code_information":[{"code":"27686","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF CALF TENDON","code_information":[{"code":"27687","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISE LOWER LEG TENDON","code_information":[{"code":"27690","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE LOWER LEG TENDON","code_information":[{"code":"27691","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE ADDITIONAL LEG TENDON","code_information":[{"code":"27692","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF ANKLE LIGAMENT","code_information":[{"code":"27695","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANKLE LIGAMENTS","code_information":[{"code":"27696","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANKLE LIGAMENT","code_information":[{"code":"27698","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"minimum":27170,"maximum":80053,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41816,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39532,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27170,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":80053,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75055,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":56417.3,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50493,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":59386.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69086,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42895,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42895,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32087,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32992.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35302.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33982.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34642.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34972.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34642.2,"methodology":"case rate"}]}]},{"description":"REVISION OF ANKLE JOINT","code_information":[{"code":"27700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT ANKLE JOINT","code_information":[{"code":"27702","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION ANKLE JOINT","code_information":[{"code":"27703","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF ANKLE IMPLANT","code_information":[{"code":"27704","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF TIBIA","code_information":[{"code":"27705","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF FIBULA","code_information":[{"code":"27707","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF TIBIA  FIBULA","code_information":[{"code":"27709","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REALIGNMENT OF LOWER LEG","code_information":[{"code":"27712","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF LOWER LEG","code_information":[{"code":"27715","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF TIBIA","code_information":[{"code":"27720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT OF TIBIA","code_information":[{"code":"27722","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT OF TIBIA","code_information":[{"code":"27724","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF LOWER LEG","code_information":[{"code":"27725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR FIBULA NONUNION","code_information":[{"code":"27726","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF LOWER LEG","code_information":[{"code":"27727","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF TIBIA EPIPHYSIS","code_information":[{"code":"27730","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF FIBULA EPIPHYSIS","code_information":[{"code":"27732","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR LOWER LEG EPIPHYSES","code_information":[{"code":"27734","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF LEG EPIPHYSES","code_information":[{"code":"27740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF LEG EPIPHYSES","code_information":[{"code":"27742","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REINFORCE TIBIA","code_information":[{"code":"27745","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27752","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27756","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27758","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TIBIA FRACTURE","code_information":[{"code":"27759","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"CLTX MEDIAL ANKLE FX","code_information":[{"code":"27760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CLTX MED ANKLE FX W/MNPJ","code_information":[{"code":"27762","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"OPTX MEDIAL ANKLE FX","code_information":[{"code":"27766","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CLTX POST ANKLE FX","code_information":[{"code":"27767","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"CLTX POST ANKLE FX W/MNPJ","code_information":[{"code":"27768","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"OPTX POST ANKLE FX","code_information":[{"code":"27769","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF FIBULA FRACTURE","code_information":[{"code":"27780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF FIBULA FRACTURE","code_information":[{"code":"27781","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF FIBULA FRACTURE","code_information":[{"code":"27784","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27786","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27788","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27792","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"minimum":21191,"maximum":74663,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44975,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42518,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25341,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":74663,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70002,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60277.45,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47093,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":63449.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74304,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46135,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21191,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35249.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37717.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36307.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37012.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37364.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37012.47,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27808","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27814","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27816","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27818","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27822","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"27823","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27824","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27826","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27827","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG FRACTURE","code_information":[{"code":"27828","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG JOINT","code_information":[{"code":"27829","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG DISLOCATION","code_information":[{"code":"27830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG DISLOCATION","code_information":[{"code":"27831","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT LOWER LEG DISLOCATION","code_information":[{"code":"27832","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27842","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27846","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT ANKLE DISLOCATION","code_information":[{"code":"27848","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FIXATION OF ANKLE JOINT","code_information":[{"code":"27860","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"FUSION OF ANKLE JOINT OPEN","code_information":[{"code":"27870","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"FUSION OF TIBIOFIBULAR JOINT","code_information":[{"code":"27871","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"HC AMPUTATIONLEGTHRU TIBIAFIB","code_information":[{"code":"27880","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2670.57,"maximum":2670.57,"gross_charge":3297,"discounted_cash":975.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2670.57,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATIONLEGTHRU TIBIAFIB","code_information":[{"code":"27880","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"gross_charge":3297,"discounted_cash":975.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2307.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.4,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LOWER LEG","code_information":[{"code":"27881","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC AMP.LEG GUILLOTINE CIRCULAR","code_information":[{"code":"27882","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2670.57,"maximum":2670.57,"gross_charge":3297,"discounted_cash":975.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2670.57,"methodology":"fee schedule"}]}]},{"description":"HC AMP.LEG GUILLOTINE CIRCULAR","code_information":[{"code":"27882","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"gross_charge":3297,"discounted_cash":975.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2670.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2307.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.4,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATIONLEG 2ND CLOS/REV","code_information":[{"code":"27884","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8811.99,"maximum":8811.99,"gross_charge":10879,"discounted_cash":3220.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8811.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8811.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8811.99,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATIONLEG 2ND CLOS/REV","code_information":[{"code":"27884","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8811.99,"gross_charge":10879,"discounted_cash":3220.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8811.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8811.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8811.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2067.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2175.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1631.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2175.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC AMPUTATLEGTHITHRU TIBIA/FIB","code_information":[{"code":"27886","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2799.36,"maximum":2799.36,"gross_charge":3456,"discounted_cash":1022.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2799.36,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATLEGTHITHRU TIBIA/FIB","code_information":[{"code":"27886","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"gross_charge":3456,"discounted_cash":1022.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF FOOT AT ANKLE","code_information":[{"code":"27888","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ANKLE DISARTICULATION","code_information":[{"code":"27889","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":19456.2,"maximum":19456.2,"gross_charge":24020,"discounted_cash":7109.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19456.2,"methodology":"fee schedule"}]}]},{"description":"HC ANKLE DISARTICULATION","code_information":[{"code":"27889","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19456.2,"gross_charge":24020,"discounted_cash":7109.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19456.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4563.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4804,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3603,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4804,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF LEG","code_information":[{"code":"27892","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF LEG","code_information":[{"code":"27893","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF LEG","code_information":[{"code":"27894","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"LEG/ANKLE SURGERY PROCEDURE","code_information":[{"code":"27899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"minimum":13352,"maximum":53575,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28804,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27231,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18184,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53575,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50230,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40516.35,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33792,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42648.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47589,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29548,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29548,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13352,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23693.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25352.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24404.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24878.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25115.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24878.46,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2791","type":"APR-DRG"}],"standard_charges":[{"minimum":4282,"maximum":4282,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4282,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4282,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4282,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2792","type":"APR-DRG"}],"standard_charges":[{"minimum":7078,"maximum":7078,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2793","type":"APR-DRG"}],"standard_charges":[{"minimum":10118,"maximum":10118,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10118,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10118,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10118,"methodology":"case rate"}]}]},{"description":"HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS","code_information":[{"code":"2794","type":"APR-DRG"}],"standard_charges":[{"minimum":13385,"maximum":13385,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13385,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13385,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13385,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITH MCC","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":9013,"maximum":32852,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14755,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13949,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9013,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32852,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30801,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23346.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17364,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20702,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16750,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24575.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15135,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9887,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13652.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14608.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14062.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14335.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14472.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14335.64,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BURSA OF FOOT","code_information":[{"code":"28001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"TREATMENT OF FOOT INFECTION","code_information":[{"code":"28002","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF FOOT INFECTION","code_information":[{"code":"28003","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FOOT BONE LESION","code_information":[{"code":"28005","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF FOOT FASCIA","code_information":[{"code":"28008","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2801","type":"APR-DRG"}],"standard_charges":[{"minimum":3594,"maximum":3594,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3594,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3594,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3594,"methodology":"case rate"}]}]},{"description":"INCISION OF TOE TENDON","code_information":[{"code":"28010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISION OF TOE TENDONS","code_information":[{"code":"28011","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2802","type":"APR-DRG"}],"standard_charges":[{"minimum":6273,"maximum":6273,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6273,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6273,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6273,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF FOOT JOINT","code_information":[{"code":"28020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF FOOT JOINT","code_information":[{"code":"28022","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF TOE JOINT","code_information":[{"code":"28024","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2803","type":"APR-DRG"}],"standard_charges":[{"minimum":9444,"maximum":9444,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9444,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9444,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9444,"methodology":"case rate"}]}]},{"description":"DECOMPRESSION OF TIBIA NERVE","code_information":[{"code":"28035","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"EXC FOOT/TOE TUM SC 1.5 CM/>","code_information":[{"code":"28039","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"ALCOHOLIC LIVER DISEASE","code_information":[{"code":"2804","type":"APR-DRG"}],"standard_charges":[{"minimum":22481,"maximum":22481,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22481,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22481,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22481,"methodology":"case rate"}]}]},{"description":"EXC FOOT/TOE TUM DEP 1.5CM/>","code_information":[{"code":"28041","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXC FOOT/TOE TUM SC < 1.5 CM","code_information":[{"code":"28043","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXC FOOT/TOE TUM DEEP <1.5CM","code_information":[{"code":"28045","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT FOOT/TOE TUMOR < 3 CM","code_information":[{"code":"28046","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"RESECT FOOT/TOE TUMOR 3 CM/>","code_information":[{"code":"28047","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"BIOPSY OF FOOT JOINT LINING","code_information":[{"code":"28050","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"BIOPSY OF FOOT JOINT LINING","code_information":[{"code":"28052","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TOE JOINT LINING","code_information":[{"code":"28054","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"NEURECTOMY FOOT","code_information":[{"code":"28055","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL FOOT FASCIA","code_information":[{"code":"28060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT FASCIA","code_information":[{"code":"28062","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT JOINT LINING","code_information":[{"code":"28070","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT JOINT LINING","code_information":[{"code":"28072","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT LESION","code_information":[{"code":"28080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"EXCISE FOOT TENDON SHEATH","code_information":[{"code":"28086","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"EXCISE FOOT TENDON SHEATH","code_information":[{"code":"28088","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT LESION","code_information":[{"code":"28090","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TOE LESIONS","code_information":[{"code":"28092","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITH CC","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":5187,"maximum":24899,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8286,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7833,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5187,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24899,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23345,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15441.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9929,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11838,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9639,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16254.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13690,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8500,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8500,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5850,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9030.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9662.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9301.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9481.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9572.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9481.77,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ANKLE/HEEL LESION","code_information":[{"code":"28100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28102","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28103","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT LESION","code_information":[{"code":"28104","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28106","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE/GRAFT FOOT LESION","code_information":[{"code":"28107","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TOE LESIONS","code_information":[{"code":"28108","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2811","type":"APR-DRG"}],"standard_charges":[{"minimum":5265,"maximum":5265,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5265,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5265,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5265,"methodology":"case rate"}]}]},{"description":"PART REMOVAL OF METATARSAL","code_information":[{"code":"28110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC OSTECTOMY COMP 1ST METAT HEAD","code_information":[{"code":"28111","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8939.97,"maximum":8939.97,"gross_charge":11037,"discounted_cash":3266.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8939.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8939.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8939.97,"methodology":"fee schedule"}]}]},{"description":"HC OSTECTOMY COMP 1ST METAT HEAD","code_information":[{"code":"28111","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8939.97,"gross_charge":11037,"discounted_cash":3266.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8939.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8939.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8939.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2207.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1655.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2207.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC OSTECTOMY234 METAT HEAD","code_information":[{"code":"28112","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8952.93,"maximum":8952.93,"gross_charge":11053,"discounted_cash":3271.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8952.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8952.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8952.93,"methodology":"fee schedule"}]}]},{"description":"HC OSTECTOMY234 METAT HEAD","code_information":[{"code":"28112","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8952.93,"gross_charge":11053,"discounted_cash":3271.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8952.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8952.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8952.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2100.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2210.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1657.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PART REMOVAL OF METATARSAL","code_information":[{"code":"28113","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF METATARSAL HEADS","code_information":[{"code":"28114","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF FOOT","code_information":[{"code":"28116","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEEL BONE","code_information":[{"code":"28118","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEEL SPUR","code_information":[{"code":"28119","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2812","type":"APR-DRG"}],"standard_charges":[{"minimum":7170,"maximum":7170,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7170,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7170,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7170,"methodology":"case rate"}]}]},{"description":"PART REMOVAL OF ANKLE/HEEL","code_information":[{"code":"28120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF FOOT BONE","code_information":[{"code":"28122","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28124","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28126","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2813","type":"APR-DRG"}],"standard_charges":[{"minimum":9846,"maximum":9846,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9846,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9846,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9846,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ANKLE BONE","code_information":[{"code":"28130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS","code_information":[{"code":"2814","type":"APR-DRG"}],"standard_charges":[{"minimum":10343,"maximum":10343,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10343,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10343,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10343,"methodology":"case rate"}]}]},{"description":"REMOVAL OF METATARSAL","code_information":[{"code":"28140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TOE","code_information":[{"code":"28150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28153","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TOE","code_information":[{"code":"28160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT TARSAL TUMOR","code_information":[{"code":"28171","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT METATARSAL TUMOR","code_information":[{"code":"28173","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT PHALANX OF TOE TUMOR","code_information":[{"code":"28175","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOREIGN BODY FOOT","code_information":[{"code":"28190","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1940.76,"maximum":1940.76,"gross_charge":2396,"discounted_cash":709.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1940.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1940.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1940.76,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF FOREIGN BODY FOOT","code_information":[{"code":"28190","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2396,"discounted_cash":709.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1940.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1940.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1940.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1677.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":479.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":479.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT FOREIGN BODY","code_information":[{"code":"28192","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FOOT FOREIGN BODY","code_information":[{"code":"28193","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION DISCHARGED ALIVE WITHOUT CC/MCC","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":4080,"maximum":24074,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6518,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6162,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4080,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24074,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22571,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13280.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7747,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9236,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7582,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13979.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10769,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6686,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5850,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7766.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8310.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7999.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8154.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8232.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8154.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF FOOT TENDON","code_information":[{"code":"28200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT OF FOOT TENDON","code_information":[{"code":"28202","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF FOOT TENDON","code_information":[{"code":"28208","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2821","type":"APR-DRG"}],"standard_charges":[{"minimum":4301,"maximum":4301,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4301,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4301,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4301,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT OF FOOT TENDON","code_information":[{"code":"28210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2822","type":"APR-DRG"}],"standard_charges":[{"minimum":5656,"maximum":5656,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5656,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5656,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5656,"methodology":"case rate"}]}]},{"description":"RELEASE OF FOOT TENDON","code_information":[{"code":"28220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RELEASE OF FOOT TENDONS","code_information":[{"code":"28222","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE OF FOOT TENDON","code_information":[{"code":"28225","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE OF FOOT TENDONS","code_information":[{"code":"28226","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2823","type":"APR-DRG"}],"standard_charges":[{"minimum":10345,"maximum":10345,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10345,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10345,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10345,"methodology":"case rate"}]}]},{"description":"INCISION OF FOOT TENDON(S)","code_information":[{"code":"28230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISION OF TOE TENDON","code_information":[{"code":"28232","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"INCISION OF FOOT TENDON","code_information":[{"code":"28234","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REVISION OF FOOT TENDON","code_information":[{"code":"28238","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY","code_information":[{"code":"2824","type":"APR-DRG"}],"standard_charges":[{"minimum":16839,"maximum":16839,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16839,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16839,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16839,"methodology":"case rate"}]}]},{"description":"RELEASE OF BIG TOE","code_information":[{"code":"28240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF FOOT FASCIA","code_information":[{"code":"28250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE OF MIDFOOT JOINT","code_information":[{"code":"28260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REVISION OF FOOT TENDON","code_information":[{"code":"28261","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REVISION OF FOOT AND ANKLE","code_information":[{"code":"28262","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"RELEASE OF MIDFOOT JOINT","code_information":[{"code":"28264","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RELEASE OF FOOT CONTRACTURE","code_information":[{"code":"28270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RELEASE OF TOE JOINT EACH","code_information":[{"code":"28272","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"FUSION OF TOES","code_information":[{"code":"28280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF HAMMERTOE","code_information":[{"code":"28285","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF HAMMERTOE","code_information":[{"code":"28286","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC PARTIAL OSTECTOMY-TARSAL/METAT","code_information":[{"code":"28288","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3914.73,"maximum":3914.73,"gross_charge":4833,"discounted_cash":1430.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3914.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3914.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3914.73,"methodology":"fee schedule"}]}]},{"description":"HC PARTIAL OSTECTOMY-TARSAL/METAT","code_information":[{"code":"28288","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"gross_charge":4833,"discounted_cash":1430.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3914.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3914.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3914.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":918.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRJ HALUX RIGDUS W/O IMPLT","code_information":[{"code":"28289","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRJ HALUX RIGDUS W/IMPLT","code_information":[{"code":"28291","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28292","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28295","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28296","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28297","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28298","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CORRECTION HALLUX VALGUS","code_information":[{"code":"28299","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION EXPIRED WITH MCC","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"minimum":7400,"maximum":29040,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17577,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16617,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11200,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25182,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23610,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26795.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20738,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24725,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20814,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28206.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29040,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18031,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18031,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7400,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15670.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16767.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16140.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16453.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16610.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16453.65,"methodology":"case rate"}]}]},{"description":"INCISION OF HEEL BONE","code_information":[{"code":"28300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF ANKLE BONE","code_information":[{"code":"28302","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF MIDFOOT BONES","code_information":[{"code":"28304","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISE/GRAFT MIDFOOT BONES","code_information":[{"code":"28305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF METATARSAL","code_information":[{"code":"28306","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF METATARSAL","code_information":[{"code":"28307","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"INCISION OF METATARSAL","code_information":[{"code":"28308","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"INCISION OF METATARSALS","code_information":[{"code":"28309","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2831","type":"APR-DRG"}],"standard_charges":[{"minimum":3384,"maximum":3384,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3384,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3384,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3384,"methodology":"case rate"}]}]},{"description":"REVISION OF BIG TOE","code_information":[{"code":"28310","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISION OF TOE","code_information":[{"code":"28312","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR DEFORMITY OF TOE","code_information":[{"code":"28313","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SESAMOID BONE","code_information":[{"code":"28315","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2832","type":"APR-DRG"}],"standard_charges":[{"minimum":5148,"maximum":5148,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5148,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5148,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5148,"methodology":"case rate"}]}]},{"description":"REPAIR OF FOOT BONES","code_information":[{"code":"28320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REPAIR OF METATARSALS","code_information":[{"code":"28322","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2833","type":"APR-DRG"}],"standard_charges":[{"minimum":9142,"maximum":9142,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9142,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9142,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9142,"methodology":"case rate"}]}]},{"description":"OTHER DISORDERS OF THE LIVER","code_information":[{"code":"2834","type":"APR-DRG"}],"standard_charges":[{"minimum":12942,"maximum":12942,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12942,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12942,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12942,"methodology":"case rate"}]}]},{"description":"RESECT ENLARGED TOE TISSUE","code_information":[{"code":"28340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"RESECT ENLARGED TOE","code_information":[{"code":"28341","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR EXTRA TOE(S)","code_information":[{"code":"28344","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR WEBBED TOE(S)","code_information":[{"code":"28345","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT FOOT","code_information":[{"code":"28360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION EXPIRED WITH CC","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"minimum":3515,"maximum":14163.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6661,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6297,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4202,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10991,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10305,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13455.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7949,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9477,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7810,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14163.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11005,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6833,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6833,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3515,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7868.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8419.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8104.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8262.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8340.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8262.23,"methodology":"case rate"}]}]},{"description":"TREATMENT OF HEEL FRACTURE","code_information":[{"code":"28400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF HEEL FRACTURE","code_information":[{"code":"28405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF HEEL FRACTURE","code_information":[{"code":"28406","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2841","type":"APR-DRG"}],"standard_charges":[{"minimum":4611,"maximum":4611,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4611,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4611,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4611,"methodology":"case rate"}]}]},{"description":"TREAT HEEL FRACTURE","code_information":[{"code":"28415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2842","type":"APR-DRG"}],"standard_charges":[{"minimum":5592,"maximum":5592,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5592,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5592,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5592,"methodology":"case rate"}]}]},{"description":"TREAT/GRAFT HEEL FRACTURE","code_information":[{"code":"28420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2843","type":"APR-DRG"}],"standard_charges":[{"minimum":11052,"maximum":11052,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11052,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11052,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11052,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"28430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"28435","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANKLE FRACTURE","code_information":[{"code":"28436","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DISORDERS OF GALLBLADDER AND BILIARY TRACT","code_information":[{"code":"2844","type":"APR-DRG"}],"standard_charges":[{"minimum":14139,"maximum":14139,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14139,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14139,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14139,"methodology":"case rate"}]}]},{"description":"TREAT ANKLE FRACTURE","code_information":[{"code":"28445","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"OSTEOCHONDRAL TALUS AUTOGRFT","code_information":[{"code":"28446","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT MIDFOOT FRACTURE EACH","code_information":[{"code":"28450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT MIDFOOT FRACTURE EACH","code_information":[{"code":"28455","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT MIDFOOT FRACTURE","code_information":[{"code":"28456","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT MIDFOOT FRACTURE EACH","code_information":[{"code":"28465","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28470","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28475","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28476","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT METATARSAL FRACTURE","code_information":[{"code":"28485","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28490","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28495","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28496","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION EXPIRED WITHOUT CC/MCC","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"minimum":2776,"maximum":12087.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5046,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4771,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10194,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9558,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11482.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6982,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5160,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12087.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8337,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5177,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5177,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3421,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6715.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7185.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6916.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7050.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7117.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7050.79,"methodology":"case rate"}]}]},{"description":"TREAT BIG TOE FRACTURE","code_information":[{"code":"28505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TOE FRACTURE","code_information":[{"code":"28510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREATMENT OF TOE FRACTURE","code_information":[{"code":"28515","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT TOE FRACTURE","code_information":[{"code":"28525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT SESAMOID BONE FRACTURE","code_information":[{"code":"28530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT SESAMOID BONE FRACTURE","code_information":[{"code":"28531","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28546","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"REPAIR FOOT DISLOCATION","code_information":[{"code":"28555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28575","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28576","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REPAIR FOOT DISLOCATION","code_information":[{"code":"28585","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"CIRCULATORY DISORDERS EXCEPT AMI WITH CARDIAC CATHETERIZATION WITH MCC","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":12247,"maximum":37700,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19895,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18809,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12247,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37700,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35346,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29629,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22926,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27333,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22759,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31188.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32870,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20409,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20409,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15312,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17326.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18539.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17846.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18193.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18366.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18193.25,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT FOOT DISLOCATION","code_information":[{"code":"28606","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR FOOT DISLOCATION","code_information":[{"code":"28615","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28635","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28636","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR TOE DISLOCATION","code_information":[{"code":"28645","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"TREAT TOE DISLOCATION","code_information":[{"code":"28666","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF TOE DISLOCATION","code_information":[{"code":"28675","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"CIRCULATORY DISORDERS EXCEPT AMI WITH CARDIAC CATHETERIZATION WITHOUT MCC","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":6145,"maximum":21096,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9795,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9260,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6145,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21096,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19779,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17286.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11892,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14178,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11420,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18195.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5573,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16183,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10048,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7919,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10108.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10816.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10412.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10614.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10715.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10614.3,"methodology":"case rate"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28705","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":40261.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40261.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27190.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16441.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17592.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16934.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17263.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18085.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17427.93,"methodology":"case rate"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28715","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28725","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28730","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28735","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"REVISION OF FOOT BONES","code_information":[{"code":"28737","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"FUSION OF FOOT BONES","code_information":[{"code":"28740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF BIG TOE JOINT","code_information":[{"code":"28750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF BIG TOE JOINT","code_information":[{"code":"28755","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"FUSION OF BIG TOE JOINT","code_information":[{"code":"28760","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"minimum":12454,"maximum":40566,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24553,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23212,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14732,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36618,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34332,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35321.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34750,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27377,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":37180.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40566,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25187,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25187,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12454,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20655.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22101.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21275.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21688.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21895.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21688.64,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF MIDFOOT","code_information":[{"code":"28800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC AMPUTATION-TRANSMETATARSAL","code_information":[{"code":"28805","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4717.44,"maximum":4717.44,"gross_charge":5824,"discounted_cash":1723.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4717.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4717.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4717.44,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATION-TRANSMETATARSAL","code_information":[{"code":"28805","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"gross_charge":5824,"discounted_cash":1723.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4717.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4717.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4717.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4076.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":873.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1164.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC AMPUTATION METALTERSAL SNG TOE","code_information":[{"code":"28810","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4256.55,"maximum":4256.55,"gross_charge":5255,"discounted_cash":1555.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4256.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4256.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4256.55,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATION METALTERSAL SNG TOE","code_information":[{"code":"28810","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"gross_charge":5255,"discounted_cash":1555.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4256.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4256.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4256.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":998.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1051,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC AMPUTATION TOE METAR JOINT","code_information":[{"code":"28820","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2803.41,"maximum":2803.41,"gross_charge":3461,"discounted_cash":1024.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2803.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2803.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2803.41,"methodology":"fee schedule"}]}]},{"description":"HC AMPUTATION TOE METAR JOINT","code_information":[{"code":"28820","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"gross_charge":3461,"discounted_cash":1024.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2803.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2803.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2803.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":692.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HC AMP-INTERPHALANGEAL JNT TOE","code_information":[{"code":"28825","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4666.41,"maximum":4666.41,"gross_charge":5761,"discounted_cash":1705.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4666.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4666.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4666.41,"methodology":"fee schedule"}]}]},{"description":"HC AMP-INTERPHALANGEAL JNT TOE","code_information":[{"code":"28825","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"gross_charge":5761,"discounted_cash":1705.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4666.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4666.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4666.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1094.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"HI ENRGY ESWT PLANTAR FASCIA","code_information":[{"code":"28890","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"FOOT/TOES SURGERY PROCEDURE","code_information":[{"code":"28899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH CC","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"minimum":7972,"maximum":23827.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14173,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13399,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8395,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21237,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19911,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22635.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17371,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20711,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15602,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23827.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23416,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14539,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14539,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7972,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13237.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14163.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13634.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13899.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14031.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13899.23,"methodology":"case rate"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"minimum":6165,"maximum":16915.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8800,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8320,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6165,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16426,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15401,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16070.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13032,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15538,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11456,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16915.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14539,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9027,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9027,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7294,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9397.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10055.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9679.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9867.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9961.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9867.6,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29015","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29035","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29044","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"APPLICATION OF BODY CAST","code_information":[{"code":"29046","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF FIGURE EIGHT","code_information":[{"code":"29049","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF SHOULDER CAST","code_information":[{"code":"29055","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF SHOULDER CAST","code_information":[{"code":"29058","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF LONG ARM CAST","code_information":[{"code":"29065","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF FOREARM CAST","code_information":[{"code":"29075","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLY HAND/WRIST CAST","code_information":[{"code":"29085","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"APPLY FINGER CAST","code_information":[{"code":"29086","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"HEART FAILURE AND SHOCK WITH MCC","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":7294,"maximum":20683.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11729,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11088,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7294,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17712,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16606,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19649.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13833,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16493,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13555,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20683.19,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19378,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12032,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12032,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8217,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11490.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12295.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11835.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12065.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12180.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12065.2,"methodology":"case rate"}]}]},{"description":"HC APPLY ARM LONG SPLINT","code_information":[{"code":"29105","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":102.87,"maximum":102.87,"gross_charge":127,"discounted_cash":37.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.87,"methodology":"fee schedule"}]}]},{"description":"HC APPLY ARM LONG SPLINT","code_information":[{"code":"29105","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":127,"discounted_cash":37.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"APPLY SPLINT FOREARM-HAND","code_information":[{"code":"29125","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":354.78,"maximum":354.78,"gross_charge":438,"discounted_cash":129.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":354.78,"methodology":"fee schedule"}]}]},{"description":"APPLY SPLINT FOREARM-HAND","code_information":[{"code":"29125","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":438,"discounted_cash":129.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC APPLY ARM SHORT SPLINT","code_information":[{"code":"29125","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":354.78,"maximum":354.78,"gross_charge":438,"discounted_cash":129.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":354.78,"methodology":"fee schedule"}]}]},{"description":"HC APPLY ARM SHORT SPLINT","code_information":[{"code":"29125","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":438,"discounted_cash":129.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":354.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC APP SHORT ARM DYNAMIC SPLINT","code_information":[{"code":"29126","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":103.68,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"}]}]},{"description":"HC APP SHORT ARM DYNAMIC SPLINT","code_information":[{"code":"29126","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":128,"discounted_cash":37.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC APPLY FINGER SPLINT STATIC","code_information":[{"code":"29130","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"HC APPLY FINGER SPLINT STATIC","code_information":[{"code":"29130","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC APP DYNAMIC FINGER SPLINT","code_information":[{"code":"29131","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"HC APP DYNAMIC FINGER SPLINT","code_information":[{"code":"29131","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HEART FAILURE AND SHOCK WITH CC","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"minimum":4866,"maximum":15553.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7741,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7318,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4866,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11361,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10652,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14776.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9326,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11119,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9043,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15553.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12790,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7941,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7941,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5301,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8640.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9245.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8900.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9073.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9159.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9073.01,"methodology":"case rate"}]}]},{"description":"STRAPPING OF CHEST","code_information":[{"code":"29200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"STRAPPING OF SHOULDER","code_information":[{"code":"29240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"STRAPPING OF ELBOW OR WRIST","code_information":[{"code":"29260","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"STRAPPING OF HAND OR FINGER","code_information":[{"code":"29280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HEART FAILURE AND SHOCK WITHOUT CC/MCC","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"minimum":3190,"maximum":11940.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4932,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4663,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3190,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8390,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7866,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11343.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6056,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7221,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5928,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":11940.21,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8149,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5060,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5060,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3680,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6633.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7097.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6832.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6965.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7031.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6965.13,"methodology":"case rate"}]}]},{"description":"APPLICATION OF HIP CAST","code_information":[{"code":"29305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF HIP CASTS","code_information":[{"code":"29325","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF LONG LEG CAST","code_information":[{"code":"29345","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF LONG LEG CAST","code_information":[{"code":"29355","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLY LONG LEG CAST BRACE","code_information":[{"code":"29358","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF LONG LEG CAST","code_information":[{"code":"29365","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"minimum":4648,"maximum":19795.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11038,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10436,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6214,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19186,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17988,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18805.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12479,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14878,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11547,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19795.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18237,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11323,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11323,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4648,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10997.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11767.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11327.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11547.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11657.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11547.17,"methodology":"case rate"}]}]},{"description":"APPLY SHORT LEG CAST","code_information":[{"code":"29405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLY SHORT LEG CAST","code_information":[{"code":"29425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLY SHORT LEG CAST","code_information":[{"code":"29435","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"ADDITION OF WALKER TO CAST","code_information":[{"code":"29440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"HC APPLY RIG TTL CNTCT LEGCAST","code_information":[{"code":"29445","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":325.62,"maximum":325.62,"gross_charge":402,"discounted_cash":119,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.62,"methodology":"fee schedule"}]}]},{"description":"HC APPLY RIG TTL CNTCT LEGCAST","code_information":[{"code":"29445","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":402,"discounted_cash":119,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"APPLICATION OF LEG CAST","code_information":[{"code":"29450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"minimum":4529,"maximum":14728.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7099,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6712,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4529,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6525,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6118,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13991.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9574,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11414,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8416,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14728.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11729,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7283,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7283,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4648,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8182.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8755.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8427.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8591.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8673.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8591.4,"methodology":"case rate"}]}]},{"description":"APPLICATION LONG LEG SPLINT","code_information":[{"code":"29505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"median_amount":177.67,"10th_percentile":177.67,"90th_percentile":177.67,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"APPLICATION LOWER LEG SPLINT","code_information":[{"code":"29515","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"median_amount":177.67,"10th_percentile":177.67,"90th_percentile":177.67,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"STRAPPING OF HIP","code_information":[{"code":"29520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"STRAPPING OF KNEE","code_information":[{"code":"29530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"STRAPPING OF ANKLE AND/OR FT","code_information":[{"code":"29540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"STRAPPING OF TOES","code_information":[{"code":"29550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"29580","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"HC STRAPPING UNNA BOOT","code_information":[{"code":"29580","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":375.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"HC UNNA BOOT APPLICATION","code_information":[{"code":"29580","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":477.9,"maximum":477.9,"gross_charge":590,"discounted_cash":174.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"}]}]},{"description":"HC UNNA BOOT APPLICATION","code_information":[{"code":"29580","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":590,"discounted_cash":174.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":413,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"HC APPLY MULTIL COMPRS LWR LEG","code_information":[{"code":"29581","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":511.92,"maximum":511.92,"gross_charge":632,"discounted_cash":187.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":511.92,"methodology":"fee schedule"}]}]},{"description":"HC APPLY MULTIL COMPRS LWR LEG","code_information":[{"code":"29581","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":632,"discounted_cash":187.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":442.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"HC VENOUS WOUND COMPR BILAT","code_information":[{"code":"29581","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":511.92,"maximum":511.92,"gross_charge":632,"discounted_cash":187.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":511.92,"methodology":"fee schedule"}]}]},{"description":"HC VENOUS WOUND COMPR BILAT","code_information":[{"code":"29581","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":632,"discounted_cash":187.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":442.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"APPL MULTLAY COMPRS ARM/HAND","code_information":[{"code":"29584","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST UNEXPLAINED WITH MCC","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"minimum":9108,"maximum":24540.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14728,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13923,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9108,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16023,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15022,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23313.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17708,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21113,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16927,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24540.7,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24332,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15108,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15108,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10215,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13633.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14588.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14042.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14315.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14451.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14315.41,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST UNEXPLAINED WITH CC","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"minimum":2876,"maximum":13740.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6332,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5986,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4139,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12206,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11444,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13053.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6878,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8200,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7693,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13740.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10461,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6495,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6495,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7633.67,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8168.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7862.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8015.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8091.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8015.36,"methodology":"case rate"}]}]},{"description":"REMOVAL/REVISION OF CAST","code_information":[{"code":"29700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"REMOVAL/REVISION OF CAST","code_information":[{"code":"29705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"REMOVAL/REVISION OF CAST","code_information":[{"code":"29710","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"REPAIR OF BODY CAST","code_information":[{"code":"29720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"WINDOWING OF CAST","code_information":[{"code":"29730","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"WEDGING OF CAST","code_information":[{"code":"29740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"WEDGING OF CLUBFOOT CAST","code_information":[{"code":"29750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":581.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":391.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":406.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":237.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":254.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":244.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":249.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":261.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":251.69,"methodology":"case rate"}]}]},{"description":"CASTING/STRAPPING PROCEDURE","code_information":[{"code":"29799","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":345.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":241.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":150.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":149.53,"methodology":"case rate"}]}]},{"description":"CARDIAC ARREST UNEXPLAINED WITHOUT CC/MCC","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"minimum":2498,"maximum":12064,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3970,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3754,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2498,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12064,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11311,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10167.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5280,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6295,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4642,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":10702.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6560,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4073,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4073,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2876,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5946.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6362.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6124.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6243.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6302.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6243.38,"methodology":"case rate"}]}]},{"description":"JAW ARTHROSCOPY/SURGERY","code_information":[{"code":"29800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"JAW ARTHROSCOPY/SURGERY","code_information":[{"code":"29804","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS DX +- SYNOVIAL BX","code_information":[{"code":"29805","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG CAPSULORPAPHY","code_information":[{"code":"29806","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG RPR SLAP LES","code_information":[{"code":"29807","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG RMVL LOOSE/FB","code_information":[{"code":"29819","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG PRTL SYNVCT","code_information":[{"code":"29820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG COMPL SYNVCT","code_information":[{"code":"29821","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG LMTD DBRDMT","code_information":[{"code":"29822","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG XTNSV DBRDMT","code_information":[{"code":"29823","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG DSTL CLAVICLC","code_information":[{"code":"29824","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG LSSRESCJ ADS","code_information":[{"code":"29825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SHO ARTHRS SRG DECOMPRESSION","code_information":[{"code":"29826","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ARTHROSCOP ROTATOR CUFF REPR","code_information":[{"code":"29827","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ARTHROSCOPY BICEPS TENODESIS","code_information":[{"code":"29828","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ELBOW ARTHROSCOPY","code_information":[{"code":"29830","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29834","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29835","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29836","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29837","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ELBOW ARTHROSCOPY/SURGERY","code_information":[{"code":"29838","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"WRIST ARTHROSCOPY","code_information":[{"code":"29840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29843","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29844","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29845","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29846","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"WRIST ARTHROSCOPY/SURGERY","code_information":[{"code":"29847","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"WRIST ENDOSCOPY/SURGERY","code_information":[{"code":"29848","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29850","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29851","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"TIBIAL ARTHROSCOPY/SURGERY","code_information":[{"code":"29855","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"TIBIAL ARTHROSCOPY/SURGERY","code_information":[{"code":"29856","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"HIP ARTHROSCOPY DX","code_information":[{"code":"29860","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HIP ARTHRO W/FB REMOVAL","code_information":[{"code":"29861","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HIP ARTHR0 W/DEBRIDEMENT","code_information":[{"code":"29862","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HIP ARTHR0 W/SYNOVECTOMY","code_information":[{"code":"29863","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"AUTGRFT IMPLNT KNEE W/SCOPE","code_information":[{"code":"29866","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ALLGRFT IMPLNT KNEE W/SCOPE","code_information":[{"code":"29867","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"MENISCAL TRNSPL KNEE W/SCPE","code_information":[{"code":"29868","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY DX","code_information":[{"code":"29870","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/DRAINAGE","code_information":[{"code":"29871","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29873","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29874","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29875","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29876","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29877","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29879","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29880","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29881","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29882","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29883","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29884","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29885","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29886","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29887","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29888","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"KNEE ARTHROSCOPY/SURGERY","code_information":[{"code":"29889","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29891","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29892","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SCOPE PLANTAR FASCIOTOMY","code_information":[{"code":"29893","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29894","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29895","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29897","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29898","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"ANKLE ARTHROSCOPY/SURGERY","code_information":[{"code":"29899","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH MCC","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":7450,"maximum":27105,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14541,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13746,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8955,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27105,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25413,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23085.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16624,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19820,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16642,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24300.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24023,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14916,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14916,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13500.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14445.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13905.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14175.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14310.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14175.11,"methodology":"case rate"}]}]},{"description":"MCP JOINT ARTHROSCOPY DX","code_information":[{"code":"29900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MCP JOINT ARTHROSCOPY SURG","code_information":[{"code":"29901","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"MCP JOINT ARTHROSCOPY SURG","code_information":[{"code":"29902","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3503.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3503.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2344.95,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2446.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1430.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1530.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1473.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1502.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1573.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1516.68,"methodology":"case rate"}]}]},{"description":"SUBTALAR ARTHRO W/FB RMVL","code_information":[{"code":"29904","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SUBTALAR ARTHRO W/EXC","code_information":[{"code":"29905","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SUBTALAR ARTHRO W/DEB","code_information":[{"code":"29906","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SUBTALAR ARTHRO W/FUSION","code_information":[{"code":"29907","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"HIP ARTHRO W/FEMOROPLASTY","code_information":[{"code":"29914","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HIP ARTHRO ACETABULOPLASTY","code_information":[{"code":"29915","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"HIP ARTHRO W/LABRAL REPAIR","code_information":[{"code":"29916","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"ARTHROSCOPY OF JOINT","code_information":[{"code":"29999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":525.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":344.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":366.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":214.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":229.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":220.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":225.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":235.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":227.33,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH CC","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":6062,"maximum":17975.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9624,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9098,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6062,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17382,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16297,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17076.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11145,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13288,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11265,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17975.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15900,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9872,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9872,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6138,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9986.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10685.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10285.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10485.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10585.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10485.46,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF NOSE LESION","code_information":[{"code":"30000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF NOSE LESION","code_information":[{"code":"30020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":3527,"maximum":16947,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6413,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6062,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4033,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16947,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15889,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13152.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7741,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9230,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7494,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13844.67,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10595,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6578,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6578,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3527,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7691.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8229.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7922.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8076.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8152.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8076.06,"methodology":"case rate"}]}]},{"description":"INTRANASAL BIOPSY","code_information":[{"code":"30100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NOSE POLYP(S)","code_information":[{"code":"30110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NOSE POLYP(S)","code_information":[{"code":"30115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF INTRANASAL LESION","code_information":[{"code":"30117","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF INTRANASAL LESION","code_information":[{"code":"30118","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NOSE LESION","code_information":[{"code":"30124","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NOSE LESION","code_information":[{"code":"30125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE INFERIOR TURBINATE","code_information":[{"code":"30130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"RESECT INFERIOR TURBINATE","code_information":[{"code":"30140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF NOSE","code_information":[{"code":"30150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NOSE","code_information":[{"code":"30160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"ATHEROSCLEROSIS WITH MCC","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"minimum":4412,"maximum":33212,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10457,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9886,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6369,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33212,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31138,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18094.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13033,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15539,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11837,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19046.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10727,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10727,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4412,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10581.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11322.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10899.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11110.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11216.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11110.75,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NOSE","code_information":[{"code":"30200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"NASAL SINUS THERAPY","code_information":[{"code":"30210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"INSERT NASAL SEPTAL BUTTON","code_information":[{"code":"30220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"ATHEROSCLEROSIS WITHOUT MCC","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"minimum":3739,"maximum":21362,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6044,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5714,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3739,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21362,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20029,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12702.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7308,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8713,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6948,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13370.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9986,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6200,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6200,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4237,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7428.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7948.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7650.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7799.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7873.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7799.51,"methodology":"case rate"}]}]},{"description":"REMOVE NASAL FOREIGN BODY","code_information":[{"code":"30300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3031","type":"APR-DRG"}],"standard_charges":[{"minimum":50700,"maximum":50700,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"}]}]},{"description":"REMOVE NASAL FOREIGN BODY","code_information":[{"code":"30310","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3032","type":"APR-DRG"}],"standard_charges":[{"minimum":50700,"maximum":50700,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"}]}]},{"description":"REMOVE NASAL FOREIGN BODY","code_information":[{"code":"30320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3033","type":"APR-DRG"}],"standard_charges":[{"minimum":50700,"maximum":50700,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50700,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK","code_information":[{"code":"3034","type":"APR-DRG"}],"standard_charges":[{"minimum":62939,"maximum":62939,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62939,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62939,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62939,"methodology":"case rate"}]}]},{"description":"HYPERTENSION WITH MCC","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":5250,"maximum":19179.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10560,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9983,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6528,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15931,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14936,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18220.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11875,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14158,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12131,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19179.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10833,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10833,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5250,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10655.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11401.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10975.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11188.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11294.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11188.32,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF NOSE","code_information":[{"code":"30400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3041","type":"APR-DRG"}],"standard_charges":[{"minimum":25874,"maximum":25874,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25874,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25874,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25874,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF NOSE","code_information":[{"code":"30410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3042","type":"APR-DRG"}],"standard_charges":[{"minimum":29289,"maximum":29289,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29289,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29289,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29289,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF NOSE","code_information":[{"code":"30420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3043","type":"APR-DRG"}],"standard_charges":[{"minimum":38460,"maximum":38460,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38460,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38460,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38460,"methodology":"case rate"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30430","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30435","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK","code_information":[{"code":"3044","type":"APR-DRG"}],"standard_charges":[{"minimum":45481,"maximum":45481,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45481,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45481,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45481,"methodology":"case rate"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30460","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION OF NOSE","code_information":[{"code":"30462","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR NASAL STENOSIS","code_information":[{"code":"30465","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RPR NSL VLV COLLAPSE W/IMPLT","code_information":[{"code":"30468","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HYPERTENSION WITHOUT MCC","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":4281,"maximum":14275.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6748,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6379,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4281,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6950,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6516,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13562.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8059,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9609,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7955,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14275.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11149,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6922,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4297,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7931.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8486.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8169.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8327.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8406.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8327.66,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3051","type":"APR-DRG"}],"standard_charges":[{"minimum":6425,"maximum":6425,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6425,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6425,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6425,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3052","type":"APR-DRG"}],"standard_charges":[{"minimum":14420,"maximum":14420,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14420,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14420,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14420,"methodology":"case rate"}]}]},{"description":"REPAIR OF NASAL SEPTUM","code_information":[{"code":"30520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3053","type":"APR-DRG"}],"standard_charges":[{"minimum":22787,"maximum":22787,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22787,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22787,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22787,"methodology":"case rate"}]}]},{"description":"AMPUTATION OF LOWER LIMB EXCEPT TOES","code_information":[{"code":"3054","type":"APR-DRG"}],"standard_charges":[{"minimum":33883,"maximum":33883,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33883,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33883,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33883,"methodology":"case rate"}]}]},{"description":"REPAIR NASAL DEFECT","code_information":[{"code":"30540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR NASAL DEFECT","code_information":[{"code":"30545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RELEASE OF NASAL ADHESIONS","code_information":[{"code":"30560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"REPAIR UPPER JAW FISTULA","code_information":[{"code":"30580","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"minimum":5336,"maximum":58078,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13460,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12725,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8731,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58078,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54452,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21764.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15952,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19019,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16226,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22910.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13808,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13808,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5336,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12727.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13618.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13109.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13364.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13491.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13364.33,"methodology":"case rate"}]}]},{"description":"REPAIR MOUTH/NOSE FISTULA","code_information":[{"code":"30600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"INTRANASAL RECONSTRUCTION","code_information":[{"code":"30620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR NASAL SEPTUM DEFECT","code_information":[{"code":"30630","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"minimum":4144,"maximum":47797,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8327,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7873,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47797,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44813,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15492.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9851,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11745,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9952,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16307.66,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13758,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8542,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8542,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4144,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9059.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9694,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9331.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9512.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9603.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9512.81,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":6830,"maximum":23254,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10840,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10248,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6830,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23254,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21802,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18562.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12675,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15111,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12693,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19539.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11120,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11120,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8004,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10855.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11615.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11180.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11398.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11506.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11398.09,"methodology":"case rate"}]}]},{"description":"ABLATE INF TURBINATE SUPERF","code_information":[{"code":"30801","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"ABLATE INF TURBINATE SUBMUC","code_information":[{"code":"30802","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3081","type":"APR-DRG"}],"standard_charges":[{"minimum":10949,"maximum":10949,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10949,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10949,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10949,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3082","type":"APR-DRG"}],"standard_charges":[{"minimum":16494,"maximum":16494,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16494,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16494,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16494,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3083","type":"APR-DRG"}],"standard_charges":[{"minimum":23712,"maximum":23712,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23712,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23712,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23712,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR FRACTURE REPAIR","code_information":[{"code":"3084","type":"APR-DRG"}],"standard_charges":[{"minimum":32242,"maximum":32242,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32242,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32242,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32242,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":4231,"maximum":14144.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6646,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6283,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4231,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13654,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12802,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13436.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7973,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9505,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7863,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14144.17,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10979,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6817,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6817,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5122,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7857.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8407.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8093.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8250.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8250.77,"methodology":"case rate"}]}]},{"description":"CONTROL OF NOSEBLEED","code_information":[{"code":"30901","type":"CPT"}],"standard_charges":[{"minimum":115.24,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"CONTROL OF NOSEBLEED","code_information":[{"code":"30903","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":121.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"CONTROL NASAL HEMORRAGE","code_information":[{"code":"30905","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":350.73,"maximum":350.73,"gross_charge":433,"discounted_cash":128.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.73,"methodology":"fee schedule"}]}]},{"description":"CONTROL NASAL HEMORRAGE","code_information":[{"code":"30905","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"gross_charge":433,"discounted_cash":128.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":121.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"REPEAT CONTROL OF NOSEBLEED","code_information":[{"code":"30906","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3091","type":"APR-DRG"}],"standard_charges":[{"minimum":15357,"maximum":15357,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15357,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15357,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15357,"methodology":"case rate"}]}]},{"description":"LIGATION NASAL SINUS ARTERY","code_information":[{"code":"30915","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3092","type":"APR-DRG"}],"standard_charges":[{"minimum":16040,"maximum":16040,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16040,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16040,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16040,"methodology":"case rate"}]}]},{"description":"LIGATION UPPER JAW ARTERY","code_information":[{"code":"30920","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3093","type":"APR-DRG"}],"standard_charges":[{"minimum":28820,"maximum":28820,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28820,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28820,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28820,"methodology":"case rate"}]}]},{"description":"THER FX NASAL INF TURBINATE","code_information":[{"code":"30930","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER SIGNIFICANT HIP AND FEMUR SURGERY","code_information":[{"code":"3094","type":"APR-DRG"}],"standard_charges":[{"minimum":31788,"maximum":31788,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31788,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31788,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31788,"methodology":"case rate"}]}]},{"description":"NASAL SURGERY PROCEDURE","code_information":[{"code":"30999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":3142,"maximum":12065.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5029,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4755,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3142,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9911,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9292,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11461.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5958,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7103,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5839,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12065.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8309,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5159,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3465,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6702.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7172.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6903.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7037.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7105,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7037.98,"methodology":"case rate"}]}]},{"description":"IRRIGATION MAXILLARY SINUS","code_information":[{"code":"31000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"IRRIGATION SPHENOID SINUS","code_information":[{"code":"31002","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3101","type":"APR-DRG"}],"standard_charges":[{"minimum":10418,"maximum":10418,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10418,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10418,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10418,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3102","type":"APR-DRG"}],"standard_charges":[{"minimum":12556,"maximum":12556,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12556,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12556,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12556,"methodology":"case rate"}]}]},{"description":"EXPLORATION MAXILLARY SINUS","code_information":[{"code":"31020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3103","type":"APR-DRG"}],"standard_charges":[{"minimum":24640,"maximum":24640,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24640,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24640,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24640,"methodology":"case rate"}]}]},{"description":"EXPLORATION MAXILLARY SINUS","code_information":[{"code":"31030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORE SINUS REMOVE POLYPS","code_information":[{"code":"31032","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"INTERVERTEBRAL DISC EXCISION AND DECOMPRESSION","code_information":[{"code":"3104","type":"APR-DRG"}],"standard_charges":[{"minimum":28668,"maximum":28668,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28668,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28668,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28668,"methodology":"case rate"}]}]},{"description":"EXPLORATION BEHIND UPPER JAW","code_information":[{"code":"31040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORATION SPHENOID SINUS","code_information":[{"code":"31050","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"SPHENOID SINUS SURGERY","code_information":[{"code":"31051","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF FRONTAL SINUS","code_information":[{"code":"31070","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF FRONTAL SINUS","code_information":[{"code":"31075","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31081","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31084","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31085","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31086","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FRONTAL SINUS","code_information":[{"code":"31087","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF SINUSES","code_information":[{"code":"31090","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"ANGINA PECTORIS","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"minimum":3966,"maximum":13670.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6277,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5934,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3966,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5993,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5618,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12986.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8610,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7371,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13670.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10370,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6439,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6439,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4343,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7594.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8126.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7822.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7974.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8050.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7974.21,"methodology":"case rate"}]}]},{"description":"SYNCOPE AND COLLAPSE","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":4535,"maximum":15670.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7832,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7404,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4906,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8547,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14886.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9217,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10989,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9117,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15670.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12940,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8034,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8034,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4535,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8705.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9315.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8967.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9141.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9228.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9141.14,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ETHMOID SINUS","code_information":[{"code":"31200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ETHMOID SINUS","code_information":[{"code":"31201","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3964.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ETHMOID SINUS","code_information":[{"code":"31205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3121","type":"APR-DRG"}],"standard_charges":[{"minimum":9202,"maximum":9202,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9202,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9202,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9202,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3122","type":"APR-DRG"}],"standard_charges":[{"minimum":16617,"maximum":16617,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16617,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16617,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16617,"methodology":"case rate"}]}]},{"description":"REMOVAL OF UPPER JAW","code_information":[{"code":"31225","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3123","type":"APR-DRG"}],"standard_charges":[{"minimum":22112,"maximum":22112,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22112,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22112,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22112,"methodology":"case rate"}]}]},{"description":"REMOVAL OF UPPER JAW","code_information":[{"code":"31230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NASAL ENDOSCOPY DX","code_information":[{"code":"31231","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":296.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":173.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":185.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":178.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":182.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":183.98,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC DX MAX SINUSC","code_information":[{"code":"31233","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC DX SPHN SINUSC","code_information":[{"code":"31235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31237","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31238","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31239","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3124","type":"APR-DRG"}],"standard_charges":[{"minimum":46267,"maximum":46267,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46267,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46267,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46267,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC W/ARTERY LIG","code_information":[{"code":"31241","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC TOTAL","code_information":[{"code":"31253","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC W/PRTL ETHMDCT","code_information":[{"code":"31254","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC W/TOT ETHMDCT","code_information":[{"code":"31255","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"EXPLORATION MAXILLARY SINUS","code_information":[{"code":"31256","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC TOT W/SPHENDT","code_information":[{"code":"31257","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC SPHN TISS RMVL","code_information":[{"code":"31259","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"ENDOSCOPY MAXILLARY SINUS","code_information":[{"code":"31267","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC FRNT TISS RMVL","code_information":[{"code":"31276","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31287","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31288","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31290","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NASAL/SINUS ENDOSCOPY SURG","code_information":[{"code":"31291","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NSL/SINS NDSC MED/INF DCMPRN","code_information":[{"code":"31292","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC MEDINF DCMPRN","code_information":[{"code":"31293","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC SURG ON DCMPRN","code_information":[{"code":"31294","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC SURG MAX SINS","code_information":[{"code":"31295","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC SURG FRNT SINS","code_information":[{"code":"31296","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC SURG SPHN SINS","code_information":[{"code":"31297","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"NSL/SINS NDSC SURG FRNTSPHN","code_information":[{"code":"31298","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"SINUS SURGERY PROCEDURE","code_information":[{"code":"31299","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"CHEST PAIN","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":4111,"maximum":13844.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6413,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6062,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4111,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7158,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6711,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13152.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7819,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9322,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7640,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13844.67,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10595,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6578,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6578,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4443,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7691.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8229.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7922.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8076.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8152.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8076.06,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LARYNX LESION","code_information":[{"code":"31300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3131","type":"APR-DRG"}],"standard_charges":[{"minimum":11222,"maximum":11222,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11222,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11222,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11222,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3132","type":"APR-DRG"}],"standard_charges":[{"minimum":14722,"maximum":14722,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14722,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14722,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14722,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3133","type":"APR-DRG"}],"standard_charges":[{"minimum":21236,"maximum":21236,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21236,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21236,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21236,"methodology":"case rate"}]}]},{"description":"KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT","code_information":[{"code":"3134","type":"APR-DRG"}],"standard_charges":[{"minimum":29871,"maximum":29871,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29871,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29871,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29871,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LARYNX","code_information":[{"code":"31360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF LARYNX","code_information":[{"code":"31365","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31367","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31368","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31370","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31375","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31380","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LARYNX","code_information":[{"code":"31382","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF LARYNX  PHARYNX","code_information":[{"code":"31390","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT LARYNX  PHARYNX","code_information":[{"code":"31395","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"minimum":11894,"maximum":31982,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19358,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18300,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11894,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23324,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21868,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28972.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22511,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26838,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22103,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30496.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31982,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19857,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19857,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13857,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16942.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18128.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17451.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17789.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17959.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17789.89,"methodology":"case rate"}]}]},{"description":"REVISION OF LARYNX","code_information":[{"code":"31400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3141","type":"APR-DRG"}],"standard_charges":[{"minimum":8572,"maximum":8572,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3142","type":"APR-DRG"}],"standard_charges":[{"minimum":9853,"maximum":9853,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9853,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9853,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9853,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EPIGLOTTIS","code_information":[{"code":"31420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3143","type":"APR-DRG"}],"standard_charges":[{"minimum":15636,"maximum":15636,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15636,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15636,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15636,"methodology":"case rate"}]}]},{"description":"FOOT AND TOE PROCEDURES","code_information":[{"code":"3144","type":"APR-DRG"}],"standard_charges":[{"minimum":18437,"maximum":18437,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18437,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18437,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18437,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"minimum":5496,"maximum":16995,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8650,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8178,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5496,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16995,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15934,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15886.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10469,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12481,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10213,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16722.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14291,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8873,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8873,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6814,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9290.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9940.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9569.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9754.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9847.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9754.96,"methodology":"case rate"}]}]},{"description":"HC INTUBATION ET EMERGENT","code_information":[{"code":"31500","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":476.28,"maximum":476.28,"gross_charge":588,"discounted_cash":174.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"}]}]},{"description":"HC INTUBATION ET EMERGENT","code_information":[{"code":"31500","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":588,"discounted_cash":174.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":411.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"HC TRACHEOSTOMY TUBE CHANGE","code_information":[{"code":"31502","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":622.08,"maximum":622.08,"gross_charge":768,"discounted_cash":227.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":622.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":622.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":622.08,"methodology":"fee schedule"}]}]},{"description":"HC TRACHEOSTOMY TUBE CHANGE","code_information":[{"code":"31502","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":768,"discounted_cash":227.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":622.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":622.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":622.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":537.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"HC LARYNGOSCOPY INDIR DIAG","code_information":[{"code":"31505","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":456.84,"maximum":456.84,"gross_charge":564,"discounted_cash":166.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.84,"methodology":"fee schedule"}]}]},{"description":"HC LARYNGOSCOPY INDIR DIAG","code_information":[{"code":"31505","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"gross_charge":564,"discounted_cash":166.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":296.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":173.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":185.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":178.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":182.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":183.98,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3151","type":"APR-DRG"}],"standard_charges":[{"minimum":6458,"maximum":6458,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6458,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6458,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6458,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY WITH BIOPSY","code_information":[{"code":"31510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY LARYNX","code_information":[{"code":"31511","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":296.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":173.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":185.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":178.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":182.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":183.98,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LARYNX LESION","code_information":[{"code":"31512","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"INJECTION INTO VOCAL CORD","code_information":[{"code":"31513","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY FOR ASPIRATION","code_information":[{"code":"31515","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3152","type":"APR-DRG"}],"standard_charges":[{"minimum":11264,"maximum":11264,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11264,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11264,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11264,"methodology":"case rate"}]}]},{"description":"DX LARYNGOSCOPY NEWBORN","code_information":[{"code":"31520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"HC DIRECT LARYNGOSCOPY W/WO TRACH","code_information":[{"code":"31525","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3180.06,"maximum":3180.06,"gross_charge":3926,"discounted_cash":1162.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3180.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3180.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3180.06,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT LARYNGOSCOPY W/WO TRACH","code_information":[{"code":"31525","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"gross_charge":3926,"discounted_cash":1162.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3180.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3180.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3180.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":745.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":588.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"DX LARYNGOSCOPY W/OPER SCOPE","code_information":[{"code":"31526","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY FOR TREATMENT","code_information":[{"code":"31527","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY AND DILATION","code_information":[{"code":"31528","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY AND DILATION","code_information":[{"code":"31529","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3153","type":"APR-DRG"}],"standard_charges":[{"minimum":17842,"maximum":17842,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17842,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17842,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17842,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY W/FB REMOVAL","code_information":[{"code":"31530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY W/FB  OP SCOPE","code_information":[{"code":"31531","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY W/BIOPSY","code_information":[{"code":"31535","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"HC DIRECT LARYNGOSCOPY W/BIOPSY","code_information":[{"code":"31536","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9189.45,"maximum":9189.45,"gross_charge":11345,"discounted_cash":3358.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9189.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9189.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9189.45,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT LARYNGOSCOPY W/BIOPSY","code_information":[{"code":"31536","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9189.45,"gross_charge":11345,"discounted_cash":3358.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9189.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9189.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9189.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2155.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2269,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2269,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"SHOULDER UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT","code_information":[{"code":"3154","type":"APR-DRG"}],"standard_charges":[{"minimum":33970,"maximum":33970,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33970,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33970,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33970,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY W/EXC OF TUMOR","code_information":[{"code":"31540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARYNSCOP W/TUMR EXC + SCOPE","code_information":[{"code":"31541","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"REMOVE VC LESION W/SCOPE","code_information":[{"code":"31545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"REMOVE VC LESION SCOPE/GRAFT","code_information":[{"code":"31546","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31551","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31553","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL STEN","code_information":[{"code":"31554","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOP W/ARYTENOIDECTOM","code_information":[{"code":"31560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"LARYNSCOP REMVE CART + SCOP","code_information":[{"code":"31561","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15155.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPE W/VC INJ","code_information":[{"code":"31570","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOP W/VC INJ + SCOPE","code_information":[{"code":"31571","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARGSC W/LASER DSTRJ LES","code_information":[{"code":"31572","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARGSC W/THER INJECTION","code_information":[{"code":"31573","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"LARGSC W/NJX AUGMENTATION","code_information":[{"code":"31574","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"HC LARYNGOSCOPY FLEX DIAG","code_information":[{"code":"31575","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2019.33,"maximum":2019.33,"gross_charge":2493,"discounted_cash":737.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2019.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2019.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2019.33,"methodology":"fee schedule"}]}]},{"description":"HC LARYNGOSCOPY FLEX DIAG","code_information":[{"code":"31575","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2493,"discounted_cash":737.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2019.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2019.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2019.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":296.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1745.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":173.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":185.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":178.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":182.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":183.98,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY WITH BIOPSY","code_information":[{"code":"31576","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"LARGSC W/RMVL FOREIGN BDY(S)","code_information":[{"code":"31577","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"LARGSC W/REMOVAL LESION","code_information":[{"code":"31578","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"LARYNGOSCOPY TELESCOPIC","code_information":[{"code":"31579","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY LARYNGEAL WEB","code_information":[{"code":"31580","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY FX RDCTJ FIXJ","code_information":[{"code":"31584","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY CRICOID SPLIT","code_information":[{"code":"31587","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REINNERVATE LARYNX","code_information":[{"code":"31590","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNGOPLASTY MEDIALIZATION","code_information":[{"code":"31591","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CRICOTRACHEAL RESECTION","code_information":[{"code":"31592","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LARYNX SURGERY PROCEDURE","code_information":[{"code":"31599","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"minimum":3935,"maximum":13729,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6137,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5802,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3935,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13729,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12872,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12815.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7372,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8789,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7314,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13489.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10139,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6295,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5221,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7494.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8018.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7719.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7868.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7943.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7868.99,"methodology":"case rate"}]}]},{"description":"TRACHEOSTOMY PLANNED","code_information":[{"code":"31600","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8497.71,"maximum":8497.71,"gross_charge":10491,"discounted_cash":3105.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8497.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8497.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8497.71,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY PLANNED","code_information":[{"code":"31600","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8497.71,"gross_charge":10491,"discounted_cash":3105.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8497.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8497.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8497.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7343.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1993.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2098.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1573.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2098.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HC EMERGENCY TRACHEOSTOMY","code_information":[{"code":"31603","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1954.53,"maximum":1954.53,"gross_charge":2413,"discounted_cash":714.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1954.53,"methodology":"fee schedule"}]}]},{"description":"HC EMERGENCY TRACHEOSTOMY","code_information":[{"code":"31603","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"gross_charge":2413,"discounted_cash":714.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":458.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3161","type":"APR-DRG"}],"standard_charges":[{"minimum":5622,"maximum":5622,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5622,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5622,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5622,"methodology":"case rate"}]}]},{"description":"INCISION OF WINDPIPE","code_information":[{"code":"31610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"SURGERY/SPEECH PROSTHESIS","code_information":[{"code":"31611","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PUNCTURE/CLEAR WINDPIPE","code_information":[{"code":"31612","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR WINDPIPE OPENING","code_information":[{"code":"31613","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR WINDPIPE OPENING","code_information":[{"code":"31614","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HC TRACHEOSTOMY THRU EST INCIS","code_information":[{"code":"31615","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":827.01,"maximum":827.01,"gross_charge":1021,"discounted_cash":302.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.01,"methodology":"fee schedule"}]}]},{"description":"HC TRACHEOSTOMY THRU EST INCIS","code_information":[{"code":"31615","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":153.15,"maximum":1836.63,"gross_charge":1021,"discounted_cash":302.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"TRACHEOBRONCHOSCOPY","code_information":[{"code":"31615","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":827.01,"maximum":827.01,"gross_charge":1021,"discounted_cash":302.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.01,"methodology":"fee schedule"}]}]},{"description":"TRACHEOBRONCHOSCOPY","code_information":[{"code":"31615","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":153.15,"maximum":1836.63,"gross_charge":1021,"discounted_cash":302.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3162","type":"APR-DRG"}],"standard_charges":[{"minimum":8954,"maximum":8954,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8954,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8954,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8954,"methodology":"case rate"}]}]},{"description":"HC BRONCHOSCOPE","code_information":[{"code":"31622","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3081.24,"maximum":3081.24,"gross_charge":3804,"discounted_cash":1125.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3081.24,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPE","code_information":[{"code":"31622","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"gross_charge":3804,"discounted_cash":1125.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"HC BRONCHOSCOPY DX WASH","code_information":[{"code":"31622","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":3081.24,"maximum":3081.24,"gross_charge":3804,"discounted_cash":1125.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3081.24,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPY DX WASH","code_information":[{"code":"31622","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3775.44,"gross_charge":3804,"discounted_cash":1125.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3081.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCHBRUSHING","code_information":[{"code":"31623","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5298.21,"maximum":5298.21,"gross_charge":6541,"discounted_cash":1936.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5298.21,"methodology":"fee schedule"}]}]},{"description":"BRONCHBRUSHING","code_information":[{"code":"31623","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5298.21,"gross_charge":6541,"discounted_cash":1936.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"HC BRNCHSC W/BRNCL ALVEOLAR LAVAGE","code_information":[{"code":"31624","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4597.56,"maximum":4597.56,"gross_charge":5676,"discounted_cash":1680.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"}]}]},{"description":"HC BRNCHSC W/BRNCL ALVEOLAR LAVAGE","code_information":[{"code":"31624","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4597.56,"gross_charge":5676,"discounted_cash":1680.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"HC BRONCHOSCOPY DX LAVAGE","code_information":[{"code":"31624","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":4597.56,"maximum":4597.56,"gross_charge":5676,"discounted_cash":1680.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPY DX LAVAGE","code_information":[{"code":"31624","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4597.56,"gross_charge":5676,"discounted_cash":1680.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCHBIOPSY","code_information":[{"code":"31625","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4827.6,"maximum":4827.6,"gross_charge":5960,"discounted_cash":1764.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4827.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4827.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4827.6,"methodology":"fee schedule"}]}]},{"description":"BRONCHBIOPSY","code_information":[{"code":"31625","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4827.6,"gross_charge":5960,"discounted_cash":1764.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4827.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4827.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4827.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":894,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCH PLACEMENT OF MARKER","code_information":[{"code":"31626","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":17541.36,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"}]}]},{"description":"BRONCH PLACEMENT OF MARKER","code_information":[{"code":"31626","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15159.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"BRONCH W/COMPUTER NAV","code_information":[{"code":"31627","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4872.15,"maximum":4872.15,"gross_charge":6015,"discounted_cash":1780.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4872.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4872.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4872.15,"methodology":"fee schedule"}]}]},{"description":"BRONCH W/COMPUTER NAV","code_information":[{"code":"31627","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4872.15,"gross_charge":6015,"discounted_cash":1780.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4872.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4872.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4872.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4210.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1203,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPY/LUNG BX EACH","code_information":[{"code":"31628","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9513.45,"maximum":9513.45,"gross_charge":11745,"discounted_cash":3476.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9513.45,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPY/LUNG BX EACH","code_information":[{"code":"31628","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9513.45,"gross_charge":11745,"discounted_cash":3476.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2231.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCH TRANSBRONCH NDL ASP BX","code_information":[{"code":"31629","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5708.07,"maximum":5708.07,"gross_charge":7047,"discounted_cash":2085.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5708.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5708.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5708.07,"methodology":"fee schedule"}]}]},{"description":"BRONCH TRANSBRONCH NDL ASP BX","code_information":[{"code":"31629","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8071.94,"gross_charge":7047,"discounted_cash":2085.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5708.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5708.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5708.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1338.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3163","type":"APR-DRG"}],"standard_charges":[{"minimum":11825,"maximum":11825,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11825,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11825,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11825,"methodology":"case rate"}]}]},{"description":"BRONCH TRACHEAL DILATION","code_information":[{"code":"31630","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9513.45,"maximum":9513.45,"gross_charge":11745,"discounted_cash":3476.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9513.45,"methodology":"fee schedule"}]}]},{"description":"BRONCH TRACHEAL DILATION","code_information":[{"code":"31630","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9513.45,"gross_charge":11745,"discounted_cash":3476.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2231.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCHDIL W/TRACHEAL STENT","code_information":[{"code":"31631","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":17030.25,"maximum":17030.25,"gross_charge":21025,"discounted_cash":6223.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17030.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17030.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17030.25,"methodology":"fee schedule"}]}]},{"description":"BRONCHDIL W/TRACHEAL STENT","code_information":[{"code":"31631","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":17030.25,"gross_charge":21025,"discounted_cash":6223.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17030.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17030.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17030.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3994.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4205,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3153.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4205,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"BRONCH TRANS LUNG BX EA ADDL","code_information":[{"code":"31632","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4537.62,"maximum":4537.62,"gross_charge":5602,"discounted_cash":1658.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4537.62,"methodology":"fee schedule"}]}]},{"description":"BRONCH TRANS LUNG BX EA ADDL","code_information":[{"code":"31632","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4537.62,"gross_charge":5602,"discounted_cash":1658.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3921.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.4,"methodology":"fee schedule"}]}]},{"description":"BRONCHTRANSBRONCH NDL ADDL.","code_information":[{"code":"31633","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4537.62,"maximum":4537.62,"gross_charge":5602,"discounted_cash":1658.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4537.62,"methodology":"fee schedule"}]}]},{"description":"BRONCHTRANSBRONCH NDL ADDL.","code_information":[{"code":"31633","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4537.62,"gross_charge":5602,"discounted_cash":1658.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4537.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3921.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.4,"methodology":"fee schedule"}]}]},{"description":"BRONCHBALLOON OCCL;SUBSTANCE","code_information":[{"code":"31634","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":17541.36,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"}]}]},{"description":"BRONCHBALLOON OCCL;SUBSTANCE","code_information":[{"code":"31634","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15159.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"BRONCH REMOVAL FOREIGN BODY","code_information":[{"code":"31635","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5034.96,"maximum":5034.96,"gross_charge":6216,"discounted_cash":1839.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5034.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5034.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5034.96,"methodology":"fee schedule"}]}]},{"description":"BRONCH REMOVAL FOREIGN BODY","code_information":[{"code":"31635","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5034.96,"gross_charge":6216,"discounted_cash":1839.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5034.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5034.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5034.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1181.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCH PLACE BRONCHIAL STENT 1ST","code_information":[{"code":"31636","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":17881.56,"maximum":17881.56,"gross_charge":22076,"discounted_cash":6534.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17881.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17881.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17881.56,"methodology":"fee schedule"}]}]},{"description":"BRONCH PLACE BRONCHIAL STENT 1ST","code_information":[{"code":"31636","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":17881.56,"gross_charge":22076,"discounted_cash":6534.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17881.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17881.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17881.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4194.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4415.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3311.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4415.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"BRONCH PLACE BRONCH STENT ADDL.","code_information":[{"code":"31637","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8940.78,"maximum":8940.78,"gross_charge":11038,"discounted_cash":3267.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8940.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8940.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8940.78,"methodology":"fee schedule"}]}]},{"description":"BRONCH PLACE BRONCH STENT ADDL.","code_information":[{"code":"31637","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8940.78,"gross_charge":11038,"discounted_cash":3267.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8940.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8940.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8940.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2207.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1655.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2207.6,"methodology":"fee schedule"}]}]},{"description":"BRONCHREVIS TRACH/BRONCH STENT","code_information":[{"code":"31638","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":16988.13,"maximum":16988.13,"gross_charge":20973,"discounted_cash":6208.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16988.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16988.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16988.13,"methodology":"fee schedule"}]}]},{"description":"BRONCHREVIS TRACH/BRONCH STENT","code_information":[{"code":"31638","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":16988.13,"gross_charge":20973,"discounted_cash":6208.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16988.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16988.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16988.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3984.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4194.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3145.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4194.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"HAND AND WRIST PROCEDURES","code_information":[{"code":"3164","type":"APR-DRG"}],"standard_charges":[{"minimum":23028,"maximum":23028,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23028,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23028,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23028,"methodology":"case rate"}]}]},{"description":"BRONCH TUMOR EXCISION","code_information":[{"code":"31640","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9332.01,"maximum":9332.01,"gross_charge":11521,"discounted_cash":3410.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9332.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9332.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9332.01,"methodology":"fee schedule"}]}]},{"description":"BRONCH TUMOR EXCISION","code_information":[{"code":"31640","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9332.01,"gross_charge":11521,"discounted_cash":3410.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9332.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9332.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9332.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2188.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2304.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCH DESTRUCTION TUMOR LASER","code_information":[{"code":"31641","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9513.45,"maximum":9513.45,"gross_charge":11745,"discounted_cash":3476.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9513.45,"methodology":"fee schedule"}]}]},{"description":"BRONCH DESTRUCTION TUMOR LASER","code_information":[{"code":"31641","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9513.45,"gross_charge":11745,"discounted_cash":3476.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9513.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2231.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCH CATHETER","code_information":[{"code":"31643","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4509.27,"maximum":4509.27,"gross_charge":5567,"discounted_cash":1647.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4509.27,"methodology":"fee schedule"}]}]},{"description":"BRONCH CATHETER","code_information":[{"code":"31643","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4509.27,"gross_charge":5567,"discounted_cash":1647.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCH ASPIR TRACH INIT","code_information":[{"code":"31645","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4643.73,"maximum":4643.73,"gross_charge":5733,"discounted_cash":1696.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4643.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4643.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4643.73,"methodology":"fee schedule"}]}]},{"description":"BRONCH ASPIR TRACH INIT","code_information":[{"code":"31645","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4643.73,"gross_charge":5733,"discounted_cash":1696.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4643.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4643.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4643.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1089.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":859.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCH ASPIR TRACH SUBS.","code_information":[{"code":"31646","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1207.71,"maximum":1207.71,"gross_charge":1491,"discounted_cash":441.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1207.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1207.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1207.71,"methodology":"fee schedule"}]}]},{"description":"BRONCH ASPIR TRACH SUBS.","code_information":[{"code":"31646","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":1491,"discounted_cash":441.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1207.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1207.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1207.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"BRONCH INSERT BRONCH VALVE 1ST","code_information":[{"code":"31647","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15549.57,"maximum":15549.57,"gross_charge":19197,"discounted_cash":5682.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15549.57,"methodology":"fee schedule"}]}]},{"description":"BRONCH INSERT BRONCH VALVE 1ST","code_information":[{"code":"31647","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15549.57,"gross_charge":19197,"discounted_cash":5682.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13437.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3647.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3839.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3839.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"HC BRONCHIAL VALVE INIT INSERT","code_information":[{"code":"31647","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":15549.57,"maximum":15549.57,"gross_charge":19197,"discounted_cash":5682.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15549.57,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHIAL VALVE INIT INSERT","code_information":[{"code":"31647","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15549.57,"gross_charge":19197,"discounted_cash":5682.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15549.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13437.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3647.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3839.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2879.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3839.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"BRONCHREMOVE BRONCH VALVE 1ST","code_information":[{"code":"31648","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9351.45,"maximum":9351.45,"gross_charge":11545,"discounted_cash":3417.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9351.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9351.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9351.45,"methodology":"fee schedule"}]}]},{"description":"BRONCHREMOVE BRONCH VALVE 1ST","code_information":[{"code":"31648","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9351.45,"gross_charge":11545,"discounted_cash":3417.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9351.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9351.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9351.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8081.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2193.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2309,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1731.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2309,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCHREMOVE BRONCH VALVE ADDL","code_information":[{"code":"31649","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4509.27,"maximum":4509.27,"gross_charge":5567,"discounted_cash":1647.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4509.27,"methodology":"fee schedule"}]}]},{"description":"BRONCHREMOVE BRONCH VALVE ADDL","code_information":[{"code":"31649","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4509.27,"gross_charge":5567,"discounted_cash":1647.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4509.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3896.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"BRONCH INSERT BRONCH VALVE ADDL","code_information":[{"code":"31651","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8768.25,"maximum":8768.25,"gross_charge":10825,"discounted_cash":3204.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8768.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8768.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8768.25,"methodology":"fee schedule"}]}]},{"description":"BRONCH INSERT BRONCH VALVE ADDL","code_information":[{"code":"31651","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8768.25,"gross_charge":10825,"discounted_cash":3204.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8768.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8768.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8768.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7577.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2056.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2165,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1623.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2165,"methodology":"fee schedule"}]}]},{"description":"BRONCHEBUS 1-2 LYMPH BX","code_information":[{"code":"31652","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":10009.98,"maximum":10009.98,"gross_charge":12358,"discounted_cash":3657.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10009.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10009.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10009.98,"methodology":"fee schedule"}]}]},{"description":"BRONCHEBUS 1-2 LYMPH BX","code_information":[{"code":"31652","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10009.98,"gross_charge":12358,"discounted_cash":3657.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10009.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10009.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10009.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2348.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2471.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1853.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2471.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCH EBUS 3 LYMPH BX","code_information":[{"code":"31653","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9533.7,"maximum":9533.7,"gross_charge":11770,"discounted_cash":3483.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9533.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9533.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9533.7,"methodology":"fee schedule"}]}]},{"description":"BRONCH EBUS 3 LYMPH BX","code_information":[{"code":"31653","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9533.7,"gross_charge":11770,"discounted_cash":3483.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9533.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9533.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9533.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8071.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5463.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5636.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2236.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2354,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1765.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2354,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3296.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3527.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3395.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3461.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3625.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3494.06,"methodology":"case rate"}]}]},{"description":"BRONCHEBUS DX/TX INT PERP","code_information":[{"code":"31654","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4958.01,"maximum":4958.01,"gross_charge":6121,"discounted_cash":1811.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4958.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4958.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4958.01,"methodology":"fee schedule"}]}]},{"description":"BRONCHEBUS DX/TX INT PERP","code_information":[{"code":"31654","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4958.01,"gross_charge":6121,"discounted_cash":1811.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4958.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4958.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4958.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1224.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":918.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1224.2,"methodology":"fee schedule"}]}]},{"description":"BRONCH THERMOPLASTY 1 LOBE","code_information":[{"code":"31660","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":17541.36,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"}]}]},{"description":"BRONCH THERMOPLASTY 1 LOBE","code_information":[{"code":"31660","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15159.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"BRONCH THERMOPLASTY 2 >LOBE","code_information":[{"code":"31661","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":17541.36,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"}]}]},{"description":"BRONCH THERMOPLASTY 2 >LOBE","code_information":[{"code":"31661","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":17541.36,"gross_charge":21656,"discounted_cash":6410.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17541.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15155.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9986.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10583.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15159.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4114.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3248.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4331.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6188.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6622.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6374.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6498.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6807.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6560.31,"methodology":"case rate"}]}]},{"description":"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"minimum":34889,"maximum":103547,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55609,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":52572,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":103547,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":97083,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73273.95,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":77130.47,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91875,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":57045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57045,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34889,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42850.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45849.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44135.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44992.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45421.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44992.78,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3171","type":"APR-DRG"}],"standard_charges":[{"minimum":8354,"maximum":8354,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8354,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8354,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8354,"methodology":"case rate"}]}]},{"description":"BRONCHIAL BRUSH BIOPSY","code_information":[{"code":"31717","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":850.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":595.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":593.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":347.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":371.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":357.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":364.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":381.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":367.99,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3172","type":"APR-DRG"}],"standard_charges":[{"minimum":11651,"maximum":11651,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11651,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11651,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11651,"methodology":"case rate"}]}]},{"description":"HC CATHETER ASPIR NASOTRACH","code_information":[{"code":"31720","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":397.71,"maximum":397.71,"gross_charge":491,"discounted_cash":145.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.71,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ASPIR NASOTRACH","code_information":[{"code":"31720","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":73.65,"maximum":1836.63,"gross_charge":491,"discounted_cash":145.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":311.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":310.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":181.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":194.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":187.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":200.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":192.75,"methodology":"case rate"}]}]},{"description":"CLEARANCE OF AIRWAYS","code_information":[{"code":"31725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3173","type":"APR-DRG"}],"standard_charges":[{"minimum":13278,"maximum":13278,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13278,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13278,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13278,"methodology":"case rate"}]}]},{"description":"INTRO WINDPIPE WIRE/TUBE","code_information":[{"code":"31730","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3775.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3775.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2476.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2636.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1541.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1649.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1588,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1618.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1695.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1634.26,"methodology":"case rate"}]}]},{"description":"TENDON MUSCLE AND OTHER SOFT TISSUE PROCEDURES","code_information":[{"code":"3174","type":"APR-DRG"}],"standard_charges":[{"minimum":24671,"maximum":24671,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24671,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24671,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24671,"methodology":"case rate"}]}]},{"description":"REPAIR OF WINDPIPE","code_information":[{"code":"31750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR OF WINDPIPE","code_information":[{"code":"31755","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR OF WINDPIPE","code_information":[{"code":"31760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCTION OF WINDPIPE","code_information":[{"code":"31766","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR/GRAFT OF BRONCHUS","code_information":[{"code":"31770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT BRONCHUS","code_information":[{"code":"31775","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT WINDPIPE","code_information":[{"code":"31780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT WINDPIPE","code_information":[{"code":"31781","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE WINDPIPE LESION","code_information":[{"code":"31785","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE WINDPIPE LESION","code_information":[{"code":"31786","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"minimum":27872,"maximum":27872,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27872,"methodology":"case rate"}]}]},{"description":"REPAIR OF WINDPIPE INJURY","code_information":[{"code":"31800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF WINDPIPE INJURY","code_information":[{"code":"31805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSURE OF WINDPIPE LESION","code_information":[{"code":"31820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR OF WINDPIPE DEFECT","code_information":[{"code":"31825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REVISION TRACHEOSTOMY SCAR","code_information":[{"code":"31830","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8618.4,"maximum":8618.4,"gross_charge":10640,"discounted_cash":3149.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8618.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8618.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8618.4,"methodology":"fee schedule"}]}]},{"description":"REVISION TRACHEOSTOMY SCAR","code_information":[{"code":"31830","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8618.4,"gross_charge":10640,"discounted_cash":3149.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8618.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8618.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8618.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2021.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2128,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1596,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2128,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"AIRWAYS SURGICAL PROCEDURE","code_information":[{"code":"31899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":296.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":173.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":185.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":178.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":182.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":183.98,"methodology":"case rate"}]}]},{"description":"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"minimum":24781,"maximum":68642,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39487,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":37330,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24781,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68642,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64356,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":53571.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46550,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55499,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46053,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":56390.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":40506,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40506,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31328.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33521.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32267.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32894.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":33207.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32894.51,"methodology":"case rate"}]}]},{"description":"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"minimum":12647,"maximum":39298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20808,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12647,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39298,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36845,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30743.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26713,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31849,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23502,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32362.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21345,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21345,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17978.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19237.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18518.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18877.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19057.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18877.89,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3201","type":"APR-DRG"}],"standard_charges":[{"minimum":11000,"maximum":11000,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11000,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11000,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11000,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3202","type":"APR-DRG"}],"standard_charges":[{"minimum":11950,"maximum":11950,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11950,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11950,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11950,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3203","type":"APR-DRG"}],"standard_charges":[{"minimum":15259,"maximum":15259,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15259,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15259,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15259,"methodology":"case rate"}]}]},{"description":"THORACOSTOMY W/RIB RESECTION","code_information":[{"code":"32035","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSTOMY W/FLAP DRAINAGE","code_information":[{"code":"32036","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE PROCEDURES","code_information":[{"code":"3204","type":"APR-DRG"}],"standard_charges":[{"minimum":24129,"maximum":24129,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24129,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24129,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24129,"methodology":"case rate"}]}]},{"description":"OPEN WEDGE/BX LUNG INFILTR","code_information":[{"code":"32096","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN WEDGE/BX LUNG NODULE","code_information":[{"code":"32097","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN BIOPSY OF LUNG PLEURA","code_information":[{"code":"32098","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":16332,"maximum":48120,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25590,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24192,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16332,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48120,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45116,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36588.07,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30351,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38513.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42278,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26250,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21396.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22894.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22038.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22466.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22680.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22466.36,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF CHEST","code_information":[{"code":"32100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3211","type":"APR-DRG"}],"standard_charges":[{"minimum":15578,"maximum":15578,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15578,"methodology":"case rate"}]}]},{"description":"EXPLORE/REPAIR CHEST","code_information":[{"code":"32110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3212","type":"APR-DRG"}],"standard_charges":[{"minimum":19913,"maximum":19913,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19913,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19913,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19913,"methodology":"case rate"}]}]},{"description":"RE-EXPLORATION OF CHEST","code_information":[{"code":"32120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORE CHEST FREE ADHESIONS","code_information":[{"code":"32124","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3213","type":"APR-DRG"}],"standard_charges":[{"minimum":26580,"maximum":26580,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26580,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26580,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26580,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION AND OTHER BACK OR NECK PROCEDURES EXCEPT DISC EXCISION OR DECOMPRESSION","code_information":[{"code":"3214","type":"APR-DRG"}],"standard_charges":[{"minimum":31984,"maximum":31984,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31984,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31984,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31984,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LUNG LESION(S)","code_information":[{"code":"32140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE/TREAT LUNG LESIONS","code_information":[{"code":"32141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF LUNG LESION(S)","code_information":[{"code":"32150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE LUNG FOREIGN BODY","code_information":[{"code":"32151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN CHEST HEART MASSAGE","code_information":[{"code":"32160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":10359,"maximum":30522,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16263,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15375,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10359,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30522,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28616,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25189.93,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19251,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26515.71,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26869,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16683,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16683,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14730.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15762.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15172.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15467.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15614.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15467.5,"methodology":"case rate"}]}]},{"description":"DRAIN OPEN LUNG LESION","code_information":[{"code":"32200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3221","type":"APR-DRG"}],"standard_charges":[{"minimum":11492,"maximum":11492,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11492,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11492,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11492,"methodology":"case rate"}]}]},{"description":"TREAT CHEST LINING","code_information":[{"code":"32215","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3222","type":"APR-DRG"}],"standard_charges":[{"minimum":13005,"maximum":13005,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13005,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13005,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13005,"methodology":"case rate"}]}]},{"description":"RELEASE OF LUNG","code_information":[{"code":"32220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL RELEASE OF LUNG","code_information":[{"code":"32225","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3223","type":"APR-DRG"}],"standard_charges":[{"minimum":17944,"maximum":17944,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17944,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17944,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17944,"methodology":"case rate"}]}]},{"description":"SHOULDER AND ELBOW JOINT REPLACEMENT","code_information":[{"code":"3224","type":"APR-DRG"}],"standard_charges":[{"minimum":19074,"maximum":19074,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19074,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19074,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19074,"methodology":"case rate"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"minimum":23521,"maximum":69299,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38288,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":36196,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23521,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69299,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64973,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52105.64,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43710,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":54848.04,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63257,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":39276,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39276,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30471.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":32604.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31385.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31994.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32299.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31994.69,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3231","type":"APR-DRG"}],"standard_charges":[{"minimum":12286,"maximum":12286,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12286,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12286,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12286,"methodology":"case rate"}]}]},{"description":"REMOVAL OF CHEST LINING","code_information":[{"code":"32310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3232","type":"APR-DRG"}],"standard_charges":[{"minimum":19423,"maximum":19423,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19423,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19423,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19423,"methodology":"case rate"}]}]},{"description":"FREE/REMOVE CHEST LINING","code_information":[{"code":"32320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3233","type":"APR-DRG"}],"standard_charges":[{"minimum":24385,"maximum":24385,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24385,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24385,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24385,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT","code_information":[{"code":"3234","type":"APR-DRG"}],"standard_charges":[{"minimum":24385,"maximum":24385,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24385,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24385,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24385,"methodology":"case rate"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"minimum":16866,"maximum":49691,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28721,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27152,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16866,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49691,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46589,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40414.2,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31342,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42541.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47451,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29462,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29462,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23634.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25288.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24343.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24815.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25052.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24815.74,"methodology":"case rate"}]}]},{"description":"HC PLEURAL BX W/NEEDLE","code_information":[{"code":"32400","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4237.92,"maximum":4237.92,"gross_charge":5232,"discounted_cash":1548.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4237.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4237.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4237.92,"methodology":"fee schedule"}]}]},{"description":"HC PLEURAL BX W/NEEDLE","code_information":[{"code":"32400","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4237.92,"gross_charge":5232,"discounted_cash":1548.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4237.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4237.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4237.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":994.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"PERCUT BX LUNG/MEDIASTINUM","code_information":[{"code":"32405","type":"CPT"}],"standard_charges":[{"minimum":1252,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CT LUNG BIOPSY WITH GUIDANCE","code_information":[{"code":"32408","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4558.68,"maximum":4558.68,"gross_charge":5628,"discounted_cash":1665.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4558.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4558.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4558.68,"methodology":"fee schedule"}]}]},{"description":"CT LUNG BIOPSY WITH GUIDANCE","code_information":[{"code":"32408","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"gross_charge":5628,"discounted_cash":1665.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4558.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4558.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4558.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3241","type":"APR-DRG"}],"standard_charges":[{"minimum":13341,"maximum":13341,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13341,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13341,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13341,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3242","type":"APR-DRG"}],"standard_charges":[{"minimum":13419,"maximum":13419,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13419,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13419,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13419,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3243","type":"APR-DRG"}],"standard_charges":[{"minimum":23935,"maximum":23935,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23935,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23935,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23935,"methodology":"case rate"}]}]},{"description":"ELECTIVE HIP JOINT REPLACEMENT","code_information":[{"code":"3244","type":"APR-DRG"}],"standard_charges":[{"minimum":24298,"maximum":24298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24298,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24298,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24298,"methodology":"case rate"}]}]},{"description":"REMOVE LUNG PNEUMONECTOMY","code_information":[{"code":"32440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SLEEVE PNEUMONECTOMY","code_information":[{"code":"32442","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF LUNG EXTRAPLEURAL","code_information":[{"code":"32445","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LUNG","code_information":[{"code":"32480","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BILOBECTOMY","code_information":[{"code":"32482","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SEGMENTECTOMY","code_information":[{"code":"32484","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SLEEVE LOBECTOMY","code_information":[{"code":"32486","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMPLETION PNEUMONECTOMY","code_information":[{"code":"32488","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUNG VOLUME REDUCTION","code_information":[{"code":"32491","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"minimum":15023,"maximum":44263,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25727,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24322,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15023,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44263,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41500,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36756.15,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27919,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38690.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42505,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26391,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26391,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21494.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22999.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22139.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22569.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22784.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22569.57,"methodology":"case rate"}]}]},{"description":"REPAIR BRONCHUS ADD-ON","code_information":[{"code":"32501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT APICAL LUNG TUMOR","code_information":[{"code":"32503","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT APICAL LUNG TUM/CHEST","code_information":[{"code":"32504","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WEDGE RESECT OF LUNG INITIAL","code_information":[{"code":"32505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WEDGE RESECT OF LUNG ADD-ON","code_information":[{"code":"32506","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WEDGE RESECT OF LUNG DIAG","code_information":[{"code":"32507","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3251","type":"APR-DRG"}],"standard_charges":[{"minimum":13225,"maximum":13225,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13225,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13225,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13225,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3252","type":"APR-DRG"}],"standard_charges":[{"minimum":20194,"maximum":20194,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20194,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20194,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20194,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3253","type":"APR-DRG"}],"standard_charges":[{"minimum":20920,"maximum":20920,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20920,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20920,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20920,"methodology":"case rate"}]}]},{"description":"NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT","code_information":[{"code":"3254","type":"APR-DRG"}],"standard_charges":[{"minimum":29098,"maximum":29098,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29098,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29098,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29098,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LUNG LESION","code_information":[{"code":"32540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INSERT INDWELL PLEURAL CTH","code_information":[{"code":"32550","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9311.76,"maximum":9311.76,"gross_charge":11496,"discounted_cash":3402.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9311.76,"methodology":"fee schedule"}]}]},{"description":"HC INSERT INDWELL PLEURAL CTH","code_information":[{"code":"32550","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9311.76,"gross_charge":11496,"discounted_cash":3402.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8047.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2184.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2299.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2299.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC PLEUREX CATH INSERTION","code_information":[{"code":"32550","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9311.76,"maximum":9311.76,"gross_charge":11496,"discounted_cash":3402.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9311.76,"methodology":"fee schedule"}]}]},{"description":"HC PLEUREX CATH INSERTION","code_information":[{"code":"32550","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9311.76,"gross_charge":11496,"discounted_cash":3402.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9311.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8047.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2184.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2299.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2299.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC INSERTION CHEST TUBE","code_information":[{"code":"32551","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1439.37,"maximum":1439.37,"gross_charge":1777,"discounted_cash":526,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1439.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1439.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1439.37,"methodology":"fee schedule"}]}]},{"description":"HC INSERTION CHEST TUBE","code_information":[{"code":"32551","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3400.99,"gross_charge":1777,"discounted_cash":526,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1439.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1439.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1439.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1243.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC PLEUREX CATH REMOVAL","code_information":[{"code":"32552","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2080.08,"maximum":2080.08,"gross_charge":2568,"discounted_cash":760.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.08,"methodology":"fee schedule"}]}]},{"description":"HC PLEUREX CATH REMOVAL","code_information":[{"code":"32552","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2568,"discounted_cash":760.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC REMOVAL LUNG CATHETER","code_information":[{"code":"32552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2080.08,"maximum":2080.08,"gross_charge":2568,"discounted_cash":760.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.08,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL LUNG CATHETER","code_information":[{"code":"32552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2568,"discounted_cash":760.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"INS MARK THOR FOR RT PERQ","code_information":[{"code":"32553","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3492,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2091.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1223.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1308.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1259.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1284.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1345.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1296.68,"methodology":"case rate"}]}]},{"description":"HC THORACENTESIS ASPIR","code_information":[{"code":"32554","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2655.18,"maximum":2655.18,"gross_charge":3278,"discounted_cash":970.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2655.18,"methodology":"fee schedule"}]}]},{"description":"HC THORACENTESIS ASPIR","code_information":[{"code":"32554","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3278,"discounted_cash":970.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2294.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC THORACENTESIS W/O GUIDANCE","code_information":[{"code":"32554","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2655.18,"maximum":2655.18,"gross_charge":3278,"discounted_cash":970.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2655.18,"methodology":"fee schedule"}]}]},{"description":"HC THORACENTESIS W/O GUIDANCE","code_information":[{"code":"32554","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3278,"discounted_cash":970.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2655.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2294.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC CT THORACENTESIS GUID","code_information":[{"code":"32555","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3793.23,"maximum":3793.23,"gross_charge":4683,"discounted_cash":1386.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3793.23,"methodology":"fee schedule"}]}]},{"description":"HC CT THORACENTESIS GUID","code_information":[{"code":"32555","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3793.23,"gross_charge":4683,"discounted_cash":1386.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3278.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC THORACENTESIS W/IMAGING","code_information":[{"code":"32555","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3793.23,"maximum":3793.23,"gross_charge":4683,"discounted_cash":1386.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3793.23,"methodology":"fee schedule"}]}]},{"description":"HC THORACENTESIS W/IMAGING","code_information":[{"code":"32555","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3793.23,"gross_charge":4683,"discounted_cash":1386.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3278.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC U/S THORACENTESIS GUID","code_information":[{"code":"32555","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":3793.23,"maximum":3793.23,"gross_charge":4683,"discounted_cash":1386.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3793.23,"methodology":"fee schedule"}]}]},{"description":"HC U/S THORACENTESIS GUID","code_information":[{"code":"32555","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3793.23,"gross_charge":4683,"discounted_cash":1386.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3793.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3278.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC CHEST TUBE INSERTION","code_information":[{"code":"32556","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4736.88,"maximum":4736.88,"gross_charge":5848,"discounted_cash":1731.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4736.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4736.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4736.88,"methodology":"fee schedule"}]}]},{"description":"HC CHEST TUBE INSERTION","code_information":[{"code":"32556","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4736.88,"gross_charge":5848,"discounted_cash":1731.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4736.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4736.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4736.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4093.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1111.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":877.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"HC CHEST TUBE INSERT W/IMAG","code_information":[{"code":"32557","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3789.99,"maximum":3789.99,"gross_charge":4679,"discounted_cash":1384.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3789.99,"methodology":"fee schedule"}]}]},{"description":"HC CHEST TUBE INSERT W/IMAG","code_information":[{"code":"32557","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3789.99,"gross_charge":4679,"discounted_cash":1384.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3275.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC INSERT PLEURAL CATH W/GUID","code_information":[{"code":"32557","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":3789.99,"maximum":3789.99,"gross_charge":4679,"discounted_cash":1384.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3789.99,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PLEURAL CATH W/GUID","code_information":[{"code":"32557","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3789.99,"gross_charge":4679,"discounted_cash":1384.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3789.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3275.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC CHEMICAL PLEURODESIS","code_information":[{"code":"32560","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3450.6,"maximum":3450.6,"gross_charge":4260,"discounted_cash":1260.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3450.6,"methodology":"fee schedule"}]}]},{"description":"HC CHEMICAL PLEURODESIS","code_information":[{"code":"32560","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3450.6,"gross_charge":4260,"discounted_cash":1260.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3450.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2982,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":852,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":639,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":852,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC INST CHEST FIBRIN INIT DAY","code_information":[{"code":"32561","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"HC INST CHEST FIBRIN INIT DAY","code_information":[{"code":"32561","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC INST/CHEST TUBE/CATHAGT/FIB","code_information":[{"code":"32561","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"HC INST/CHEST TUBE/CATHAGT/FIB","code_information":[{"code":"32561","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC INST/CHEST CATH SUBSQ DAY","code_information":[{"code":"32562","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"HC INST/CHEST CATH SUBSQ DAY","code_information":[{"code":"32562","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"INSTILL AGENT FIBRIN SBSQ DAY","code_information":[{"code":"32562","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"INSTILL AGENT FIBRIN SBSQ DAY","code_information":[{"code":"32562","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"minimum":27784,"maximum":81457,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45655,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":43161,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28856,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":81457,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":76372,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61109.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55329,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65966,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53624,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":64325.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75429,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46833,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46833,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27784,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35736.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38237.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36808.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37523.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37880.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37523.09,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY DIAGNOSTIC","code_information":[{"code":"32601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY WBX SAC","code_information":[{"code":"32604","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY W/BX MED SPACE","code_information":[{"code":"32606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY W/BX INFILTRATE","code_information":[{"code":"32607","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY W/BX NODULE","code_information":[{"code":"32608","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY W/BX PLEURA","code_information":[{"code":"32609","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3261","type":"APR-DRG"}],"standard_charges":[{"minimum":11523,"maximum":11523,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11523,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11523,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11523,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3262","type":"APR-DRG"}],"standard_charges":[{"minimum":14582,"maximum":14582,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3263","type":"APR-DRG"}],"standard_charges":[{"minimum":14582,"maximum":14582,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"}]}]},{"description":"ELECTIVE KNEE JOINT REPLACEMENT","code_information":[{"code":"3264","type":"APR-DRG"}],"standard_charges":[{"minimum":21747,"maximum":21747,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21747,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21747,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21747,"methodology":"case rate"}]}]},{"description":"THORACOSCOPY W/PLEURODESIS","code_information":[{"code":"32650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY REMOVE CORTEX","code_information":[{"code":"32651","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY REM TOTL CORTEX","code_information":[{"code":"32652","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY REMOV FB/FIBRIN","code_information":[{"code":"32653","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY CONTRL BLEEDING","code_information":[{"code":"32654","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY RESECT BULLAE","code_information":[{"code":"32655","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/PLEURECTOMY","code_information":[{"code":"32656","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/SAC FB REMOVE","code_information":[{"code":"32658","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/SAC DRAINAGE","code_information":[{"code":"32659","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/PERICARD EXC","code_information":[{"code":"32661","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/MEDIAST EXC","code_information":[{"code":"32662","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/LOBECTOMY","code_information":[{"code":"32663","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/ TH NRV EXC","code_information":[{"code":"32664","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOP W/ESOPH MUSC EXC","code_information":[{"code":"32665","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/WEDGE RESECT","code_information":[{"code":"32666","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/W RESECT ADDL","code_information":[{"code":"32667","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/W RESECT DIAG","code_information":[{"code":"32668","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY REMOVE SEGMENT","code_information":[{"code":"32669","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY BILOBECTOMY","code_information":[{"code":"32670","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY PNEUMONECTOMY","code_information":[{"code":"32671","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY FOR LVRS","code_information":[{"code":"32672","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY W/THYMUS RESECT","code_information":[{"code":"32673","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOSCOPY LYMPH NODE EXC","code_information":[{"code":"32674","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"minimum":13898,"maximum":36553,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21826,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20634,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14189,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36553,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34271,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31988.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27685,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33007,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26368,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33672.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36060,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22390,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22390,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13898,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18706.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20016.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19268,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19642.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19829.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19642.13,"methodology":"case rate"}]}]},{"description":"THORAX STEREO RAD TARGETW/TX","code_information":[{"code":"32701","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6238,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5369,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6238,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"STOMACH ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"minimum":8451,"maximum":24397,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14324,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13542,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9075,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24397,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22874,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22820.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17918,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21363,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16864,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24021.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23665,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14694,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14694,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8451,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13345.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14279.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13745.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14012.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14146,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14012.55,"methodology":"case rate"}]}]},{"description":"REPAIR LUNG HERNIA","code_information":[{"code":"32800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE CHEST AFTER DRAINAGE","code_information":[{"code":"32810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE BRONCHIAL FISTULA","code_information":[{"code":"32815","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT INJURED CHEST","code_information":[{"code":"32820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DONOR PNEUMONECTOMY","code_information":[{"code":"32850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUNG TRANSPLANT SINGLE","code_information":[{"code":"32851","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUNG TRANSPLANT WITH BYPASS","code_information":[{"code":"32852","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUNG TRANSPLANT DOUBLE","code_information":[{"code":"32853","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LUNG TRANSPLANT WITH BYPASS","code_information":[{"code":"32854","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE DONOR LUNG SINGLE","code_information":[{"code":"32855","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE DONOR LUNG DOUBLE","code_information":[{"code":"32856","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":25661,"maximum":68195,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41276,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39022,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25661,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60845,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57046,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":55758.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49973,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59580,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47688,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":58692.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68195,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42342,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28972,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32607.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34889.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33585.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34237.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34563.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34237.48,"methodology":"case rate"}]}]},{"description":"REMOVAL OF RIB(S)","code_information":[{"code":"32900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE  REPAIR CHEST WALL","code_information":[{"code":"32905","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE  REPAIR CHEST WALL","code_information":[{"code":"32906","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF LUNG","code_information":[{"code":"32940","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THERAPEUTIC PNEUMOTHORAX","code_information":[{"code":"32960","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"ABLATE PULM TUMOR PERQ CRYBL","code_information":[{"code":"32994","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"TOTAL LUNG LAVAGE","code_information":[{"code":"32997","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE PULM TUMOR PERQ RF","code_information":[{"code":"32998","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"UNLISTED PROC LUNGS & PLEURA","code_information":[{"code":"32999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"UNLISTED PROC LUNGS & PLEURA","code_information":[{"code":"32999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":13477,"maximum":35103,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21247,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20087,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13477,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33121,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31054,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31281.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26540,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31643,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25045,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32927.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35103,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21796,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21796,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18293.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19573.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18841.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19207.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19390.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19207.74,"methodology":"case rate"}]}]},{"description":"HC PERICARDIOCENTESIS","code_information":[{"code":"33016","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4767.66,"maximum":4767.66,"gross_charge":5886,"discounted_cash":1742.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4767.66,"methodology":"fee schedule"}]}]},{"description":"HC PERICARDIOCENTESIS","code_information":[{"code":"33016","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"gross_charge":5886,"discounted_cash":1742.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC PERICARDIOCENTESIS W/IMAGING","code_information":[{"code":"33016","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4767.66,"maximum":4767.66,"gross_charge":5886,"discounted_cash":1742.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4767.66,"methodology":"fee schedule"}]}]},{"description":"HC PERICARDIOCENTESIS W/IMAGING","code_information":[{"code":"33016","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7669,"gross_charge":5886,"discounted_cash":1742.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4767.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1177.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC PERICARDIOCENTESIS W/DRAIN","code_information":[{"code":"33017","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5959.98,"maximum":5959.98,"gross_charge":7358,"discounted_cash":2177.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5959.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5959.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5959.98,"methodology":"fee schedule"}]}]},{"description":"HC PERICARDIOCENTESIS W/DRAIN","code_information":[{"code":"33017","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5959.98,"gross_charge":7358,"discounted_cash":2177.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5959.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5959.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5959.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1398.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1471.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1471.6,"methodology":"fee schedule"}]}]},{"description":"PRCRD DRG 0-5YR OR W/ANOMLY","code_information":[{"code":"33018","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERQ PRCRD DRG INSJ CATH CT","code_information":[{"code":"33019","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF HEART SAC","code_information":[{"code":"33020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PERICARDIAL WINDOW","code_information":[{"code":"33025","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5284.44,"maximum":5284.44,"gross_charge":6524,"discounted_cash":1931.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5284.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5284.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5284.44,"methodology":"fee schedule"}]}]},{"description":"HC PERICARDIAL WINDOW","code_information":[{"code":"33025","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5284.44,"gross_charge":6524,"discounted_cash":1931.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5284.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5284.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5284.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4566.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1239.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.8,"methodology":"fee schedule"}]}]},{"description":"PARTIAL REMOVAL OF HEART SAC","code_information":[{"code":"33030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF HEART SAC","code_information":[{"code":"33031","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT HEART SAC LESION","code_information":[{"code":"33050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":9499,"maximum":24686.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14841,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14030,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9499,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22603,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21192,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23452.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18470,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22021,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17653,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24686.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24519,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15224,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15224,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10018,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13714.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14674.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14126.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14400.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14537.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14400.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEART LESION","code_information":[{"code":"33120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF HEART LESION","code_information":[{"code":"33130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEART REVASCULARIZE (TMR)","code_information":[{"code":"33140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEART TMR W/OTHER PROCEDURE","code_information":[{"code":"33141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECTAL RESECTION WITH MCC","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"minimum":20761,"maximum":52325,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31180,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29477,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20761,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49839,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46727,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43419.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43888,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52325,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38582,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45704.96,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51514,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31985,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31985,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21260,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25391.64,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27169.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26153.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26661.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26915.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26661.23,"methodology":"case rate"}]}]},{"description":"INSERT EPICARD ELTRD OPEN","code_information":[{"code":"33202","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT EPICARD ELTRD ENDO","code_information":[{"code":"33203","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INSERT PM ATRIAL LD","code_information":[{"code":"33206","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3790.8,"maximum":3790.8,"gross_charge":4680,"discounted_cash":1385.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3790.8,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PM ATRIAL LD","code_information":[{"code":"33206","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22912.01,"gross_charge":4680,"discounted_cash":1385.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3790.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3276,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":936,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":702,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":936,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC INSERT PM VENTRICULAR LEAD","code_information":[{"code":"33207","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29160,"maximum":29160,"gross_charge":36000,"discounted_cash":10656,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29160,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PM VENTRICULAR LEAD","code_information":[{"code":"33207","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":29160,"gross_charge":36000,"discounted_cash":10656,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25200,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6840,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7200,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5400,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7200,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC INSERT PM W/ATRL&VENT LEAD","code_information":[{"code":"33208","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29160,"maximum":29160,"gross_charge":36000,"discounted_cash":10656,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29160,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PM W/ATRL&VENT LEAD","code_information":[{"code":"33208","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":29160,"gross_charge":36000,"discounted_cash":10656,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29160,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25200,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6840,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7200,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5400,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7200,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC INSERT TMP PACING CATH SNGL","code_information":[{"code":"33210","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":23838.3,"maximum":23838.3,"gross_charge":29430,"discounted_cash":8711.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23838.3,"methodology":"fee schedule"}]}]},{"description":"HC INSERT TMP PACING CATH SNGL","code_information":[{"code":"33210","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":23838.3,"gross_charge":29430,"discounted_cash":8711.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23838.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20601,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5591.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5886,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4414.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5886,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"INSERT CARD ELECTRODES DUAL","code_information":[{"code":"33211","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":18118.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC INSERT PULSE GEN EXST SGL LD","code_information":[{"code":"33212","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":12458.61,"maximum":12458.61,"gross_charge":15381,"discounted_cash":4552.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12458.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12458.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12458.61,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PULSE GEN EXST SGL LD","code_information":[{"code":"33212","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":18118.82,"gross_charge":15381,"discounted_cash":4552.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12458.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12458.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12458.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2922.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3076.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2307.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3076.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"INS PPM GENER ONLY W/DUAL LEADS","code_information":[{"code":"33213","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":32295.51,"maximum":32295.51,"gross_charge":39871,"discounted_cash":11801.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32295.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32295.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32295.51,"methodology":"fee schedule"}]}]},{"description":"INS PPM GENER ONLY W/DUAL LEADS","code_information":[{"code":"33213","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":32295.51,"gross_charge":39871,"discounted_cash":11801.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32295.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32295.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32295.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7575.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7974.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5980.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7974.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC UPGRADE PM SGL TO DUAL","code_information":[{"code":"33214","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3431.97,"maximum":3431.97,"gross_charge":4237,"discounted_cash":1254.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3431.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3431.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3431.97,"methodology":"fee schedule"}]}]},{"description":"HC UPGRADE PM SGL TO DUAL","code_information":[{"code":"33214","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22912.01,"gross_charge":4237,"discounted_cash":1254.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3431.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3431.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3431.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":805.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC REPOS PREV PACING/DEFIB LEAD","code_information":[{"code":"33215","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6889.86,"maximum":6889.86,"gross_charge":8506,"discounted_cash":2517.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6889.86,"methodology":"fee schedule"}]}]},{"description":"HC REPOS PREV PACING/DEFIB LEAD","code_information":[{"code":"33215","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":8506,"discounted_cash":2517.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5954.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC INSERT LEAD ONLYSNGL PM/CD","code_information":[{"code":"33216","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4459.86,"maximum":4459.86,"gross_charge":5506,"discounted_cash":1629.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4459.86,"methodology":"fee schedule"}]}]},{"description":"HC INSERT LEAD ONLYSNGL PM/CD","code_information":[{"code":"33216","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":18118.82,"gross_charge":5506,"discounted_cash":1629.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3854.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC INSERT LEAD ONLYDUAL PM/CD","code_information":[{"code":"33217","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4255.74,"maximum":4255.74,"gross_charge":5254,"discounted_cash":1555.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4255.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4255.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4255.74,"methodology":"fee schedule"}]}]},{"description":"HC INSERT LEAD ONLYDUAL PM/CD","code_information":[{"code":"33217","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":18118.82,"gross_charge":5254,"discounted_cash":1555.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4255.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4255.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4255.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3677.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":998.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":788.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC REPAIR LD ONLY SINGLE","code_information":[{"code":"33218","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4459.86,"maximum":4459.86,"gross_charge":5506,"discounted_cash":1629.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4459.86,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR LD ONLY SINGLE","code_information":[{"code":"33218","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7967.61,"gross_charge":5506,"discounted_cash":1629.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4459.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3854.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1046.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"HC REPAIR LD ONLY DUAL","code_information":[{"code":"33220","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":10179.27,"maximum":10179.27,"gross_charge":12567,"discounted_cash":3719.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10179.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10179.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10179.27,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR LD ONLY DUAL","code_information":[{"code":"33220","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10179.27,"gross_charge":12567,"discounted_cash":3719.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10179.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10179.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10179.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8796.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2387.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2513.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1885.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2513.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"HC INSERT PM GENEXST MULT LDS","code_information":[{"code":"33221","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29724.57,"maximum":29724.57,"gross_charge":36697,"discounted_cash":10862.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29724.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29724.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29724.57,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PM GENEXST MULT LDS","code_information":[{"code":"33221","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":41752.99,"gross_charge":36697,"discounted_cash":10862.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29724.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29724.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29724.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41752.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":41752.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28429.53,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29156.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25687.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6972.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7339.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5504.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7339.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17050.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18243.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17561.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17902.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18755.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18073.4,"methodology":"case rate"}]}]},{"description":"HC REVISION OF POCKET PM","code_information":[{"code":"33222","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3735.72,"maximum":3735.72,"gross_charge":4612,"discounted_cash":1365.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3735.72,"methodology":"fee schedule"}]}]},{"description":"HC REVISION OF POCKET PM","code_information":[{"code":"33222","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"gross_charge":4612,"discounted_cash":1365.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"HC REVISION OF POCKET ICD","code_information":[{"code":"33223","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3735.72,"maximum":3735.72,"gross_charge":4612,"discounted_cash":1365.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3735.72,"methodology":"fee schedule"}]}]},{"description":"HC REVISION OF POCKET ICD","code_information":[{"code":"33223","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"gross_charge":4612,"discounted_cash":1365.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"HC INSERT CS/LV LEAD-PREV IMPL","code_information":[{"code":"33224","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6889.86,"maximum":6889.86,"gross_charge":8506,"discounted_cash":2517.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6889.86,"methodology":"fee schedule"}]}]},{"description":"HC INSERT CS/LV LEAD-PREV IMPL","code_information":[{"code":"33224","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22912.01,"gross_charge":8506,"discounted_cash":2517.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6889.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5954.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1275.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC INSERT CS/LV LD NEW IMPL","code_information":[{"code":"33225","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8095.14,"maximum":8095.14,"gross_charge":9994,"discounted_cash":2958.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8095.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8095.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8095.14,"methodology":"fee schedule"}]}]},{"description":"HC INSERT CS/LV LD NEW IMPL","code_information":[{"code":"33225","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12250,"gross_charge":9994,"discounted_cash":2958.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8095.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8095.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8095.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6995.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1898.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1998.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1998.8,"methodology":"fee schedule"}]}]},{"description":"HC REPOS PREV IMPL LV/CS LD","code_information":[{"code":"33226","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5298.21,"maximum":5298.21,"gross_charge":6541,"discounted_cash":1936.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5298.21,"methodology":"fee schedule"}]}]},{"description":"HC REPOS PREV IMPL LV/CS LD","code_information":[{"code":"33226","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":6541,"discounted_cash":1936.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5298.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4578.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1308.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC REMOVE&REPLC PM GEN SNGL LD","code_information":[{"code":"33227","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4284.9,"maximum":4284.9,"gross_charge":5290,"discounted_cash":1565.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4284.9,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE&REPLC PM GEN SNGL LD","code_information":[{"code":"33227","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":18118.82,"gross_charge":5290,"discounted_cash":1565.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3703,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC REMOVE&REPLC PM GEN DUAL LD","code_information":[{"code":"33228","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4284.9,"maximum":4284.9,"gross_charge":5290,"discounted_cash":1565.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4284.9,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE&REPLC PM GEN DUAL LD","code_information":[{"code":"33228","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22912.01,"gross_charge":5290,"discounted_cash":1565.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4284.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22912.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15579.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15999.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3703,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1005.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9356.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10011.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9637.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9824.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10292.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9917.81,"methodology":"case rate"}]}]},{"description":"HC REMOVE&REPLC PM GEN MULT LD","code_information":[{"code":"33229","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":54675,"maximum":54675,"gross_charge":67500,"discounted_cash":19980,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54675,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54675,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54675,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE&REPLC PM GEN MULT LD","code_information":[{"code":"33229","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":54675,"gross_charge":67500,"discounted_cash":19980,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54675,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54675,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54675,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41752.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":41752.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28429.53,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29156.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47250,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12825,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13500,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10125,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13500,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17050.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18243.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17561.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17902.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18755.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18073.4,"methodology":"case rate"}]}]},{"description":"INSRT PULSE GEN W/DUAL LEADS","code_information":[{"code":"33230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":49142.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34391.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34315.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20067.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21472.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20669.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21071.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22074.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21271.86,"methodology":"case rate"}]}]},{"description":"INSRT PULSE GEN W/MULT LEADS","code_information":[{"code":"33231","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":70193.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48000.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49016,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28664.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30670.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29524.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30097.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31530.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30384.19,"methodology":"case rate"}]}]},{"description":"HC REMOVAL PM GEN ONLY","code_information":[{"code":"33233","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5006.61,"maximum":5006.61,"gross_charge":6181,"discounted_cash":1829.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5006.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5006.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5006.61,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL PM GEN ONLY","code_information":[{"code":"33233","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":18118.82,"gross_charge":6181,"discounted_cash":1829.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5006.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5006.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5006.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC REMOVAL PM TRANV LD SGL","code_information":[{"code":"33234","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2703.78,"maximum":2703.78,"gross_charge":3338,"discounted_cash":988.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2703.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2703.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2703.78,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL PM TRANV LD SGL","code_information":[{"code":"33234","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7967.61,"gross_charge":3338,"discounted_cash":988.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2703.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2703.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2703.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2336.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"HC REMOVAL PM TRANV LD DUAL","code_information":[{"code":"33235","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4706.1,"maximum":4706.1,"gross_charge":5810,"discounted_cash":1719.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4706.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4706.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4706.1,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL PM TRANV LD DUAL","code_information":[{"code":"33235","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7967.61,"gross_charge":5810,"discounted_cash":1719.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4706.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4706.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4706.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":871.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"REMOVE ELECTRODE/THORACOTOMY","code_information":[{"code":"33236","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE ELECTRODE/THORACOTOMY","code_information":[{"code":"33237","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE ELECTRODE/THORACOTOMY","code_information":[{"code":"33238","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSRT PULSE GEN W/SINGL LEAD","code_information":[{"code":"33240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":49142.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34391.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34315.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20067.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21472.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20669.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21071.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22074.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21271.86,"methodology":"case rate"}]}]},{"description":"HC REMOVAL ICD/PCD GEN ONLY","code_information":[{"code":"33241","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":10696.05,"maximum":10696.05,"gross_charge":13205,"discounted_cash":3908.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10696.05,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL ICD/PCD GEN ONLY","code_information":[{"code":"33241","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":10696.05,"gross_charge":13205,"discounted_cash":3908.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9243.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2508.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2641,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1980.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2641,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"REMOVE ELTRD/THORACOTOMY","code_information":[{"code":"33243","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REMOVAL ICD/PCD TV SGL/DUAL","code_information":[{"code":"33244","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4763.61,"maximum":4763.61,"gross_charge":5881,"discounted_cash":1740.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4763.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4763.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4763.61,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL ICD/PCD TV SGL/DUAL","code_information":[{"code":"33244","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7967.61,"gross_charge":5881,"discounted_cash":1740.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4763.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4763.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4763.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4116.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1117.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1176.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1176.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"HC INSERT ICD+LEAD SNGL/DUAL","code_information":[{"code":"33249","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":72641.61,"maximum":72641.61,"gross_charge":89681,"discounted_cash":26545.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72641.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72641.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72641.61,"methodology":"fee schedule"}]}]},{"description":"HC INSERT ICD+LEAD SNGL/DUAL","code_information":[{"code":"33249","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":72641.61,"gross_charge":89681,"discounted_cash":26545.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72641.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72641.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72641.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48000.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49016,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62776.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17039.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17936.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13452.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17936.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28664.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30670.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29524.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30097.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31530.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30384.19,"methodology":"case rate"}]}]},{"description":"ABLATE HEART DYSRHYTHM FOCUS","code_information":[{"code":"33250","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE HEART DYSRHYTHM FOCUS","code_information":[{"code":"33251","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA LMTD","code_information":[{"code":"33254","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA W/O BYPASS EXT","code_information":[{"code":"33255","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA W/BYPASS EXTEN","code_information":[{"code":"33256","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA LMTD ADD-ON","code_information":[{"code":"33257","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA X10SV ADD-ON","code_information":[{"code":"33258","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA W/BYPASS ADD-ON","code_information":[{"code":"33259","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE HEART DYSRHYTHM FOCUS","code_information":[{"code":"33261","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REMOVAL&REPL ICD GEN SNG LD","code_information":[{"code":"33262","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6174.63,"maximum":6174.63,"gross_charge":7623,"discounted_cash":2256.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6174.63,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL&REPL ICD GEN SNG LD","code_information":[{"code":"33262","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":49142.03,"gross_charge":7623,"discounted_cash":2256.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34391.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34315.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5336.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20067.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21472.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20669.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21071.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22074.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21271.86,"methodology":"case rate"}]}]},{"description":"HC REMOVAL&REPL ICD GN DUAL LD","code_information":[{"code":"33263","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6174.63,"maximum":6174.63,"gross_charge":7623,"discounted_cash":2256.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6174.63,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL&REPL ICD GN DUAL LD","code_information":[{"code":"33263","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":49142.03,"gross_charge":7623,"discounted_cash":2256.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49142.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34391.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34315.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5336.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20067.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21472.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20669.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21071.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22074.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21271.86,"methodology":"case rate"}]}]},{"description":"HC REMOVAL&REPL ICD GN MULT LD","code_information":[{"code":"33264","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6174.63,"maximum":6174.63,"gross_charge":7623,"discounted_cash":2256.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6174.63,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL&REPL ICD GN MULT LD","code_information":[{"code":"33264","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":70193.24,"gross_charge":7623,"discounted_cash":2256.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6174.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48000.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49016,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5336.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28664.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30670.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29524.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30097.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31530.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30384.19,"methodology":"case rate"}]}]},{"description":"ABLATE ATRIA LMTD ENDO","code_information":[{"code":"33265","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABLATE ATRIA X10SV ENDO","code_information":[{"code":"33266","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INS/REP SUBC DEFIBRILLATOR","code_information":[{"code":"33270","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":63761.58,"maximum":63761.58,"gross_charge":78718,"discounted_cash":23300.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63761.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63761.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63761.58,"methodology":"fee schedule"}]}]},{"description":"HC INS/REP SUBC DEFIBRILLATOR","code_information":[{"code":"33270","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":70193.24,"gross_charge":78718,"discounted_cash":23300.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63761.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63761.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63761.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":70193.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48000.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49016,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14956.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15743.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11807.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15743.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28664.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30670.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29524.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30097.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31530.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30384.19,"methodology":"case rate"}]}]},{"description":"HC INSJ SUBQ IMPLTBL DFB ELCTRD","code_information":[{"code":"33271","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":12669.21,"maximum":12669.21,"gross_charge":15641,"discounted_cash":4629.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12669.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12669.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12669.21,"methodology":"fee schedule"}]}]},{"description":"HC INSJ SUBQ IMPLTBL DFB ELCTRD","code_information":[{"code":"33271","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":18118.82,"gross_charge":15641,"discounted_cash":4629.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12669.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12669.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12669.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2971.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3128.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2346.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3128.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC RMVL OF SUBC DEFIBRILLATOR","code_information":[{"code":"33272","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6480.81,"maximum":6480.81,"gross_charge":8001,"discounted_cash":2368.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6480.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6480.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6480.81,"methodology":"fee schedule"}]}]},{"description":"HC RMVL OF SUBC DEFIBRILLATOR","code_information":[{"code":"33272","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7967.61,"gross_charge":8001,"discounted_cash":2368.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6480.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6480.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6480.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1520.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1600.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1600.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"HC REPOS PREV IMPLTBL SUBC DFB","code_information":[{"code":"33273","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":10696.05,"maximum":10696.05,"gross_charge":13205,"discounted_cash":3908.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10696.05,"methodology":"fee schedule"}]}]},{"description":"HC REPOS PREV IMPLTBL SUBC DFB","code_information":[{"code":"33273","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10696.05,"gross_charge":13205,"discounted_cash":3908.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10696.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2508.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2641,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1980.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2641,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"HC INSRT/REP LDLES PM NCT03039712","code_information":[{"code":"33274","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":51473.07,"maximum":51473.07,"gross_charge":63547,"discounted_cash":18809.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51473.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51473.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51473.07,"methodology":"fee schedule"}]}]},{"description":"HC INSRT/REP LDLES PM NCT03039712","code_information":[{"code":"33274","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":51473.07,"gross_charge":63547,"discounted_cash":18809.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51473.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51473.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51473.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41752.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":41752.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28429.53,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29156.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12073.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12709.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9532.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12709.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17050.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18243.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17561.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17902.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18755.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18073.4,"methodology":"case rate"}]}]},{"description":"HC TRANSCATH REMO LEADLESS PPM","code_information":[{"code":"33275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8751.24,"maximum":8751.24,"gross_charge":10804,"discounted_cash":3197.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8751.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8751.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8751.24,"methodology":"fee schedule"}]}]},{"description":"HC TRANSCATH REMO LEADLESS PPM","code_information":[{"code":"33275","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8751.24,"gross_charge":10804,"discounted_cash":3197.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8751.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8751.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8751.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2052.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2160.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1620.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2160.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INST PHRNC NRV STIM SYS","code_information":[{"code":"33276","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":66181.05,"maximum":66181.05,"gross_charge":81705,"discounted_cash":24184.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66181.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66181.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66181.05,"methodology":"fee schedule"}]}]},{"description":"INST PHRNC NRV STIM SYS","code_information":[{"code":"33276","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5079,"maximum":66181.05,"gross_charge":81705,"discounted_cash":24184.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66181.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66181.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66181.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15523.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16341,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12255.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16341,"methodology":"fee schedule"}]}]},{"description":"INST PHRNC NRV SENS LEAD","code_information":[{"code":"33277","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":33092.55,"maximum":33092.55,"gross_charge":40855,"discounted_cash":12093.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33092.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33092.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33092.55,"methodology":"fee schedule"}]}]},{"description":"INST PHRNC NRV SENS LEAD","code_information":[{"code":"33277","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5079,"maximum":33092.55,"gross_charge":40855,"discounted_cash":12093.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33092.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33092.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33092.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7762.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8171,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6128.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8171,"methodology":"fee schedule"}]}]},{"description":"REMOV PHRNC NRV STIM SYS","code_information":[{"code":"33278","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9553.95,"maximum":9553.95,"gross_charge":11795,"discounted_cash":3491.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9553.95,"methodology":"fee schedule"}]}]},{"description":"REMOV PHRNC NRV STIM SYS","code_information":[{"code":"33278","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1769.25,"maximum":9553.95,"gross_charge":11795,"discounted_cash":3491.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2241.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2359,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1769.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2359,"methodology":"fee schedule"}]}]},{"description":"REPOS PHRNC NRV LEAD","code_information":[{"code":"33281","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9553.95,"maximum":9553.95,"gross_charge":11795,"discounted_cash":3491.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9553.95,"methodology":"fee schedule"}]}]},{"description":"REPOS PHRNC NRV LEAD","code_information":[{"code":"33281","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1769.25,"maximum":9553.95,"gross_charge":11795,"discounted_cash":3491.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9553.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2241.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2359,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1769.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2359,"methodology":"fee schedule"}]}]},{"description":"HC CARDIAC EVENT RECRDR IMPLANT","code_information":[{"code":"33285","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15633.81,"maximum":15633.81,"gross_charge":19301,"discounted_cash":5713.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15633.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15633.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15633.81,"methodology":"fee schedule"}]}]},{"description":"HC CARDIAC EVENT RECRDR IMPLANT","code_information":[{"code":"33285","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":18118.82,"gross_charge":19301,"discounted_cash":5713.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15633.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15633.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15633.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18118.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12395.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12652.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3667.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3860.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2895.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3860.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7399.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7916.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7621.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8138.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7843,"methodology":"case rate"}]}]},{"description":"HC CARDIAC EVENT RECRDR REMOVAL","code_information":[{"code":"33286","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1954.53,"maximum":1954.53,"gross_charge":2413,"discounted_cash":714.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1954.53,"methodology":"fee schedule"}]}]},{"description":"HC CARDIAC EVENT RECRDR REMOVAL","code_information":[{"code":"33286","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2413,"discounted_cash":714.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1954.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":458.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":361.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"IMPT WIRELESS PULM/ART SENSOR","code_information":[{"code":"33289","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":89302.5,"maximum":89302.5,"gross_charge":110250,"discounted_cash":32634,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89302.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89302.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89302.5,"methodology":"fee schedule"}]}]},{"description":"IMPT WIRELESS PULM/ART SENSOR","code_information":[{"code":"33289","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":89302.5,"gross_charge":110250,"discounted_cash":32634,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89302.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89302.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89302.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62238.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":62238.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42406.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43461.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20947.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22050,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16537.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22050,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25416.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27195.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26178.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26686.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27957.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26941.02,"methodology":"case rate"}]}]},{"description":"RECTAL RESECTION WITH CC","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"minimum":11700,"maximum":33220,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19104,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18061,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11814,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33220,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31146,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28662.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24138,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28778,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21955,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30170.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31563,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19597,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19597,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11700,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16761.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17934.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17264.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17599.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17767.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17599.67,"methodology":"case rate"}]}]},{"description":"REPAIR OF HEART WOUND","code_information":[{"code":"33300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART WOUND","code_information":[{"code":"33305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATORY HEART SURGERY","code_information":[{"code":"33310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATORY HEART SURGERY","code_information":[{"code":"33315","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SUT REP/AORTA;W/O BYPASS","code_information":[{"code":"33320","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9430.02,"maximum":9430.02,"gross_charge":11642,"discounted_cash":3446.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9430.02,"methodology":"fee schedule"}]}]},{"description":"HC SUT REP/AORTA;W/O BYPASS","code_information":[{"code":"33320","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9430.02,"gross_charge":11642,"discounted_cash":3446.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8149.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2211.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1746.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.4,"methodology":"fee schedule"}]}]},{"description":"REPAIR MAJOR VESSEL","code_information":[{"code":"33321","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR MAJOR BLOOD VESSEL(S)","code_information":[{"code":"33322","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT MAJOR VESSEL GRAFT","code_information":[{"code":"33330","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT MAJOR VESSEL GRAFT","code_information":[{"code":"33335","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAA CLOSURE W/IMPLANT","code_information":[{"code":"33340","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1816.83,"maximum":1816.83,"gross_charge":2243,"discounted_cash":663.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1816.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1816.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1816.83,"methodology":"fee schedule"}]}]},{"description":"HC LAA CLOSURE W/IMPLANT","code_information":[{"code":"33340","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2243,"discounted_cash":663.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1816.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1816.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1816.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.6,"methodology":"fee schedule"}]}]},{"description":"TAVR-PERCUT FEMORAL","code_information":[{"code":"33361","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8804.7,"maximum":8804.7,"gross_charge":10870,"discounted_cash":3217.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8804.7,"methodology":"fee schedule"}]}]},{"description":"TAVR-PERCUT FEMORAL","code_information":[{"code":"33361","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8804.7,"gross_charge":10870,"discounted_cash":3217.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7609,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174,"methodology":"fee schedule"}]}]},{"description":"TAVR-OPEN FEMORAL","code_information":[{"code":"33362","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8804.7,"maximum":8804.7,"gross_charge":10870,"discounted_cash":3217.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8804.7,"methodology":"fee schedule"}]}]},{"description":"TAVR-OPEN FEMORAL","code_information":[{"code":"33362","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8804.7,"gross_charge":10870,"discounted_cash":3217.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8804.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7609,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2174,"methodology":"fee schedule"}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33363","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33364","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE AORTIC VALVE OPEN","code_information":[{"code":"33365","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRCATH REPLACE AORTIC VALVE","code_information":[{"code":"33366","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE AORTIC VALVE W/BYP","code_information":[{"code":"33367","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE AORTIC VALVE W/BYP","code_information":[{"code":"33368","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE AORTIC VALVE W/BYP","code_information":[{"code":"33369","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VALVULOPLASTY AORTIC VALVE","code_information":[{"code":"33390","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VALVULOPLASTY AORTIC VALVE","code_information":[{"code":"33391","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECTAL RESECTION WITHOUT CC/MCC","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"minimum":9061,"maximum":24774.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14909,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14095,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9119,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22822,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21397,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23535.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18532,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22095,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16947,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24774.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24632,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15294,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15294,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9061,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13763.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14726.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14176.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14451.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14589.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14451.67,"methodology":"case rate"}]}]},{"description":"PREPARE HEART-AORTA CONDUIT","code_information":[{"code":"33404","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT AORTIC VALVE OPN","code_information":[{"code":"33405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT AORTIC VALVE OPN","code_information":[{"code":"33406","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT AORTIC VALVE OPN","code_information":[{"code":"33410","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT OF AORTIC VALVE","code_information":[{"code":"33411","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT OF AORTIC VALVE","code_information":[{"code":"33412","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT OF AORTIC VALVE","code_information":[{"code":"33413","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF AORTIC VALVE","code_information":[{"code":"33414","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION SUBVALVULAR TISSUE","code_information":[{"code":"33415","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE VENTRICLE MUSCLE","code_information":[{"code":"33416","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF AORTIC VALVE","code_information":[{"code":"33417","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REPAIR TCAT MITRAL VALVE","code_information":[{"code":"33418","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8451.54,"maximum":8451.54,"gross_charge":10434,"discounted_cash":3088.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8451.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8451.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8451.54,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR TCAT MITRAL VALVE","code_information":[{"code":"33418","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8451.54,"gross_charge":10434,"discounted_cash":3088.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8451.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8451.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8451.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1982.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2086.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1565.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2086.8,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR TCAT MITRAL VALVE EA ADDL","code_information":[{"code":"33419","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4837.32,"maximum":4837.32,"gross_charge":5972,"discounted_cash":1767.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4837.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4837.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4837.32,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR TCAT MITRAL VALVE EA ADDL","code_information":[{"code":"33419","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":5972,"discounted_cash":1767.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4837.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4837.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4837.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1194.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1194.4,"methodology":"fee schedule"}]}]},{"description":"REVISION OF MITRAL VALVE","code_information":[{"code":"33420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF MITRAL VALVE","code_information":[{"code":"33422","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF MITRAL VALVE","code_information":[{"code":"33425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF MITRAL VALVE","code_information":[{"code":"33426","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF MITRAL VALVE","code_information":[{"code":"33427","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT OF MITRAL VALVE","code_information":[{"code":"33430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPLCMT A-VALVE TLCJ AUTOL PV","code_information":[{"code":"33440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF TRICUSPID VALVE","code_information":[{"code":"33460","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VALVULOPLASTY TRICUSPID","code_information":[{"code":"33463","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VALVULOPLASTY TRICUSPID","code_information":[{"code":"33464","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE TRICUSPID VALVE","code_information":[{"code":"33465","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF TRICUSPID VALVE","code_information":[{"code":"33468","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF PULMONARY VALVE","code_information":[{"code":"33470","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VALVOTOMY PULMONARY VALVE","code_information":[{"code":"33471","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF PULMONARY VALVE","code_information":[{"code":"33474","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACEMENT PULMONARY VALVE","code_information":[{"code":"33475","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33476","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT TCAT PULM VLV PERQ","code_information":[{"code":"33477","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33478","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR PROSTH VALVE CLOT","code_information":[{"code":"33496","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH MCC","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"minimum":20311,"maximum":66564,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32571,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30792,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20311,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66564,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62409,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45119.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39818,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47473,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37745,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":47493.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53811,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33411,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33411,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28807,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26385.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28232.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27177.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27704.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27968.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27704.72,"methodology":"case rate"}]}]},{"description":"REPAIR HEART VESSEL FISTULA","code_information":[{"code":"33500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART VESSEL FISTULA","code_information":[{"code":"33501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY ARTERY CORRECTION","code_information":[{"code":"33502","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY ARTERY GRAFT","code_information":[{"code":"33503","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY ARTERY GRAFT","code_information":[{"code":"33504","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY W/TUNNEL","code_information":[{"code":"33505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY TRANSLOCATION","code_information":[{"code":"33506","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ART INTRAMURAL","code_information":[{"code":"33507","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENDOSCOPIC VEIN HARVEST","code_information":[{"code":"33508","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG VEIN SINGLE","code_information":[{"code":"33510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG VEIN TWO","code_information":[{"code":"33511","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG VEIN THREE","code_information":[{"code":"33512","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG VEIN FOUR","code_information":[{"code":"33513","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG VEIN FIVE","code_information":[{"code":"33514","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG VEIN SIX OR MORE","code_information":[{"code":"33516","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERY-VEIN SINGLE","code_information":[{"code":"33517","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERY-VEIN TWO","code_information":[{"code":"33518","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERY-VEIN THREE","code_information":[{"code":"33519","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERY-VEIN FOUR","code_information":[{"code":"33521","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERY-VEIN FIVE","code_information":[{"code":"33522","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ART-VEIN SIX OR MORE","code_information":[{"code":"33523","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORONARY ARTERY BYPASS/REOP","code_information":[{"code":"33530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERIAL SINGLE","code_information":[{"code":"33533","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERIAL TWO","code_information":[{"code":"33534","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERIAL THREE","code_information":[{"code":"33535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CABG ARTERIAL FOUR OR MORE","code_information":[{"code":"33536","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF HEART LESION","code_information":[{"code":"33542","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DAMAGE","code_information":[{"code":"33545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESTORE/REMODEL VENTRICLE","code_information":[{"code":"33548","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN CORONARY ENDARTERECTOMY","code_information":[{"code":"33572","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH CC","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":11961,"maximum":32122,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18987,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17950,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11961,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32122,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30117,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28519.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22991,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27411,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22228,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30020.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31370,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19478,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19478,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14639,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16678.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17845.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17178.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17511.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17678.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17511.98,"methodology":"case rate"}]}]},{"description":"CLOSURE OF VALVE","code_information":[{"code":"33600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSURE OF VALVE","code_information":[{"code":"33602","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANASTOMOSIS/ARTERY-AORTA","code_information":[{"code":"33606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ANOMALY W/CONDUIT","code_information":[{"code":"33608","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BY ENLARGEMENT","code_information":[{"code":"33610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DOUBLE VENTRICLE","code_information":[{"code":"33611","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DOUBLE VENTRICLE","code_information":[{"code":"33612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR MODIFIED FONTAN","code_information":[{"code":"33615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SINGLE VENTRICLE","code_information":[{"code":"33617","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SINGLE VENTRICLE","code_information":[{"code":"33619","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPLY RL PULM ART BANDS","code_information":[{"code":"33620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSTHOR CATH FOR STENT","code_information":[{"code":"33621","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REDO COMPL CARDIAC ANOMALY","code_information":[{"code":"33622","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33641","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HEART VEINS","code_information":[{"code":"33645","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART SEPTUM DEFECTS","code_information":[{"code":"33647","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33665","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART CHAMBERS","code_information":[{"code":"33670","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE MULT VSD","code_information":[{"code":"33675","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE MULT VSD W/RESECTION","code_information":[{"code":"33676","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CL MULT VSD W/REM PUL BAND","code_information":[{"code":"33677","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33681","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33684","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART SEPTUM DEFECT","code_information":[{"code":"33688","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REINFORCE PULMONARY ARTERY","code_information":[{"code":"33690","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33692","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33694","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33697","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":8502,"maximum":23346.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13799,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13045,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8502,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20880,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19577,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22178.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17030,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20303,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15799,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23346.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22798,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14155,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14155,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8950,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12970.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13878.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13359.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13618.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13748.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13618.63,"methodology":"case rate"}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33702","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECTS","code_information":[{"code":"33710","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECT","code_information":[{"code":"33720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HEART DEFECT","code_information":[{"code":"33722","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR VENOUS ANOMALY","code_information":[{"code":"33724","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR PUL VENOUS STENOSIS","code_information":[{"code":"33726","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART-VEIN DEFECT(S)","code_information":[{"code":"33730","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR HEART-VEIN DEFECT","code_information":[{"code":"33732","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33735","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33736","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HEART CHAMBER","code_information":[{"code":"33737","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TAS CONGENITAL CAR ANOMAL","code_information":[{"code":"33741","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TIS CGEN CAR ANOMAL 1ST SHNT","code_information":[{"code":"33745","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TIS CGEN CAR ANOMAL EA ADDL","code_information":[{"code":"33746","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33755","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33762","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR VESSEL SHUNT  GRAFT","code_information":[{"code":"33764","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33766","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR VESSEL SHUNT","code_information":[{"code":"33767","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CAVOPULMONARY SHUNTING","code_information":[{"code":"33768","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33771","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33774","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33775","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33776","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33777","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33778","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33779","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR GREAT VESSELS DEFECT","code_information":[{"code":"33781","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NIKAIDOH PROC","code_information":[{"code":"33782","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NIKAIDOH PROC W/OSTIA IMPLT","code_information":[{"code":"33783","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERIAL TRUNK","code_information":[{"code":"33786","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF PULMONARY ARTERY","code_information":[{"code":"33788","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"minimum":13327,"maximum":34234,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28714,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34234,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13327,"methodology":"case rate"}]}]},{"description":"AORTIC SUSPENSION","code_information":[{"code":"33800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR VESSEL DEFECT","code_information":[{"code":"33802","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR VESSEL DEFECT","code_information":[{"code":"33803","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33813","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33814","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE MAJOR VESSEL","code_information":[{"code":"33820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12250,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE MAJOR VESSEL","code_information":[{"code":"33822","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE MAJOR VESSEL","code_information":[{"code":"33824","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12250,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE AORTA CONSTRICTION","code_information":[{"code":"33840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE AORTA CONSTRICTION","code_information":[{"code":"33845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE AORTA CONSTRICTION","code_information":[{"code":"33851","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33852","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SEPTAL DEFECT","code_information":[{"code":"33853","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AS-AORT GRF F/AORTIC DSJ","code_information":[{"code":"33858","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AS-AORT GRF F/DS OTH/THN DSJ","code_information":[{"code":"33859","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ASCENDING AORTIC GRAFT","code_information":[{"code":"33863","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ASCENDING AORTIC GRAFT","code_information":[{"code":"33864","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AORTIC HEMIARCH GRAFT","code_information":[{"code":"33866","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSVRS A-ARCH GRF HYPTHRM","code_information":[{"code":"33871","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACIC AORTIC GRAFT","code_information":[{"code":"33875","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACOABDOMINAL GRAFT","code_information":[{"code":"33877","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ENDOVASC TAA REPR W/ SUBCL","code_information":[{"code":"33880","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":9248.58,"maximum":9248.58,"gross_charge":11418,"discounted_cash":3379.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9248.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9248.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9248.58,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVASC TAA REPR W/ SUBCL","code_information":[{"code":"33880","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9248.58,"gross_charge":11418,"discounted_cash":3379.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9248.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9248.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9248.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7992.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2169.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2283.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1712.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2283.6,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVAS TAA REPR W/O SUBCL","code_information":[{"code":"33881","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8397.27,"maximum":8397.27,"gross_charge":10367,"discounted_cash":3068.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8397.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8397.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8397.27,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVAS TAA REPR W/O SUBCL","code_information":[{"code":"33881","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8397.27,"gross_charge":10367,"discounted_cash":3068.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8397.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8397.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8397.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7256.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1969.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2073.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1555.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2073.4,"methodology":"fee schedule"}]}]},{"description":"HC INSERT ENDOVASC PROSTH TAA","code_information":[{"code":"33883","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5783.4,"maximum":5783.4,"gross_charge":7140,"discounted_cash":2113.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5783.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5783.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5783.4,"methodology":"fee schedule"}]}]},{"description":"HC INSERT ENDOVASC PROSTH TAA","code_information":[{"code":"33883","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5783.4,"gross_charge":7140,"discounted_cash":2113.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5783.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5783.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5783.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4998,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1356.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1428,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1428,"methodology":"fee schedule"}]}]},{"description":"ENDOVASC PROSTH TAA ADD-ON","code_information":[{"code":"33884","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ENDOVAS PROSTH TAA DELAYED","code_information":[{"code":"33886","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6033.69,"maximum":6033.69,"gross_charge":7449,"discounted_cash":2204.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6033.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6033.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6033.69,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVAS PROSTH TAA DELAYED","code_information":[{"code":"33886","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6033.69,"gross_charge":7449,"discounted_cash":2204.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6033.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6033.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6033.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5214.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1415.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1117.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.8,"methodology":"fee schedule"}]}]},{"description":"BYPASS; CAROTID-SC W/TAA","code_information":[{"code":"33889","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8152.65,"maximum":8152.65,"gross_charge":10065,"discounted_cash":2979.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8152.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8152.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8152.65,"methodology":"fee schedule"}]}]},{"description":"BYPASS; CAROTID-SC W/TAA","code_information":[{"code":"33889","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8152.65,"gross_charge":10065,"discounted_cash":2979.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8152.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8152.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8152.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7045.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1912.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1509.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2013,"methodology":"fee schedule"}]}]},{"description":"CAR-CAR BP GRFT/ENDOVAS TAA","code_information":[{"code":"33891","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"minimum":10043,"maximum":20985,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17601,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20985,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10043,"methodology":"case rate"}]}]},{"description":"REMOVE LUNG ARTERY EMBOLI","code_information":[{"code":"33910","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE LUNG ARTERY EMBOLI","code_information":[{"code":"33915","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGERY OF GREAT VESSEL","code_information":[{"code":"33916","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR PULMONARY ARTERY","code_information":[{"code":"33917","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR PULMONARY ATRESIA","code_information":[{"code":"33920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSECT PULMONARY ARTERY","code_information":[{"code":"33922","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PULMONARY SHUNT","code_information":[{"code":"33924","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR PUL ART UNIFOCAL W/O CPB","code_information":[{"code":"33925","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPR PUL ART UNIFOCAL W/CPB","code_information":[{"code":"33926","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLTJ TOT RPLCMT HRT SYS","code_information":[{"code":"33927","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL  RPLCMT TOT HRT SYS","code_information":[{"code":"33928","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL RPLCMT HRT SYS F/TRNSPL","code_information":[{"code":"33929","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF DONOR HEART/LUNG","code_information":[{"code":"33930","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE DONOR HEART/LUNG","code_information":[{"code":"33933","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION HEART/LUNG","code_information":[{"code":"33935","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF DONOR HEART","code_information":[{"code":"33940","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE DONOR HEART","code_information":[{"code":"33944","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":937.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":742.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION OF HEART","code_information":[{"code":"33945","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ECMO/ECLS INITIATION VENOUS","code_information":[{"code":"33946","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1066.77,"maximum":1066.77,"gross_charge":1317,"discounted_cash":389.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1066.77,"methodology":"fee schedule"}]}]},{"description":"HC ECMO/ECLS INITIATION VENOUS","code_information":[{"code":"33946","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1317,"discounted_cash":389.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1066.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.4,"methodology":"fee schedule"}]}]},{"description":"HC ECMO INITIAL DAY","code_information":[{"code":"33947","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2321.46,"maximum":2321.46,"gross_charge":2866,"discounted_cash":848.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2321.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2321.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2321.46,"methodology":"fee schedule"}]}]},{"description":"HC ECMO INITIAL DAY","code_information":[{"code":"33947","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2866,"discounted_cash":848.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2321.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2321.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2321.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":573.2,"methodology":"fee schedule"}]}]},{"description":"HC ECMO SUBSQ DAYS - VENOUS","code_information":[{"code":"33948","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1477.44,"maximum":1477.44,"gross_charge":1824,"discounted_cash":539.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1477.44,"methodology":"fee schedule"}]}]},{"description":"HC ECMO SUBSQ DAYS - VENOUS","code_information":[{"code":"33948","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1824,"discounted_cash":539.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.8,"methodology":"fee schedule"}]}]},{"description":"HC ECMO SUBSQ DAYS - ARTERIAL","code_information":[{"code":"33949","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1477.44,"maximum":1477.44,"gross_charge":1824,"discounted_cash":539.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1477.44,"methodology":"fee schedule"}]}]},{"description":"HC ECMO SUBSQ DAYS - ARTERIAL","code_information":[{"code":"33949","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1824,"discounted_cash":539.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.8,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ PRPH CANNULA","code_information":[{"code":"33951","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ECMO/ECLS INSJ PRPH CANNULA PERC","code_information":[{"code":"33952","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4057.29,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"}]}]},{"description":"HC ECMO/ECLS INSJ PRPH CANNULA PERC","code_information":[{"code":"33952","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CANNULA ECMO","code_information":[{"code":"33952","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4057.29,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CANNULA ECMO","code_information":[{"code":"33952","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ PRPH CANNULA","code_information":[{"code":"33953","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ECMO/ECLS INSJ PRPH CNULA OPEN","code_information":[{"code":"33954","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3863.7,"maximum":3863.7,"gross_charge":4770,"discounted_cash":1411.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3863.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3863.7,"methodology":"fee schedule"}]}]},{"description":"HC ECMO/ECLS INSJ PRPH CNULA OPEN","code_information":[{"code":"33954","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3863.7,"gross_charge":4770,"discounted_cash":1411.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3863.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3863.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3863.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":954,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":954,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS INSJ CTR CANNULA","code_information":[{"code":"33955","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS INSJ CTR CANNULA","code_information":[{"code":"33956","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33957","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO (EXTRACORPOREAL OXYGEN) 33958","code_information":[{"code":"33958","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2029.05,"maximum":2029.05,"gross_charge":2505,"discounted_cash":741.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2029.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2029.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2029.05,"methodology":"fee schedule"}]}]},{"description":"ECMO (EXTRACORPOREAL OXYGEN) 33958","code_information":[{"code":"33958","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2505,"discounted_cash":741.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2029.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2029.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2029.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":501,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":501,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33959","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33962","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33963","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS REPOS PERPH CNULA","code_information":[{"code":"33964","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS RMVL PERPH CANNULA","code_information":[{"code":"33965","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DECANNULATION OF ECMO","code_information":[{"code":"33966","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":797.85,"maximum":797.85,"gross_charge":985,"discounted_cash":291.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.85,"methodology":"fee schedule"}]}]},{"description":"HC DECANNULATION OF ECMO","code_information":[{"code":"33966","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":985,"discounted_cash":291.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":197,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":197,"methodology":"fee schedule"}]}]},{"description":"HC IABP INSERTION PERC","code_information":[{"code":"33967","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6697.89,"maximum":6697.89,"gross_charge":8269,"discounted_cash":2447.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6697.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6697.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6697.89,"methodology":"fee schedule"}]}]},{"description":"HC IABP INSERTION PERC","code_information":[{"code":"33967","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12896,"gross_charge":8269,"discounted_cash":2447.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6697.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6697.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6697.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5788.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1571.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1653.8,"methodology":"fee schedule"}]}]},{"description":"HC IABP REMOVAL PERC","code_information":[{"code":"33968","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6295.32,"maximum":6295.32,"gross_charge":7772,"discounted_cash":2300.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6295.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6295.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6295.32,"methodology":"fee schedule"}]}]},{"description":"HC IABP REMOVAL PERC","code_information":[{"code":"33968","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12896,"gross_charge":7772,"discounted_cash":2300.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6295.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6295.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6295.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5440.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1554.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1554.4,"methodology":"fee schedule"}]}]},{"description":"ECMO/ECLS RMVL PERPH CANNULA","code_information":[{"code":"33969","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AORTIC CIRCULATION ASSIST","code_information":[{"code":"33970","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REMVL INTRA AORT BP","code_information":[{"code":"33971","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11233.08,"maximum":11233.08,"gross_charge":13868,"discounted_cash":4104.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11233.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11233.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11233.08,"methodology":"fee schedule"}]}]},{"description":"HC REMVL INTRA AORT BP","code_information":[{"code":"33971","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11233.08,"gross_charge":13868,"discounted_cash":4104.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11233.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11233.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11233.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9707.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2634.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2773.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2773.6,"methodology":"fee schedule"}]}]},{"description":"INSERT BALLOON DEVICE","code_information":[{"code":"33973","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE INTRA-AORTIC BALLOON","code_information":[{"code":"33974","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT VENTRICULAR DEVICE","code_information":[{"code":"33975","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT VENTRICULAR DEVICE","code_information":[{"code":"33976","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VENTRICULAR DEVICE","code_information":[{"code":"33977","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VENTRICULAR DEVICE","code_information":[{"code":"33978","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT INTRACORPOREAL DEVICE","code_information":[{"code":"33979","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE INTRACORPOREAL DEVICE","code_information":[{"code":"33980","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE VAD PUMP EXT","code_information":[{"code":"33981","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE VAD INTRA W/O BP","code_information":[{"code":"33982","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE VAD INTRA W/BP","code_information":[{"code":"33983","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS RMVL PRPH CANNULA","code_information":[{"code":"33984","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS RMVL CTR CANNULA","code_information":[{"code":"33985","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ECMO/ECLS RMVL CTR CANNULA","code_information":[{"code":"33986","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ARTERY EXPOS/GRAFT ARTERY","code_information":[{"code":"33987","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERTION OF LEFT HEART VENT","code_information":[{"code":"33988","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF LEFT HEART VENT","code_information":[{"code":"33989","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INS VAD ARTRY ACCESS","code_information":[{"code":"33990","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2511,"maximum":2511,"gross_charge":3100,"discounted_cash":917.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2511,"methodology":"fee schedule"}]}]},{"description":"HC INS VAD ARTRY ACCESS","code_information":[{"code":"33990","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3100,"discounted_cash":917.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2170,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":620,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":465,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":620,"methodology":"fee schedule"}]}]},{"description":"INSERT VAD ARTVEIN ACCESS","code_information":[{"code":"33991","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REMOVE VAD DIFF SESS","code_information":[{"code":"33992","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2059.02,"maximum":2059.02,"gross_charge":2542,"discounted_cash":752.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2059.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2059.02,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE VAD DIFF SESS","code_information":[{"code":"33992","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2542,"discounted_cash":752.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2059.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2059.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1779.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.4,"methodology":"fee schedule"}]}]},{"description":"REPOSITION OF IMPELLA","code_information":[{"code":"33993","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1355.94,"maximum":1355.94,"gross_charge":1674,"discounted_cash":495.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1355.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1355.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1355.94,"methodology":"fee schedule"}]}]},{"description":"REPOSITION OF IMPELLA","code_information":[{"code":"33993","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1674,"discounted_cash":495.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1355.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1355.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1355.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1171.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":318.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.8,"methodology":"fee schedule"}]}]},{"description":"INSJ PERQ VAD R HRT VENOUS","code_information":[{"code":"33995","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RMVL PERQ RIGHT HEART VAD","code_information":[{"code":"33997","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PQ MITRAL VALVE REP ACCUCINCH","code_information":[{"code":"33999","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2535.3,"maximum":2535.3,"gross_charge":3130,"discounted_cash":926.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2535.3,"methodology":"fee schedule"}]}]},{"description":"HC PQ MITRAL VALVE REP ACCUCINCH","code_information":[{"code":"33999","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3130,"discounted_cash":926.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2191,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":594.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":626,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":626,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HIS LEAD IMPLANTATION","code_information":[{"code":"33999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2535.3,"maximum":2535.3,"gross_charge":3130,"discounted_cash":926.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2535.3,"methodology":"fee schedule"}]}]},{"description":"HIS LEAD IMPLANTATION","code_information":[{"code":"33999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3130,"discounted_cash":926.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2535.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2191,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":594.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":626,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":626,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"minimum":7865,"maximum":15463,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12970,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15463,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7865,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3401","type":"APR-DRG"}],"standard_charges":[{"minimum":3135,"maximum":3135,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3135,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3135,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3135,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3402","type":"APR-DRG"}],"standard_charges":[{"minimum":3898,"maximum":3898,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3898,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3898,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3898,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3403","type":"APR-DRG"}],"standard_charges":[{"minimum":5199,"maximum":5199,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5199,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5199,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5199,"methodology":"case rate"}]}]},{"description":"FRACTURE OF FEMUR","code_information":[{"code":"3404","type":"APR-DRG"}],"standard_charges":[{"minimum":9681,"maximum":9681,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9681,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9681,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9681,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34051","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"minimum":11814,"maximum":29112,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24418,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29112,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11814,"methodology":"case rate"}]}]},{"description":"HC EMBOL/THROM.ART.BY ARM INCIS","code_information":[{"code":"34101","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7782.48,"maximum":7782.48,"gross_charge":9608,"discounted_cash":2843.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"}]}]},{"description":"HC EMBOL/THROM.ART.BY ARM INCIS","code_information":[{"code":"34101","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":9608,"discounted_cash":2843.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6725.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3411","type":"APR-DRG"}],"standard_charges":[{"minimum":3757,"maximum":3757,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3757,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3757,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3757,"methodology":"case rate"}]}]},{"description":"HC EMB/THROMB RADIAL/ULNAR ARTERY","code_information":[{"code":"34111","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7782.48,"maximum":7782.48,"gross_charge":9608,"discounted_cash":2843.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"}]}]},{"description":"HC EMB/THROMB RADIAL/ULNAR ARTERY","code_information":[{"code":"34111","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":9608,"discounted_cash":2843.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6725.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3412","type":"APR-DRG"}],"standard_charges":[{"minimum":6502,"maximum":6502,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6502,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6502,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6502,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3413","type":"APR-DRG"}],"standard_charges":[{"minimum":6502,"maximum":6502,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6502,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6502,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6502,"methodology":"case rate"}]}]},{"description":"FRACTURE OF PELVIS OR DISLOCATION OF HIP","code_information":[{"code":"3414","type":"APR-DRG"}],"standard_charges":[{"minimum":8031,"maximum":8031,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8031,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8031,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8031,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ARTERY CLOT","code_information":[{"code":"34151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"minimum":6601,"maximum":18727,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15708,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18727,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6601,"methodology":"case rate"}]}]},{"description":"HC FEM POP EMBOLECTOMY LEG INCIS","code_information":[{"code":"34201","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7364.52,"maximum":7364.52,"gross_charge":9092,"discounted_cash":2691.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7364.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7364.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7364.52,"methodology":"fee schedule"}]}]},{"description":"HC FEM POP EMBOLECTOMY LEG INCIS","code_information":[{"code":"34201","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":9092,"discounted_cash":2691.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7364.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7364.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7364.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6364.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1727.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1363.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1818.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC POP-TIB-PERON EMBOLECTOMY","code_information":[{"code":"34203","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5010.66,"maximum":5010.66,"gross_charge":6186,"discounted_cash":1831.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5010.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5010.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5010.66,"methodology":"fee schedule"}]}]},{"description":"HC POP-TIB-PERON EMBOLECTOMY","code_information":[{"code":"34203","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":6186,"discounted_cash":1831.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5010.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5010.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5010.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4330.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1237.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1237.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3421","type":"APR-DRG"}],"standard_charges":[{"minimum":4636,"maximum":4636,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4636,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4636,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4636,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3422","type":"APR-DRG"}],"standard_charges":[{"minimum":6985,"maximum":6985,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6985,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6985,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6985,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3423","type":"APR-DRG"}],"standard_charges":[{"minimum":6985,"maximum":6985,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6985,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6985,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6985,"methodology":"case rate"}]}]},{"description":"FRACTURES AND DISLOCATIONS EXCEPT FEMUR PELVIS AND BACK","code_information":[{"code":"3424","type":"APR-DRG"}],"standard_charges":[{"minimum":13112,"maximum":13112,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13112,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13112,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13112,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"minimum":5254,"maximum":14082,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11811,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14082,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5254,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3431","type":"APR-DRG"}],"standard_charges":[{"minimum":5139,"maximum":5139,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5139,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5139,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5139,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3432","type":"APR-DRG"}],"standard_charges":[{"minimum":6269,"maximum":6269,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6269,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6269,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6269,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3433","type":"APR-DRG"}],"standard_charges":[{"minimum":10670,"maximum":10670,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10670,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10670,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10670,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY","code_information":[{"code":"3434","type":"APR-DRG"}],"standard_charges":[{"minimum":14950,"maximum":14950,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14950,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14950,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14950,"methodology":"case rate"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"minimum":15325,"maximum":62795,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24221,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22898,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15569,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":62795,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58874,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34915.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28455,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33925,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28933,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36752.67,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40016,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24846,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15325,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20418.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21847.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21030.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21439.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21643.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21439.06,"methodology":"case rate"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34401","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3441","type":"APR-DRG"}],"standard_charges":[{"minimum":4828,"maximum":4828,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3442","type":"APR-DRG"}],"standard_charges":[{"minimum":7931,"maximum":7931,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7931,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7931,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7931,"methodology":"case rate"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34421","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3443","type":"APR-DRG"}],"standard_charges":[{"minimum":13479,"maximum":13479,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13479,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13479,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13479,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS","code_information":[{"code":"3444","type":"APR-DRG"}],"standard_charges":[{"minimum":15409,"maximum":15409,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15409,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15409,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15409,"methodology":"case rate"}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34451","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF VEIN CLOT","code_information":[{"code":"34471","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"THROMBECTOMY AX/SC VEIN","code_information":[{"code":"34490","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8760.15,"maximum":8760.15,"gross_charge":10815,"discounted_cash":3201.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8760.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8760.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8760.15,"methodology":"fee schedule"}]}]},{"description":"THROMBECTOMY AX/SC VEIN","code_information":[{"code":"34490","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8760.15,"gross_charge":10815,"discounted_cash":3201.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8760.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8760.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8760.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7570.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2054.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2163,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1622.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2163,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"minimum":8060,"maximum":28413,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13382,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12651,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8753,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28413,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26639,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21669.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16770,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19994,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16266,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22809.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22109,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13727,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13727,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8060,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12672.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13559.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13052.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13305.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13432.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13305.65,"methodology":"case rate"}]}]},{"description":"REPAIR VALVE FEMORAL VEIN","code_information":[{"code":"34501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT VENA CAVA","code_information":[{"code":"34502","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VENOUS VALVE TRANSPOSITION","code_information":[{"code":"34510","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":14671.53,"maximum":14671.53,"gross_charge":18113,"discounted_cash":5361.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14671.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14671.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14671.53,"methodology":"fee schedule"}]}]},{"description":"HC VENOUS VALVE TRANSPOSITION","code_information":[{"code":"34510","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":14671.53,"gross_charge":18113,"discounted_cash":5361.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14671.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14671.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14671.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12679.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3441.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3622.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2716.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3622.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"CROSS-OVER VEIN GRAFT","code_information":[{"code":"34520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"LEG VEIN FUSION","code_information":[{"code":"34530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"minimum":5744,"maximum":20547,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11194,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10583,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7316,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20547,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19264,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18995.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13519,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16118,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13597,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19995.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18494,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11483,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11483,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5744,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11108.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11886.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11441.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11663.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11774.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11663.86,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3461","type":"APR-DRG"}],"standard_charges":[{"minimum":6758,"maximum":6758,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6758,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3462","type":"APR-DRG"}],"standard_charges":[{"minimum":9642,"maximum":9642,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9642,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9642,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9642,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3463","type":"APR-DRG"}],"standard_charges":[{"minimum":11371,"maximum":11371,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11371,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11371,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11371,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS","code_information":[{"code":"3464","type":"APR-DRG"}],"standard_charges":[{"minimum":18354,"maximum":18354,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18354,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18354,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18354,"methodology":"case rate"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITH MCC","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"minimum":7109,"maximum":35607,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21275,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20113,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14482,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35607,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33384,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31315.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27435,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32710,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26913,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32963.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35149,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21824,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21824,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7109,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18312.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19594.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18862.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19228.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19411.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19228.64,"methodology":"case rate"}]}]},{"description":"HC EVAS RPR A-AO ND GFT","code_information":[{"code":"34701","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8553.6,"maximum":8553.6,"gross_charge":10560,"discounted_cash":3125.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8553.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8553.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8553.6,"methodology":"fee schedule"}]}]},{"description":"HC EVAS RPR A-AO ND GFT","code_information":[{"code":"34701","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8553.6,"gross_charge":10560,"discounted_cash":3125.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8553.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8553.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8553.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2112,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2112,"methodology":"fee schedule"}]}]},{"description":"ENDO RPR A-AO GFT RUPTURE","code_information":[{"code":"34702","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8304.12,"maximum":8304.12,"gross_charge":10252,"discounted_cash":3034.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8304.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8304.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8304.12,"methodology":"fee schedule"}]}]},{"description":"ENDO RPR A-AO GFT RUPTURE","code_information":[{"code":"34702","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8304.12,"gross_charge":10252,"discounted_cash":3034.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8304.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8304.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8304.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1947.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2050.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1537.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2050.4,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR A-UNILAC NDGRFT","code_information":[{"code":"34703","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4555.44,"maximum":4555.44,"gross_charge":5624,"discounted_cash":1664.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4555.44,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR A-UNILAC NDGRFT","code_information":[{"code":"34703","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4555.44,"gross_charge":5624,"discounted_cash":1664.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.8,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR A-UNIILIAC RUPTURE","code_information":[{"code":"34704","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4555.44,"maximum":4555.44,"gross_charge":5624,"discounted_cash":1664.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4555.44,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR A-UNIILIAC RUPTURE","code_information":[{"code":"34704","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4555.44,"gross_charge":5624,"discounted_cash":1664.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.8,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR A-BILIAC NDGRFT","code_information":[{"code":"34705","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5731.56,"maximum":5731.56,"gross_charge":7076,"discounted_cash":2094.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5731.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5731.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5731.56,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR A-BILIAC NDGRFT","code_information":[{"code":"34705","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5731.56,"gross_charge":7076,"discounted_cash":2094.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5731.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5731.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5731.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1415.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1415.2,"methodology":"fee schedule"}]}]},{"description":"HC EVASC RPR A-BIILIAC RPT","code_information":[{"code":"34706","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5465.07,"maximum":5465.07,"gross_charge":6747,"discounted_cash":1997.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5465.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5465.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5465.07,"methodology":"fee schedule"}]}]},{"description":"HC EVASC RPR A-BIILIAC RPT","code_information":[{"code":"34706","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5465.07,"gross_charge":6747,"discounted_cash":1997.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5465.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5465.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5465.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1281.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1349.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1349.4,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR ILIO-ILIAC NDGFT","code_information":[{"code":"34707","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1061.1,"maximum":1061.1,"gross_charge":1310,"discounted_cash":387.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1061.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1061.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1061.1,"methodology":"fee schedule"}]}]},{"description":"HC EVAR RPR ILIO-ILIAC NDGFT","code_information":[{"code":"34707","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1310,"discounted_cash":387.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1061.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1061.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1061.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":262,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":262,"methodology":"fee schedule"}]}]},{"description":"HC EVASC RPR ILIO-ILIAC RPT","code_information":[{"code":"34708","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5204.25,"maximum":5204.25,"gross_charge":6425,"discounted_cash":1901.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5204.25,"methodology":"fee schedule"}]}]},{"description":"HC EVASC RPR ILIO-ILIAC RPT","code_information":[{"code":"34708","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5204.25,"gross_charge":6425,"discounted_cash":1901.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1220.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285,"methodology":"fee schedule"}]}]},{"description":"HC PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"34709","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1131.57,"maximum":1131.57,"gross_charge":1397,"discounted_cash":413.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1131.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1131.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1131.57,"methodology":"fee schedule"}]}]},{"description":"HC PLMT XTN PROSTH EVASC RPR","code_information":[{"code":"34709","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1397,"discounted_cash":413.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1131.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1131.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1131.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.4,"methodology":"fee schedule"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3471","type":"APR-DRG"}],"standard_charges":[{"minimum":4925,"maximum":4925,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4925,"methodology":"case rate"}]}]},{"description":"HC DLYD PLMT XTN PROSTH 1ST VSL","code_information":[{"code":"34710","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8681.58,"maximum":8681.58,"gross_charge":10718,"discounted_cash":3172.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8681.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8681.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8681.58,"methodology":"fee schedule"}]}]},{"description":"HC DLYD PLMT XTN PROSTH 1ST VSL","code_information":[{"code":"34710","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8681.58,"gross_charge":10718,"discounted_cash":3172.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8681.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8681.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8681.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2036.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2143.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1607.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2143.6,"methodology":"fee schedule"}]}]},{"description":"HC DELAY EXTEN; EACH ADDTL","code_information":[{"code":"34711","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2892.51,"maximum":2892.51,"gross_charge":3571,"discounted_cash":1057.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2892.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2892.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2892.51,"methodology":"fee schedule"}]}]},{"description":"HC DELAY EXTEN; EACH ADDTL","code_information":[{"code":"34711","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3571,"discounted_cash":1057.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2892.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2892.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2892.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":535.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.2,"methodology":"fee schedule"}]}]},{"description":"HC TCAT DLVR ENHNCD FIXJ DEV","code_information":[{"code":"34712","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4555.44,"maximum":4555.44,"gross_charge":5624,"discounted_cash":1664.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4555.44,"methodology":"fee schedule"}]}]},{"description":"HC TCAT DLVR ENHNCD FIXJ DEV","code_information":[{"code":"34712","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4555.44,"gross_charge":5624,"discounted_cash":1664.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4555.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.8,"methodology":"fee schedule"}]}]},{"description":"HC PERQ ACCESS & CLSR FEM ART","code_information":[{"code":"34713","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2289.06,"maximum":2289.06,"gross_charge":2826,"discounted_cash":836.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2289.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2289.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2289.06,"methodology":"fee schedule"}]}]},{"description":"HC PERQ ACCESS & CLSR FEM ART","code_information":[{"code":"34713","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":2826,"discounted_cash":836.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2289.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2289.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2289.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.2,"methodology":"fee schedule"}]}]},{"description":"OPN FEM ART EXPOS CNDT CRTJ","code_information":[{"code":"34714","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OPEN AX/SUBCL EXP EV PROST","code_information":[{"code":"34715","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8224.74,"maximum":8224.74,"gross_charge":10154,"discounted_cash":3005.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8224.74,"methodology":"fee schedule"}]}]},{"description":"HC OPEN AX/SUBCL EXP EV PROST","code_information":[{"code":"34715","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8224.74,"gross_charge":10154,"discounted_cash":3005.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1929.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2030.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1523.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2030.8,"methodology":"fee schedule"}]}]},{"description":"OPN AX/SUBCLA ART EXPOS CNDT","code_information":[{"code":"34716","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ENDO RPR.ILIAC W/AG GRAFT","code_information":[{"code":"34717","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4553.82,"maximum":4553.82,"gross_charge":5622,"discounted_cash":1664.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4553.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4553.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4553.82,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR.ILIAC W/AG GRAFT","code_information":[{"code":"34717","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":5622,"discounted_cash":1664.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4553.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4553.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4553.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.4,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR ILIAC ART.W/BIF.GR","code_information":[{"code":"34718","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5205.87,"maximum":5205.87,"gross_charge":6427,"discounted_cash":1902.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5205.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5205.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5205.87,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR ILIAC ART.W/BIF.GR","code_information":[{"code":"34718","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5205.87,"gross_charge":6427,"discounted_cash":1902.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5205.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5205.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5205.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1221.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285.4,"methodology":"fee schedule"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3472","type":"APR-DRG"}],"standard_charges":[{"minimum":6839,"maximum":6839,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6839,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6839,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6839,"methodology":"case rate"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3473","type":"APR-DRG"}],"standard_charges":[{"minimum":9023,"maximum":9023,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9023,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9023,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9023,"methodology":"case rate"}]}]},{"description":"OTHER BACK AND NECK DISORDERS FRACTURES AND INJURIES","code_information":[{"code":"3474","type":"APR-DRG"}],"standard_charges":[{"minimum":14057,"maximum":14057,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14057,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14057,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14057,"methodology":"case rate"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITH CC","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"minimum":6708,"maximum":20152.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11316,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10698,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7394,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18989,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17803,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19144.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14927,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17797,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13740,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20152.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18696,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11608,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11608,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6708,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11195.8,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11979.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11531.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11755.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11867.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11755.59,"methodology":"case rate"}]}]},{"description":"PLACE ILIAC ART OCCLS DEVC","code_information":[{"code":"34808","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9243.72,"maximum":9243.72,"gross_charge":11412,"discounted_cash":3377.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9243.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9243.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9243.72,"methodology":"fee schedule"}]}]},{"description":"PLACE ILIAC ART OCCLS DEVC","code_information":[{"code":"34808","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9243.72,"gross_charge":11412,"discounted_cash":3377.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9243.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9243.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9243.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7988.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2168.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2282.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1711.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2282.4,"methodology":"fee schedule"}]}]},{"description":"HC FEM ART EXP FOR PRSTH","code_information":[{"code":"34812","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC FEM ART EXP FOR PRSTH","code_information":[{"code":"34812","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"HC FEM-FEM BYPASS W/AAA REPAIR","code_information":[{"code":"34813","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC FEM-FEM BYPASS W/AAA REPAIR","code_information":[{"code":"34813","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"HC OPEN ILIAC EXPOSURE","code_information":[{"code":"34820","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":14936.4,"maximum":14936.4,"gross_charge":18440,"discounted_cash":5458.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14936.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14936.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14936.4,"methodology":"fee schedule"}]}]},{"description":"HC OPEN ILIAC EXPOSURE","code_information":[{"code":"34820","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":14936.4,"gross_charge":18440,"discounted_cash":5458.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14936.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14936.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14936.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12908,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3503.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3688,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2766,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3688,"methodology":"fee schedule"}]}]},{"description":"OPEN AORTIC TUBE PROSTH REPR","code_information":[{"code":"34830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN AORTOILIAC PROSTH REPR","code_information":[{"code":"34831","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN AORTOFEMOR PROSTH REPR","code_information":[{"code":"34832","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OPEN ILIAC EXP W/CONDUIT","code_information":[{"code":"34833","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5052.78,"maximum":5052.78,"gross_charge":6238,"discounted_cash":1846.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5052.78,"methodology":"fee schedule"}]}]},{"description":"HC OPEN ILIAC EXP W/CONDUIT","code_information":[{"code":"34833","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5052.78,"gross_charge":6238,"discounted_cash":1846.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4366.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.6,"methodology":"fee schedule"}]}]},{"description":"HC EXPOSE ENDOPROSTH BRACHIAL","code_information":[{"code":"34834","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7782.48,"maximum":7782.48,"gross_charge":9608,"discounted_cash":2843.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"}]}]},{"description":"HC EXPOSE ENDOPROSTH BRACHIAL","code_information":[{"code":"34834","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7782.48,"gross_charge":9608,"discounted_cash":2843.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6725.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"}]}]},{"description":"HC XPOSE ENDOPROSTH BRACHIAL","code_information":[{"code":"34834","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":7782.48,"maximum":7782.48,"gross_charge":9608,"discounted_cash":2843.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"}]}]},{"description":"HC XPOSE ENDOPROSTH BRACHIAL","code_information":[{"code":"34834","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7782.48,"gross_charge":9608,"discounted_cash":2843.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7782.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6725.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.6,"methodology":"fee schedule"}]}]},{"description":"PLNNING PT SPEC FENEST GRAFT","code_information":[{"code":"34839","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ENDOVAS RPR VIS AORTA W/FEN","code_information":[{"code":"34841","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5052.78,"maximum":5052.78,"gross_charge":6238,"discounted_cash":1846.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5052.78,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVAS RPR VIS AORTA W/FEN","code_information":[{"code":"34841","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5052.78,"gross_charge":6238,"discounted_cash":1846.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4366.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.6,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVASC VISC AORTA 2 GRT","code_information":[{"code":"34842","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5052.78,"maximum":5052.78,"gross_charge":6238,"discounted_cash":1846.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5052.78,"methodology":"fee schedule"}]}]},{"description":"HC ENDOVASC VISC AORTA 2 GRT","code_information":[{"code":"34842","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5052.78,"gross_charge":6238,"discounted_cash":1846.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5052.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4366.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.6,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR VISC AORT FEN X 3","code_information":[{"code":"34843","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6012.63,"maximum":6012.63,"gross_charge":7423,"discounted_cash":2197.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6012.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6012.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6012.63,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR VISC AORT FEN X 3","code_information":[{"code":"34843","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6012.63,"gross_charge":7423,"discounted_cash":2197.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6012.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6012.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6012.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5196.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1113.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.6,"methodology":"fee schedule"}]}]},{"description":"HC ENDO REP VISCERAL AORTA FEN","code_information":[{"code":"34844","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6316.38,"maximum":6316.38,"gross_charge":7798,"discounted_cash":2308.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6316.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6316.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6316.38,"methodology":"fee schedule"}]}]},{"description":"HC ENDO REP VISCERAL AORTA FEN","code_information":[{"code":"34844","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6316.38,"gross_charge":7798,"discounted_cash":2308.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6316.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6316.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6316.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5458.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1481.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1559.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1169.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1559.6,"methodology":"fee schedule"}]}]},{"description":"HC ENDO REP VISC/ABD AORTA FEN","code_information":[{"code":"34845","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4956.39,"maximum":4956.39,"gross_charge":6119,"discounted_cash":1811.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4956.39,"methodology":"fee schedule"}]}]},{"description":"HC ENDO REP VISC/ABD AORTA FEN","code_information":[{"code":"34845","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4956.39,"gross_charge":6119,"discounted_cash":1811.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4283.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1223.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1223.8,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR VISC AORT FEN X 2","code_information":[{"code":"34846","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4956.39,"maximum":4956.39,"gross_charge":6119,"discounted_cash":1811.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4956.39,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RPR VISC AORT FEN X 2","code_information":[{"code":"34846","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4956.39,"gross_charge":6119,"discounted_cash":1811.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4956.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4283.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1162.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1223.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":917.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1223.8,"methodology":"fee schedule"}]}]},{"description":"HC RPR VISCERAL FENEST.3 HOLE","code_information":[{"code":"34847","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5204.25,"maximum":5204.25,"gross_charge":6425,"discounted_cash":1901.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5204.25,"methodology":"fee schedule"}]}]},{"description":"HC RPR VISCERAL FENEST.3 HOLE","code_information":[{"code":"34847","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5204.25,"gross_charge":6425,"discounted_cash":1901.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5204.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4497.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1220.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1285,"methodology":"fee schedule"}]}]},{"description":"VISC  INFRAREN ABD 4+ PROST","code_information":[{"code":"34848","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"minimum":4608,"maximum":15781.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7918,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7486,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5544,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14509,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13604,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14992.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10779,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12851,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10302,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15781.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13082,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8123,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8123,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4608,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8767.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9381.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9030.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9205.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9293.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9205.89,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3491","type":"APR-DRG"}],"standard_charges":[{"minimum":5057,"maximum":5057,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3492","type":"APR-DRG"}],"standard_charges":[{"minimum":6298,"maximum":6298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6298,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6298,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6298,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3493","type":"APR-DRG"}],"standard_charges":[{"minimum":7282,"maximum":7282,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7282,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7282,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7282,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF ORTHOPEDIC DEVICE OR PROCEDURE","code_information":[{"code":"3494","type":"APR-DRG"}],"standard_charges":[{"minimum":11212,"maximum":11212,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11212,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11212,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11212,"methodology":"case rate"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"minimum":11990,"maximum":39991,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21742,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20554,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13635,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39991,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37495,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31885.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25477,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30375,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25339,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33563.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35920,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22303,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22303,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11990,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18646.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19951.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19205.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19578.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19765.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19578.72,"methodology":"case rate"}]}]},{"description":"HC DIR REP ANEUR CAROTIDSUB","code_information":[{"code":"35001","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":14917.77,"maximum":14917.77,"gross_charge":18417,"discounted_cash":5451.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14917.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14917.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14917.77,"methodology":"fee schedule"}]}]},{"description":"HC DIR REP ANEUR CAROTIDSUB","code_information":[{"code":"35001","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":14917.77,"gross_charge":18417,"discounted_cash":5451.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14917.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14917.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14917.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12891.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3499.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3683.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2762.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3683.4,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE NECK","code_information":[{"code":"35002","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DIR REP ANEUR AX-BRACH ART","code_information":[{"code":"35011","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15138.9,"maximum":15138.9,"gross_charge":18690,"discounted_cash":5532.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15138.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15138.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15138.9,"methodology":"fee schedule"}]}]},{"description":"HC DIR REP ANEUR AX-BRACH ART","code_information":[{"code":"35011","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15138.9,"gross_charge":18690,"discounted_cash":5532.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15138.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15138.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15138.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13083,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3551.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3738,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2803.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3738,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REPAIR ARTERY RUPTURE ARM","code_information":[{"code":"35013","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35021","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY RUPTURE CHEST","code_information":[{"code":"35022","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DIRECT REPAIR ANEURYSM RADIAL OR ULNAR ARTERY","code_information":[{"code":"35045","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15365.7,"maximum":15365.7,"gross_charge":18970,"discounted_cash":5615.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15365.7,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT REPAIR ANEURYSM RADIAL OR ULNAR ARTERY","code_information":[{"code":"35045","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15365.7,"gross_charge":18970,"discounted_cash":5615.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13279,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3604.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2845.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC OPEN REP ABDOM AORTIC ANEU","code_information":[{"code":"35081","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9430.02,"maximum":9430.02,"gross_charge":11642,"discounted_cash":3446.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9430.02,"methodology":"fee schedule"}]}]},{"description":"HC OPEN REP ABDOM AORTIC ANEU","code_information":[{"code":"35081","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9430.02,"gross_charge":11642,"discounted_cash":3446.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9430.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8149.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2211.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1746.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2328.4,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE AORTA","code_information":[{"code":"35082","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35091","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY RUPTURE AORTA","code_information":[{"code":"35092","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"minimum":7609,"maximum":23908,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13524,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12785,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8270,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23908,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22416,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21842.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15891,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18946,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15368,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22992.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22343,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13873,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13873,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7609,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12773.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13667.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13156.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13412.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13539.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13412.22,"methodology":"case rate"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35102","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY RUPTURE AORTA","code_information":[{"code":"35103","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3511","type":"APR-DRG"}],"standard_charges":[{"minimum":5185,"maximum":5185,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5185,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5185,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5185,"methodology":"case rate"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35111","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY RUPTURE SPLEEN","code_information":[{"code":"35112","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3512","type":"APR-DRG"}],"standard_charges":[{"minimum":6042,"maximum":6042,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6042,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6042,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6042,"methodology":"case rate"}]}]},{"description":"REPAIR DEFECT OF ARTERY","code_information":[{"code":"35121","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ARTERY RUPTURE BELLY","code_information":[{"code":"35122","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3513","type":"APR-DRG"}],"standard_charges":[{"minimum":11517,"maximum":11517,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11517,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11517,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11517,"methodology":"case rate"}]}]},{"description":"HC ENDO REPAIR ILIAC ANEURSYM","code_information":[{"code":"35131","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5994.81,"maximum":5994.81,"gross_charge":7401,"discounted_cash":2190.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5994.81,"methodology":"fee schedule"}]}]},{"description":"HC ENDO REPAIR ILIAC ANEURSYM","code_information":[{"code":"35131","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5994.81,"gross_charge":7401,"discounted_cash":2190.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5180.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.2,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERY RUPTURE GROIN","code_information":[{"code":"35132","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES","code_information":[{"code":"3514","type":"APR-DRG"}],"standard_charges":[{"minimum":11621,"maximum":11621,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11621,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11621,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11621,"methodology":"case rate"}]}]},{"description":"HC DIRECT REPAIR ANEURYSM FEM","code_information":[{"code":"35141","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5994.81,"maximum":5994.81,"gross_charge":7401,"discounted_cash":2190.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5994.81,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT REPAIR ANEURYSM FEM","code_information":[{"code":"35141","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5994.81,"gross_charge":7401,"discounted_cash":2190.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5180.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.2,"methodology":"fee schedule"}]}]},{"description":"HC DIR REP ANEURYSM; RUPT FEM","code_information":[{"code":"35142","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5710.5,"maximum":5710.5,"gross_charge":7050,"discounted_cash":2086.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5710.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5710.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5710.5,"methodology":"fee schedule"}]}]},{"description":"HC DIR REP ANEURYSM; RUPT FEM","code_information":[{"code":"35142","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5710.5,"gross_charge":7050,"discounted_cash":2086.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5710.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5710.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5710.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4935,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT REP.ANEURYSM POP.","code_information":[{"code":"35151","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5994.81,"maximum":5994.81,"gross_charge":7401,"discounted_cash":2190.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5994.81,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT REP.ANEURYSM POP.","code_information":[{"code":"35151","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5994.81,"gross_charge":7401,"discounted_cash":2190.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5994.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5180.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1406.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1110.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.2,"methodology":"fee schedule"}]}]},{"description":"REPAIR RUPTD POPLITEAL ART","code_information":[{"code":"35152","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3400.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35182","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35184","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35188","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35189","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35190","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"minimum":4733,"maximum":18345.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9911,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9370,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6301,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15356,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14398,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17427.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11913,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14203,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11709,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18345.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16375,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10167,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10167,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4733,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10191.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10905.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10497.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10701.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10803.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10701.31,"methodology":"case rate"}]}]},{"description":"HC REP BLD VESSELDIRECT;NECK","code_information":[{"code":"35201","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":14813.28,"maximum":14813.28,"gross_charge":18288,"discounted_cash":5413.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14813.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14813.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14813.28,"methodology":"fee schedule"}]}]},{"description":"HC REP BLD VESSELDIRECT;NECK","code_information":[{"code":"35201","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":14813.28,"gross_charge":18288,"discounted_cash":5413.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14813.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14813.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14813.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12801.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3474.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3657.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2743.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3657.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC REPAIR BLD. VESSEL UPPER EXT","code_information":[{"code":"35206","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5469.12,"maximum":5469.12,"gross_charge":6752,"discounted_cash":1998.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5469.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5469.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5469.12,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR BLD. VESSEL UPPER EXT","code_information":[{"code":"35206","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":6752,"discounted_cash":1998.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5469.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5469.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5469.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4726.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35207","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35211","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35216","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35221","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REPAIR BLOOD VES DIR; LWR EX","code_information":[{"code":"35226","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6552.09,"maximum":6552.09,"gross_charge":8089,"discounted_cash":2394.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6552.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6552.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6552.09,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR BLOOD VES DIR; LWR EX","code_information":[{"code":"35226","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6552.09,"gross_charge":8089,"discounted_cash":2394.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6552.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6552.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6552.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5662.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1536.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1617.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1617.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35231","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35236","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35241","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35246","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35251","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35256","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35261","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35266","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35271","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35276","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLOOD VESSEL LESION","code_information":[{"code":"35281","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REP BLD VESSEL W/GRAFT LE","code_information":[{"code":"35286","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":14633.46,"maximum":14633.46,"gross_charge":18066,"discounted_cash":5347.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14633.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14633.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14633.46,"methodology":"fee schedule"}]}]},{"description":"HC REP BLD VESSEL W/GRAFT LE","code_information":[{"code":"35286","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":14633.46,"gross_charge":18066,"discounted_cash":5347.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14633.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14633.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14633.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12646.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3432.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3613.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2709.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3613.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"minimum":13263,"maximum":43558,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26365,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24925,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16614,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39015,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36580,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37534.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30998,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36957,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30875,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39510.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43558,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27045,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27045,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13263,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21950.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23486.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22608.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23047.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23267.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23047.8,"methodology":"case rate"}]}]},{"description":"HC THROMBOENDARTERECTOMY-NECK","code_information":[{"code":"35301","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8767.44,"maximum":8767.44,"gross_charge":10824,"discounted_cash":3203.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8767.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8767.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8767.44,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOENDARTERECTOMY-NECK","code_information":[{"code":"35301","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8767.44,"gross_charge":10824,"discounted_cash":3203.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8767.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8767.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8767.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7576.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2056.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2164.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1623.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2164.8,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. INCL. GRAFT SFA","code_information":[{"code":"35302","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6019.11,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. INCL. GRAFT SFA","code_information":[{"code":"35302","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5201.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. INCL. GRAFT POP","code_information":[{"code":"35303","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6019.11,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. INCL. GRAFT POP","code_information":[{"code":"35303","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5201.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. W/GRAFT TIBIO","code_information":[{"code":"35304","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6019.11,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. W/GRAFT TIBIO","code_information":[{"code":"35304","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5201.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. W/GRAFT TIB","code_information":[{"code":"35305","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6019.11,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOEND. W/GRAFT TIB","code_information":[{"code":"35305","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6019.11,"gross_charge":7431,"discounted_cash":2199.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6019.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5201.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.2,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35306","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35311","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35321","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35331","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35341","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35351","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35355","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35361","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35363","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FEMORAL ENDARTERECTOMY","code_information":[{"code":"35371","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5554.17,"maximum":5554.17,"gross_charge":6857,"discounted_cash":2029.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5554.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5554.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5554.17,"methodology":"fee schedule"}]}]},{"description":"HC FEMORAL ENDARTERECTOMY","code_information":[{"code":"35371","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5554.17,"gross_charge":6857,"discounted_cash":2029.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5554.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5554.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5554.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4799.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1302.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.4,"methodology":"fee schedule"}]}]},{"description":"RECHANNELING OF ARTERY","code_information":[{"code":"35372","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REOPERATION CAROTID ADD-ON","code_information":[{"code":"35390","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":9501,"maximum":25265.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14456,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9759,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24046,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22544,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24002.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18937,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22578,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18137,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25265.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25263,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15686,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9501,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14036.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15019.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14457.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14738.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14878.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14738.34,"methodology":"case rate"}]}]},{"description":"ANGIOSCOPY","code_information":[{"code":"35400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":6713,"maximum":21011.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11984,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11330,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7741,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19603,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18379,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19961.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14833,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17685,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14386,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21011.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19799,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12293,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12293,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6713,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11673.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12490.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12023.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12256.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12373.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12256.76,"methodology":"case rate"}]}]},{"description":"HARVEST VEIN FOR BYPASS","code_information":[{"code":"35500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT IPSILAT CAROTID","code_information":[{"code":"35501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT SUBCLAV-CAROTID","code_information":[{"code":"35506","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT CAROTID-VERTBRL","code_information":[{"code":"35508","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT CONTRAL CAROTID","code_information":[{"code":"35509","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT CAROTID-BRCHIAL","code_information":[{"code":"35510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT SUBCLAV-SUBCLAV","code_information":[{"code":"35511","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT SUBCLAV-BRCHIAL","code_information":[{"code":"35512","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT SUBCLAV-VERTBRL","code_information":[{"code":"35515","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT SUBCLAV-AXILARY","code_information":[{"code":"35516","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AXILLARY-AXILRY","code_information":[{"code":"35518","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AXILL-FEMORAL","code_information":[{"code":"35521","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BYPASS AX-BRACHIAL W/VIEN","code_information":[{"code":"35522","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8803.89,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS AX-BRACHIAL W/VIEN","code_information":[{"code":"35522","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT BRCHL-ULNR-RDL","code_information":[{"code":"35523","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BYPASS W/VEIN;BRACHIAL-BRACH","code_information":[{"code":"35525","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"BYPASS W/VEIN;BRACHIAL-BRACH","code_information":[{"code":"35525","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AOR/CAROT/INNOM","code_information":[{"code":"35526","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AORCEL/AORMESEN","code_information":[{"code":"35531","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AXILL/FEM/FEM","code_information":[{"code":"35533","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT HEPATORENAL","code_information":[{"code":"35535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT SPLENORENAL","code_information":[{"code":"35536","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AORTOILIAC","code_information":[{"code":"35537","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AORTOBI-ILIAC","code_information":[{"code":"35538","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AORTOFEMORAL","code_information":[{"code":"35539","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT AORTBIFEMORAL","code_information":[{"code":"35540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FEM POP BYPASS W/VEIN","code_information":[{"code":"35556","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC FEM POP BYPASS W/VEIN","code_information":[{"code":"35556","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT FEM-FEMORAL","code_information":[{"code":"35558","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8803.89,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT FEM-FEMORAL","code_information":[{"code":"35558","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"}]}]},{"description":"ART BYP GRFT AORTORENAL","code_information":[{"code":"35560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP GRFT ILIOILIAC","code_information":[{"code":"35563","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BYPASS GRAFT W/VEIN;ILEOFEM","code_information":[{"code":"35565","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8636.22,"maximum":8636.22,"gross_charge":10662,"discounted_cash":3155.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8636.22,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS GRAFT W/VEIN;ILEOFEM","code_information":[{"code":"35565","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8636.22,"gross_charge":10662,"discounted_cash":3155.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7463.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2025.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2132.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1599.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2132.4,"methodology":"fee schedule"}]}]},{"description":"HC FEM-ANT TIB OPEN BYPASS","code_information":[{"code":"35566","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC FEM-ANT TIB OPEN BYPASS","code_information":[{"code":"35566","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"ART BYP TIBIAL-TIB/PERONEAL","code_information":[{"code":"35570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC POP-TIBIAL BYPASS W/VEIN","code_information":[{"code":"35571","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC POP-TIBIAL BYPASS W/VEIN","code_information":[{"code":"35571","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"HARVEST FEMOROPOPLITEAL VEIN","code_information":[{"code":"35572","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IN SITU VEIN BYPASS;FEM-POP","code_information":[{"code":"35583","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8636.22,"maximum":8636.22,"gross_charge":10662,"discounted_cash":3155.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8636.22,"methodology":"fee schedule"}]}]},{"description":"IN SITU VEIN BYPASS;FEM-POP","code_information":[{"code":"35583","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8636.22,"gross_charge":10662,"discounted_cash":3155.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8636.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7463.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2025.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2132.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1599.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2132.4,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS INSITU FEM-TIB","code_information":[{"code":"35585","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS INSITU FEM-TIB","code_information":[{"code":"35585","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"VEIN BYP POP-TIBL PERONEAL","code_information":[{"code":"35587","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"minimum":21070,"maximum":63350,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38344,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":36250,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24309,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55342,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51888,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52174.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45641,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54415,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45175,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":54920.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":39334,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39334,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21070,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30511.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":32647.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31426.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32037.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32342.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32037.18,"methodology":"case rate"}]}]},{"description":"HARVEST ART FOR CABG ADD-ON","code_information":[{"code":"35600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP COMMON IPSI CAROTID","code_information":[{"code":"35601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BYPASS CAROTID SUBCLAVIAN","code_information":[{"code":"35606","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS CAROTID SUBCLAVIAN","code_information":[{"code":"35606","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"ART BYP SUBCLAV-SUBCLAVIAN","code_information":[{"code":"35612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP SUBCLAV-AXILLARY","code_information":[{"code":"35616","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BYPASS GRAFT AXIL - FEM UNI","code_information":[{"code":"35621","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8803.89,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS GRAFT AXIL - FEM UNI","code_information":[{"code":"35621","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"}]}]},{"description":"ART BYP AXILLARY-POP-TIBIAL","code_information":[{"code":"35623","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP AORSUBCL/CAROT/INNOM","code_information":[{"code":"35626","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP AOR-CELIAC-MSN-RENAL","code_information":[{"code":"35631","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP ILIO-CELIAC","code_information":[{"code":"35632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP ILIO-MESENTERIC","code_information":[{"code":"35633","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP ILIORENAL","code_information":[{"code":"35634","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP SPENORENAL","code_information":[{"code":"35636","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP AORTOILIAC","code_information":[{"code":"35637","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP AORTOBI-ILIAC","code_information":[{"code":"35638","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP CAROTID-VERTEBRAL","code_information":[{"code":"35642","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP SUBCLAV-VERTEBRL","code_information":[{"code":"35645","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP AORTOBIFEMORAL","code_information":[{"code":"35646","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BYPASS THAN VEIN AORTOFEM","code_information":[{"code":"35647","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS THAN VEIN AORTOFEM","code_information":[{"code":"35647","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"ART BYP AXILLARY-AXILLARY","code_information":[{"code":"35650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART BYP AXILL-FEM-FEMORAL","code_information":[{"code":"35654","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OPEN BYPASS FEM-POP PROSTHESIS","code_information":[{"code":"35656","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8803.89,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"}]}]},{"description":"HC OPEN BYPASS FEM-POP PROSTHESIS","code_information":[{"code":"35656","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"}]}]},{"description":"HC OPEN FEM-SYNTHETIC GRAFT","code_information":[{"code":"35661","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8803.89,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"}]}]},{"description":"HC OPEN FEM-SYNTHETIC GRAFT","code_information":[{"code":"35661","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8803.89,"gross_charge":10869,"discounted_cash":3217.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.8,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS GRAFT ILILIAC","code_information":[{"code":"35663","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8026.29,"maximum":8026.29,"gross_charge":9909,"discounted_cash":2933.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8026.29,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS GRAFT ILILIAC","code_information":[{"code":"35663","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8026.29,"gross_charge":9909,"discounted_cash":2933.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6936.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1882.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1981.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1981.8,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS ILEOMESENTERIC","code_information":[{"code":"35663","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8224.74,"maximum":8224.74,"gross_charge":10154,"discounted_cash":3005.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8224.74,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS ILEOMESENTERIC","code_information":[{"code":"35663","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8224.74,"gross_charge":10154,"discounted_cash":3005.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8224.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7107.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1929.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2030.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1523.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2030.8,"methodology":"fee schedule"}]}]},{"description":"HC ILEO FEMORAL BYPASS W/SYN GRFT","code_information":[{"code":"35665","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8026.29,"maximum":8026.29,"gross_charge":9909,"discounted_cash":2933.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8026.29,"methodology":"fee schedule"}]}]},{"description":"HC ILEO FEMORAL BYPASS W/SYN GRFT","code_information":[{"code":"35665","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8026.29,"gross_charge":9909,"discounted_cash":2933.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8026.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6936.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1882.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1981.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1981.8,"methodology":"fee schedule"}]}]},{"description":"HC FEM TIBIAL BYPASS","code_information":[{"code":"35666","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9067.95,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"}]}]},{"description":"HC FEM TIBIAL BYPASS","code_information":[{"code":"35666","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9067.95,"gross_charge":11195,"discounted_cash":3313.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9067.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7836.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239,"methodology":"fee schedule"}]}]},{"description":"ART BYP POP-TIBL-PRL-OTHER","code_information":[{"code":"35671","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BYPASS; COMPOSITEPROSTH/VEIN","code_information":[{"code":"35681","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7781.67,"maximum":7781.67,"gross_charge":9607,"discounted_cash":2843.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7781.67,"methodology":"fee schedule"}]}]},{"description":"BYPASS; COMPOSITEPROSTH/VEIN","code_information":[{"code":"35681","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7781.67,"gross_charge":9607,"discounted_cash":2843.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6724.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.4,"methodology":"fee schedule"}]}]},{"description":"COMPOSITE BYP GRFT 2 VEINS","code_information":[{"code":"35682","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMPOSITE BYP GRFT 3/> SEGMT","code_information":[{"code":"35683","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VEIN GRAFT SYNTHETIC GRAFT","code_information":[{"code":"35685","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4246.02,"maximum":4246.02,"gross_charge":5242,"discounted_cash":1551.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4246.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4246.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4246.02,"methodology":"fee schedule"}]}]},{"description":"HC VEIN GRAFT SYNTHETIC GRAFT","code_information":[{"code":"35685","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4246.02,"gross_charge":5242,"discounted_cash":1551.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4246.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4246.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4246.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3669.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.4,"methodology":"fee schedule"}]}]},{"description":"BYPASS GRAFT/AV FIST PATENCY","code_information":[{"code":"35686","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART TRNSPOSJ VERTBRL CAROTID","code_information":[{"code":"35691","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART TRNSPOSJ SUBCLAVIAN","code_information":[{"code":"35693","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART TRNSPOSJ SUBCLAV CAROTID","code_information":[{"code":"35694","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ART TRNSPOSJ CAROTID SUBCLAV","code_information":[{"code":"35695","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REIMPLANTATIONVISC ARTERY","code_information":[{"code":"35697","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4516.56,"maximum":4516.56,"gross_charge":5576,"discounted_cash":1650.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4516.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4516.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4516.56,"methodology":"fee schedule"}]}]},{"description":"HC REIMPLANTATIONVISC ARTERY","code_information":[{"code":"35697","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4516.56,"gross_charge":5576,"discounted_cash":1650.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4516.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4516.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4516.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3903.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.2,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"minimum":9739,"maximum":33445,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20243,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19137,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12481,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29583,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27736,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30054.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24279,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28947,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23194,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31635.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33445,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20766,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20766,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9739,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17575.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18805.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18102.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18454.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18630.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18454.29,"methodology":"case rate"}]}]},{"description":"HC REOP; FEM-POP OR FEM","code_information":[{"code":"35700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5794.74,"maximum":5794.74,"gross_charge":7154,"discounted_cash":2117.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5794.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5794.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5794.74,"methodology":"fee schedule"}]}]},{"description":"HC REOP; FEM-POP OR FEM","code_information":[{"code":"35700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5794.74,"gross_charge":7154,"discounted_cash":2117.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5794.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5794.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5794.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5007.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1359.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.8,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORATIONARTERY;NECK","code_information":[{"code":"35701","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1316.25,"maximum":1316.25,"gross_charge":1625,"discounted_cash":481,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1316.25,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORATIONARTERY;NECK","code_information":[{"code":"35701","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1625,"discounted_cash":481,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1137.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":325,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":325,"methodology":"fee schedule"}]}]},{"description":"HC EXPLO ONLY UPPER EXTR","code_information":[{"code":"35702","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2736.18,"maximum":2736.18,"gross_charge":3378,"discounted_cash":999.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2736.18,"methodology":"fee schedule"}]}]},{"description":"HC EXPLO ONLY UPPER EXTR","code_information":[{"code":"35702","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":3378,"discounted_cash":999.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.6,"methodology":"fee schedule"}]}]},{"description":"HC EXPLO ONLY LOWER EXTR","code_information":[{"code":"35703","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2736.18,"maximum":2736.18,"gross_charge":3378,"discounted_cash":999.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2736.18,"methodology":"fee schedule"}]}]},{"description":"HC EXPLO ONLY LOWER EXTR","code_information":[{"code":"35703","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":3378,"discounted_cash":999.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.6,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"minimum":7278,"maximum":21264.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12181,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11516,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7278,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18984,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17799,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20201.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14994,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17877,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13526,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21264.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20125,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12495,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12495,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8905,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11813.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12640.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12168.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12404.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12522.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12404.48,"methodology":"case rate"}]}]},{"description":"EXPLORE NECK VESSELS","code_information":[{"code":"35800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORE CHEST VESSELS","code_information":[{"code":"35820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORE ABDOMINAL VESSELS","code_information":[{"code":"35840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC EXPL/POST HEM THROM INF EXT","code_information":[{"code":"35860","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8425.62,"maximum":8425.62,"gross_charge":10402,"discounted_cash":3079,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8425.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8425.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8425.62,"methodology":"fee schedule"}]}]},{"description":"HC EXPL/POST HEM THROM INF EXT","code_information":[{"code":"35860","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8425.62,"gross_charge":10402,"discounted_cash":3079,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8425.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8425.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8425.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7281.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1976.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1560.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REPAIR VESSEL GRAFT DEFECT","code_information":[{"code":"35870","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC THROMBECTOMY ART OR VEN GRAFT","code_information":[{"code":"35875","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7781.67,"maximum":7781.67,"gross_charge":9607,"discounted_cash":2843.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7781.67,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY ART OR VEN GRAFT","code_information":[{"code":"35875","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":9607,"discounted_cash":2843.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7781.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1825.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1921.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC THROMBECTOMY OF GRAFT W/ REV","code_information":[{"code":"35876","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7081.83,"maximum":7081.83,"gross_charge":8743,"discounted_cash":2587.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7081.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7081.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7081.83,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY OF GRAFT W/ REV","code_information":[{"code":"35876","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":8743,"discounted_cash":2587.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7081.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7081.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7081.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1661.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1748.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1748.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC REVISION LE BYPASS; W/O THROMB","code_information":[{"code":"35879","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15365.7,"maximum":15365.7,"gross_charge":18970,"discounted_cash":5615.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15365.7,"methodology":"fee schedule"}]}]},{"description":"HC REVISION LE BYPASS; W/O THROMB","code_information":[{"code":"35879","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15365.7,"gross_charge":18970,"discounted_cash":5615.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13279,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3604.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2845.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC REVISIONLE BYPASS SEG.VEIN","code_information":[{"code":"35881","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15365.7,"maximum":15365.7,"gross_charge":18970,"discounted_cash":5615.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15365.7,"methodology":"fee schedule"}]}]},{"description":"HC REVISIONLE BYPASS SEG.VEIN","code_information":[{"code":"35881","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15365.7,"gross_charge":18970,"discounted_cash":5615.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15365.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13279,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3604.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2845.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3794,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REVISE GRAFT W/NONAUTO GRAFT","code_information":[{"code":"35883","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REVISE GRAFT W/VEIN","code_information":[{"code":"35884","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"EXCISION GRAFT NECK","code_information":[{"code":"35901","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC EXCISON OF INFECT GRFT EXT.","code_information":[{"code":"35903","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7626.96,"maximum":7626.96,"gross_charge":9416,"discounted_cash":2787.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7626.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7626.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7626.96,"methodology":"fee schedule"}]}]},{"description":"HC EXCISON OF INFECT GRFT EXT.","code_information":[{"code":"35903","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7626.96,"gross_charge":9416,"discounted_cash":2787.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7626.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7626.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7626.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6591.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1789.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1883.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1412.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1883.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"EXCISION GRAFT THORAX","code_information":[{"code":"35905","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION GRAFT ABDOMEN","code_information":[{"code":"35907","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLACE NEEDLE IN VEIN","code_information":[{"code":"36000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INJ PROC EXT.PSEUDOANEURYSM","code_information":[{"code":"36002","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1719.63,"maximum":1719.63,"gross_charge":2123,"discounted_cash":628.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1719.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1719.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1719.63,"methodology":"fee schedule"}]}]},{"description":"HC INJ PROC EXT.PSEUDOANEURYSM","code_information":[{"code":"36002","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2123,"discounted_cash":628.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1719.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1719.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1719.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1486.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":318.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC INJ TX PERC EXTR ANEURYSM","code_information":[{"code":"36002","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2387.88,"maximum":2387.88,"gross_charge":2948,"discounted_cash":872.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2387.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2387.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2387.88,"methodology":"fee schedule"}]}]},{"description":"HC INJ TX PERC EXTR ANEURYSM","code_information":[{"code":"36002","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2948,"discounted_cash":872.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2387.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2387.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2387.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2063.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC INJ EXTREM VENOGRAM","code_information":[{"code":"36005","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1600.56,"maximum":1600.56,"gross_charge":1976,"discounted_cash":584.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1600.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1600.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1600.56,"methodology":"fee schedule"}]}]},{"description":"HC INJ EXTREM VENOGRAM","code_information":[{"code":"36005","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":1976,"discounted_cash":584.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1600.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1600.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1600.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1383.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.2,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH SVC OR IVC","code_information":[{"code":"36010","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1512.27,"maximum":1512.27,"gross_charge":1867,"discounted_cash":552.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1512.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1512.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1512.27,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH SVC OR IVC","code_information":[{"code":"36010","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":1867,"discounted_cash":552.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1512.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1512.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1512.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1306.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.4,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH VENOUS IST ORDER","code_information":[{"code":"36011","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2007.99,"maximum":2007.99,"gross_charge":2479,"discounted_cash":733.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2007.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2007.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2007.99,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH VENOUS IST ORDER","code_information":[{"code":"36011","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":2479,"discounted_cash":733.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2007.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2007.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2007.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1735.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.8,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH VENOUS 2ND ORDER","code_information":[{"code":"36012","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2868.21,"maximum":2868.21,"gross_charge":3541,"discounted_cash":1048.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2868.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2868.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2868.21,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH VENOUS 2ND ORDER","code_information":[{"code":"36012","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":3541,"discounted_cash":1048.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2868.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2868.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2868.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2478.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.2,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH RT HRT/PUL ART","code_information":[{"code":"36013","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3427.92,"maximum":3427.92,"gross_charge":4232,"discounted_cash":1252.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3427.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3427.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3427.92,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH RT HRT/PUL ART","code_information":[{"code":"36013","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":4232,"discounted_cash":1252.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3427.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3427.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3427.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2962.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.4,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH LT/RT PUL ART","code_information":[{"code":"36014","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1496.88,"maximum":1496.88,"gross_charge":1848,"discounted_cash":547.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1496.88,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH LT/RT PUL ART","code_information":[{"code":"36014","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":1848,"discounted_cash":547.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1293.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH PLACEPULMONARY SEG","code_information":[{"code":"36015","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1736.64,"maximum":1736.64,"gross_charge":2144,"discounted_cash":634.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1736.64,"methodology":"fee schedule"}]}]},{"description":"HC CATH PLACEPULMONARY SEG","code_information":[{"code":"36015","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2144,"discounted_cash":634.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1500.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.8,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH SEGMENTL ART","code_information":[{"code":"36015","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1736.64,"maximum":1736.64,"gross_charge":2144,"discounted_cash":634.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1736.64,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH SEGMENTL ART","code_information":[{"code":"36015","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":2144,"discounted_cash":634.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1736.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1500.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.8,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH ACCESS TO ARTERY","code_information":[{"code":"36100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3611","type":"APR-DRG"}],"standard_charges":[{"minimum":11720,"maximum":11720,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11720,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11720,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11720,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3612","type":"APR-DRG"}],"standard_charges":[{"minimum":14028,"maximum":14028,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14028,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14028,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14028,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3613","type":"APR-DRG"}],"standard_charges":[{"minimum":20989,"maximum":20989,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20989,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20989,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20989,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES","code_information":[{"code":"3614","type":"APR-DRG"}],"standard_charges":[{"minimum":37916,"maximum":37916,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37916,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37916,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37916,"methodology":"case rate"}]}]},{"description":"HC NS CATH EXT UPPER OR LOWER","code_information":[{"code":"36140","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1897.02,"maximum":1897.02,"gross_charge":2342,"discounted_cash":693.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1897.02,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH EXT UPPER OR LOWER","code_information":[{"code":"36140","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":2342,"discounted_cash":693.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1639.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.4,"methodology":"fee schedule"}]}]},{"description":"ESTABLISH ACCESS TO AORTA","code_information":[{"code":"36160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC NS CATH AORTA","code_information":[{"code":"36200","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1189.08,"maximum":1189.08,"gross_charge":1468,"discounted_cash":434.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1189.08,"methodology":"fee schedule"}]}]},{"description":"HC NS CATH AORTA","code_information":[{"code":"36200","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6047,"gross_charge":1468,"discounted_cash":434.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1189.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1027.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.6,"methodology":"fee schedule"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3621","type":"APR-DRG"}],"standard_charges":[{"minimum":11077,"maximum":11077,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11077,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11077,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11077,"methodology":"case rate"}]}]},{"description":"CATH BRACH/CEPH 1 ORD","code_information":[{"code":"36215","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3217.32,"maximum":3217.32,"gross_charge":3972,"discounted_cash":1175.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3217.32,"methodology":"fee schedule"}]}]},{"description":"CATH BRACH/CEPH 1 ORD","code_information":[{"code":"36215","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3217.32,"gross_charge":3972,"discounted_cash":1175.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2780.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.4,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH BRACH/CEPH 1 ORD","code_information":[{"code":"36215","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3217.32,"maximum":3217.32,"gross_charge":3972,"discounted_cash":1175.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3217.32,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH BRACH/CEPH 1 ORD","code_information":[{"code":"36215","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":3972,"discounted_cash":1175.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3217.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2780.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.4,"methodology":"fee schedule"}]}]},{"description":"CATH BRACH/CEPH 2 ORD","code_information":[{"code":"36216","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4260.6,"maximum":4260.6,"gross_charge":5260,"discounted_cash":1556.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4260.6,"methodology":"fee schedule"}]}]},{"description":"CATH BRACH/CEPH 2 ORD","code_information":[{"code":"36216","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4260.6,"gross_charge":5260,"discounted_cash":1556.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3682,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":789,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH BRACH/CEPH 2 ORD","code_information":[{"code":"36216","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4260.6,"maximum":4260.6,"gross_charge":5260,"discounted_cash":1556.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4260.6,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH BRACH/CEPH 2 ORD","code_information":[{"code":"36216","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":5260,"discounted_cash":1556.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4260.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3682,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":789,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052,"methodology":"fee schedule"}]}]},{"description":"CATH PLACE BRACH/CEPH 3 ORD","code_information":[{"code":"36217","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3909.06,"maximum":3909.06,"gross_charge":4826,"discounted_cash":1428.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"}]}]},{"description":"CATH PLACE BRACH/CEPH 3 ORD","code_information":[{"code":"36217","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3909.06,"gross_charge":4826,"discounted_cash":1428.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3378.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH BRACH/CEPH 3 ORD","code_information":[{"code":"36217","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3909.06,"maximum":3909.06,"gross_charge":4826,"discounted_cash":1428.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH BRACH/CEPH 3 ORD","code_information":[{"code":"36217","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":4826,"discounted_cash":1428.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3378.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"}]}]},{"description":"CATH PLAC ADDL 23 ORD BEYOND","code_information":[{"code":"36218","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3909.06,"maximum":3909.06,"gross_charge":4826,"discounted_cash":1428.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"}]}]},{"description":"CATH PLAC ADDL 23 ORD BEYOND","code_information":[{"code":"36218","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3909.06,"gross_charge":4826,"discounted_cash":1428.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3378.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3622","type":"APR-DRG"}],"standard_charges":[{"minimum":16013,"maximum":16013,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16013,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16013,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16013,"methodology":"case rate"}]}]},{"description":"HC PLACE CATH THORACIC AORTA","code_information":[{"code":"36221","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7285.14,"maximum":7285.14,"gross_charge":8994,"discounted_cash":2662.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7285.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7285.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7285.14,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH THORACIC AORTA","code_information":[{"code":"36221","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7285.14,"gross_charge":8994,"discounted_cash":2662.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7285.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7285.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7285.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4317.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5036.64,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6295.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1708.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1798.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1349.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1798.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"THORACIC AORTAARCH","code_information":[{"code":"36221","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6602.31,"maximum":6602.31,"gross_charge":8151,"discounted_cash":2412.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6602.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6602.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6602.31,"methodology":"fee schedule"}]}]},{"description":"THORACIC AORTAARCH","code_information":[{"code":"36221","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":8151,"discounted_cash":2412.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6602.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6602.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6602.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5705.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1548.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1222.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"COMMON CAROTID UNILATERAL","code_information":[{"code":"36222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9106.83,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"}]}]},{"description":"COMMON CAROTID UNILATERAL","code_information":[{"code":"36222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7870.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2136.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC PLACE CATH CAROTID/INOM EC","code_information":[{"code":"36222","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9106.83,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH CAROTID/INOM EC","code_information":[{"code":"36222","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7870.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2136.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC PLC CATH CAROTID/INOM EC BILAT","code_information":[{"code":"36222","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":13659.84,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"}]}]},{"description":"HC PLC CATH CAROTID/INOM EC BILAT","code_information":[{"code":"36222","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11804.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC SELECTIVE CAROTID BILATERAL","code_information":[{"code":"36222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":13659.84,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"}]}]},{"description":"HC SELECTIVE CAROTID BILATERAL","code_information":[{"code":"36222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11804.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"CAROTID/CEREBRAL UNILAT","code_information":[{"code":"36223","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15253.11,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"}]}]},{"description":"CAROTID/CEREBRAL UNILAT","code_information":[{"code":"36223","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13181.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3577.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2824.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC ARTERIOGRAMCAROTID CERVBIL","code_information":[{"code":"36223","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":22766.67,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIOGRAMCAROTID CERVBIL","code_information":[{"code":"36223","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19674.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5340.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4216.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC BIL CAROTID/CEREBRAL","code_information":[{"code":"36223","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":14797.89,"maximum":14797.89,"gross_charge":18269,"discounted_cash":5407.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14797.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14797.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14797.89,"methodology":"fee schedule"}]}]},{"description":"HC BIL CAROTID/CEREBRAL","code_information":[{"code":"36223","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":14797.89,"gross_charge":18269,"discounted_cash":5407.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14797.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14797.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14797.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12788.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3471.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3653.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2740.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3653.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC PLACE CATH CAROTID/INOM IC","code_information":[{"code":"36223","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":15253.11,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH CAROTID/INOM IC","code_information":[{"code":"36223","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13181.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3577.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2824.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC PLC CATH CAROTID/INOM IC BILAT","code_information":[{"code":"36223","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":22766.67,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"}]}]},{"description":"HC PLC CATH CAROTID/INOM IC BILAT","code_information":[{"code":"36223","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19674.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5340.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4216.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC PLC CATH CRTD/INOM IC/EC BILAT","code_information":[{"code":"36224","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":22766.67,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"}]}]},{"description":"HC PLC CATH CRTD/INOM IC/EC BILAT","code_information":[{"code":"36224","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19674.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5340.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4216.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"INTERNAL CAROTID BILAT","code_information":[{"code":"36224","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":22766.67,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"}]}]},{"description":"INTERNAL CAROTID BILAT","code_information":[{"code":"36224","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19674.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5340.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4216.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"INTERNAL CAROTID UNILAT","code_information":[{"code":"36224","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15253.11,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"}]}]},{"description":"INTERNAL CAROTID UNILAT","code_information":[{"code":"36224","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13181.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3577.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2824.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC PLACE CATH SUBCLAVIAN ART","code_information":[{"code":"36225","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9106.83,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH SUBCLAVIAN ART","code_information":[{"code":"36225","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7870.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2136.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC PLC CATH SUBCLAVIAN ART BILAT","code_information":[{"code":"36225","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":13659.84,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"}]}]},{"description":"HC PLC CATH SUBCLAVIAN ART BILAT","code_information":[{"code":"36225","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11804.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"VERTEBRAL CP/INNOM-SUBCLAV BIL","code_information":[{"code":"36225","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":13659.84,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"}]}]},{"description":"VERTEBRAL CP/INNOM-SUBCLAV BIL","code_information":[{"code":"36225","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13659.84,"gross_charge":16864,"discounted_cash":4991.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13659.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11804.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3204.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2529.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"VERTEBRAL CP/INNOM-SUBCLAV UNI","code_information":[{"code":"36225","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9106.83,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"}]}]},{"description":"VERTEBRAL CP/INNOM-SUBCLAV UNI","code_information":[{"code":"36225","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9106.83,"gross_charge":11243,"discounted_cash":3327.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9106.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7870.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2136.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1686.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2248.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"VERTEBRAL UNILAT/CP IN SUBCL","code_information":[{"code":"36225","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8879.22,"maximum":8879.22,"gross_charge":10962,"discounted_cash":3244.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8879.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8879.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8879.22,"methodology":"fee schedule"}]}]},{"description":"VERTEBRAL UNILAT/CP IN SUBCL","code_information":[{"code":"36225","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8879.22,"gross_charge":10962,"discounted_cash":3244.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8879.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8879.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8879.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7673.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2082.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2192.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1644.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2192.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC BIL VERTEBRAL CP ART","code_information":[{"code":"36226","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":22766.67,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"}]}]},{"description":"HC BIL VERTEBRAL CP ART","code_information":[{"code":"36226","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19674.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5340.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4216.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC PLACEMNT CATH VERTEBRAL ART","code_information":[{"code":"36226","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":15253.11,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"}]}]},{"description":"HC PLACEMNT CATH VERTEBRAL ART","code_information":[{"code":"36226","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13181.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3577.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2824.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC PLCMNT CATH VERTEBRAL ART BILAT","code_information":[{"code":"36226","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":22766.67,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"}]}]},{"description":"HC PLCMNT CATH VERTEBRAL ART BILAT","code_information":[{"code":"36226","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":22766.67,"gross_charge":28107,"discounted_cash":8319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22766.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19674.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5340.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4216.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5621.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"VERTEBRAL ARTERY UNILAT","code_information":[{"code":"36226","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15253.11,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"}]}]},{"description":"VERTEBRAL ARTERY UNILAT","code_information":[{"code":"36226","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15253.11,"gross_charge":18831,"discounted_cash":5573.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15253.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13181.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3577.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2824.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3766.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"EXTERNAL CAROTID UNILAT","code_information":[{"code":"36227","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7512.75,"maximum":7512.75,"gross_charge":9275,"discounted_cash":2745.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7512.75,"methodology":"fee schedule"}]}]},{"description":"EXTERNAL CAROTID UNILAT","code_information":[{"code":"36227","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7512.75,"gross_charge":9275,"discounted_cash":2745.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6492.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1762.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1391.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH XTRNL CAROTID","code_information":[{"code":"36227","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7512.75,"maximum":7512.75,"gross_charge":9275,"discounted_cash":2745.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7512.75,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH XTRNL CAROTID","code_information":[{"code":"36227","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7512.75,"gross_charge":9275,"discounted_cash":2745.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7512.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6492.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1762.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1391.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH XTRNL CAROTID BILAT","code_information":[{"code":"36227","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11382.93,"maximum":11382.93,"gross_charge":14053,"discounted_cash":4159.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11382.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11382.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11382.93,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CATH XTRNL CAROTID BILAT","code_information":[{"code":"36227","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11382.93,"gross_charge":14053,"discounted_cash":4159.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11382.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11382.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11382.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9837.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2670.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2810.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2107.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2810.6,"methodology":"fee schedule"}]}]},{"description":"HC PLACE INTRACRANIAL ART","code_information":[{"code":"36228","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3463.56,"maximum":3463.56,"gross_charge":4276,"discounted_cash":1265.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3463.56,"methodology":"fee schedule"}]}]},{"description":"HC PLACE INTRACRANIAL ART","code_information":[{"code":"36228","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3463.56,"gross_charge":4276,"discounted_cash":1265.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2993.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.2,"methodology":"fee schedule"}]}]},{"description":"INTRACARNIAL BRANCH EA","code_information":[{"code":"36228","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3463.56,"maximum":3463.56,"gross_charge":4276,"discounted_cash":1265.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3463.56,"methodology":"fee schedule"}]}]},{"description":"INTRACARNIAL BRANCH EA","code_information":[{"code":"36228","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3463.56,"gross_charge":4276,"discounted_cash":1265.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3463.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2993.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.2,"methodology":"fee schedule"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3623","type":"APR-DRG"}],"standard_charges":[{"minimum":16206,"maximum":16206,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16206,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16206,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16206,"methodology":"case rate"}]}]},{"description":"MASTECTOMY PROCEDURES","code_information":[{"code":"3624","type":"APR-DRG"}],"standard_charges":[{"minimum":28776,"maximum":28776,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28776,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28776,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28776,"methodology":"case rate"}]}]},{"description":"CATH ABD 1 ORD","code_information":[{"code":"36245","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4136.67,"maximum":4136.67,"gross_charge":5107,"discounted_cash":1511.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4136.67,"methodology":"fee schedule"}]}]},{"description":"CATH ABD 1 ORD","code_information":[{"code":"36245","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":5107,"discounted_cash":1511.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3574.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":970.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021.4,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART 1ORD","code_information":[{"code":"36245","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4136.67,"maximum":4136.67,"gross_charge":5107,"discounted_cash":1511.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4136.67,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART 1ORD","code_information":[{"code":"36245","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6047,"gross_charge":5107,"discounted_cash":1511.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4136.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3574.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":970.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021.4,"methodology":"fee schedule"}]}]},{"description":"CATH ABD 2 ORD","code_information":[{"code":"36246","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3237.57,"maximum":3237.57,"gross_charge":3997,"discounted_cash":1183.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"}]}]},{"description":"CATH ABD 2 ORD","code_information":[{"code":"36246","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":3997,"discounted_cash":1183.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2797.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART 2ORD","code_information":[{"code":"36246","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3237.57,"maximum":3237.57,"gross_charge":3997,"discounted_cash":1183.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART 2ORD","code_information":[{"code":"36246","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6047,"gross_charge":3997,"discounted_cash":1183.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2797.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"}]}]},{"description":"CATH ABD 3 ORD","code_information":[{"code":"36247","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3237.57,"maximum":3237.57,"gross_charge":3997,"discounted_cash":1183.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"}]}]},{"description":"CATH ABD 3 ORD","code_information":[{"code":"36247","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3237.57,"gross_charge":3997,"discounted_cash":1183.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2797.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART 3ORD","code_information":[{"code":"36247","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3237.57,"maximum":3237.57,"gross_charge":3997,"discounted_cash":1183.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART 3ORD","code_information":[{"code":"36247","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":3997,"discounted_cash":1183.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3237.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2797.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.4,"methodology":"fee schedule"}]}]},{"description":"ADDL CP 2ND/3RD ORD BEYOND","code_information":[{"code":"36248","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4047.57,"maximum":4047.57,"gross_charge":4997,"discounted_cash":1479.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4047.57,"methodology":"fee schedule"}]}]},{"description":"ADDL CP 2ND/3RD ORD BEYOND","code_information":[{"code":"36248","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4047.57,"gross_charge":4997,"discounted_cash":1479.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3497.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.4,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART ADDL","code_information":[{"code":"36248","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4047.57,"maximum":4047.57,"gross_charge":4997,"discounted_cash":1479.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4047.57,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH ABD/EXT ART ADDL","code_information":[{"code":"36248","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":4997,"discounted_cash":1479.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4047.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3497.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":999.4,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH RENAL 1ST ORD UNI","code_information":[{"code":"36251","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3827.25,"maximum":3827.25,"gross_charge":4725,"discounted_cash":1398.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3827.25,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH RENAL 1ST ORD UNI","code_information":[{"code":"36251","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4725,"discounted_cash":1398.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3307.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":945,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":945,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC SA CATH RENAL 1ST ORD BIL","code_information":[{"code":"36252","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4725.54,"maximum":4725.54,"gross_charge":5834,"discounted_cash":1726.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4725.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4725.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4725.54,"methodology":"fee schedule"}]}]},{"description":"HC SA CATH RENAL 1ST ORD BIL","code_information":[{"code":"36252","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":5834,"discounted_cash":1726.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4725.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4725.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4725.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4083.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1108.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC SL CATH RENAL 2ND ORD UNI","code_information":[{"code":"36253","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3827.25,"maximum":3827.25,"gross_charge":4725,"discounted_cash":1398.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3827.25,"methodology":"fee schedule"}]}]},{"description":"HC SL CATH RENAL 2ND ORD UNI","code_information":[{"code":"36253","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":4725,"discounted_cash":1398.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3827.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3307.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":897.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":945,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":945,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC SL CATH RENAL 2ND ORD BIL","code_information":[{"code":"36254","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5150.79,"maximum":5150.79,"gross_charge":6359,"discounted_cash":1882.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5150.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5150.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5150.79,"methodology":"fee schedule"}]}]},{"description":"HC SL CATH RENAL 2ND ORD BIL","code_information":[{"code":"36254","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":6359,"discounted_cash":1882.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5150.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5150.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5150.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4451.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1271.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1271.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERTION OF INFUSION PUMP","code_information":[{"code":"36260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REVISION OF INFUSION PUMP","code_information":[{"code":"36261","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7967.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"REMOVAL OF INFUSION PUMP","code_information":[{"code":"36262","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7967.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7967.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5729.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5563.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3253.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3481.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3351.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3416.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3579.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3448.9,"methodology":"case rate"}]}]},{"description":"VESSEL INJECTION PROCEDURE","code_information":[{"code":"36299","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3631","type":"APR-DRG"}],"standard_charges":[{"minimum":10603,"maximum":10603,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10603,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10603,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10603,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3632","type":"APR-DRG"}],"standard_charges":[{"minimum":11295,"maximum":11295,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11295,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11295,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11295,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3633","type":"APR-DRG"}],"standard_charges":[{"minimum":17267,"maximum":17267,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17267,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17267,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17267,"methodology":"case rate"}]}]},{"description":"BREAST PROCEDURES EXCEPT MASTECTOMY","code_information":[{"code":"3634","type":"APR-DRG"}],"standard_charges":[{"minimum":23256,"maximum":23256,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23256,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23256,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23256,"methodology":"case rate"}]}]},{"description":"BL DRAW < 3 YRS FEM/JUGULAR","code_information":[{"code":"36400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BL DRAW <3 YRS SCALP VEIN","code_information":[{"code":"36405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BL DRAW <3 YRS OTHER VEIN","code_information":[{"code":"36406","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3641","type":"APR-DRG"}],"standard_charges":[{"minimum":5099,"maximum":5099,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5099,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5099,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5099,"methodology":"case rate"}]}]},{"description":"NON-ROUTINE BL DRAW 3/> YRS","code_information":[{"code":"36410","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VENIPUNCTURE","code_information":[{"code":"36415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"HC VENIPUNCTURE","code_information":[{"code":"36415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":60,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.54,"standard_charge_algorithm": "Lesser of $15.54 or 171 Percent of Billed Charges","median_amount":24.99,"10th_percentile":24.27,"90th_percentile":24.99,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.09,"standard_charge_algorithm": "Lesser of $9.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.73,"standard_charge_algorithm": "Lesser of $9.73 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.36,"standard_charge_algorithm": "Lesser of $9.36 or 103 Percent of Billed Charges","median_amount":9.36,"10th_percentile":9.09,"90th_percentile":9.36,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.54,"standard_charge_algorithm": "Lesser of $9.54 or 105 Percent of Billed Charges","median_amount":9.54,"10th_percentile":9.54,"90th_percentile":9.54,"count":"12","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10,"standard_charge_algorithm": "Lesser of $10.00 or 110 Percent of Billed Charges","median_amount":10,"10th_percentile":4.83,"90th_percentile":32.02,"count":"16","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.64,"standard_charge_algorithm": "Lesser of $9.64 or 106 Percent of Billed Charges","median_amount":24.52,"10th_percentile":9.64,"90th_percentile":24.52,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD DRAW CAPILLARY","code_information":[{"code":"36416","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD DRAW CAPILLARY","code_information":[{"code":"36416","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3642","type":"APR-DRG"}],"standard_charges":[{"minimum":8918,"maximum":8918,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8918,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8918,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8918,"methodology":"case rate"}]}]},{"description":"VEIN ACCESS CUTDOWN < 1 YR","code_information":[{"code":"36420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"VEIN ACCESS CUTDOWN > 1 YR","code_information":[{"code":"36425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3643","type":"APR-DRG"}],"standard_charges":[{"minimum":14261,"maximum":14261,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14261,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14261,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14261,"methodology":"case rate"}]}]},{"description":"HC PLATELETS TRANSFUSION PROCESS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":1295.19,"maximum":1295.19,"gross_charge":1599,"discounted_cash":473.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1295.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1295.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1295.19,"methodology":"fee schedule"}]}]},{"description":"HC PLATELETS TRANSFUSION PROCESS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1599,"discounted_cash":473.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1295.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1295.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1295.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1119.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HC TRANSFUSION BLOOD","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":1188.27,"maximum":1188.27,"gross_charge":1467,"discounted_cash":434.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1188.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1188.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1188.27,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFUSION BLOOD","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1467,"discounted_cash":434.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1188.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1188.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1188.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1026.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HC TRANSFUSION PROCESS - 12 HRS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":3339.63,"maximum":3339.63,"gross_charge":4123,"discounted_cash":1220.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3339.63,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFUSION PROCESS - 12 HRS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3339.63,"gross_charge":4123,"discounted_cash":1220.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2886.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HC TRANSFUSION PROCESS - 6 HRS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":1723.68,"maximum":1723.68,"gross_charge":2128,"discounted_cash":629.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1723.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1723.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1723.68,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFUSION PROCESS - 6 HRS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2128,"discounted_cash":629.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1723.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1723.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1723.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1489.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HC TRANSFUSION PROCESS - 8 HRS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":2269.62,"maximum":2269.62,"gross_charge":2802,"discounted_cash":829.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2269.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2269.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2269.62,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFUSION PROCESS - 8 HRS","code_information":[{"code":"36430","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2802,"discounted_cash":829.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2269.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2269.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2269.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1961.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND RELATED PROCEDURES","code_information":[{"code":"3644","type":"APR-DRG"}],"standard_charges":[{"minimum":21655,"maximum":21655,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21655,"methodology":"case rate"}]}]},{"description":"BL PUSH TRANSFUSE 2 YR/<","code_information":[{"code":"36440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"BL EXCHANGE/TRANSFUSE NB","code_information":[{"code":"36450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HC RED CELL EXCHANGE","code_information":[{"code":"36455","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":1287.9,"maximum":1287.9,"gross_charge":1590,"discounted_cash":470.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1287.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1287.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1287.9,"methodology":"fee schedule"}]}]},{"description":"HC RED CELL EXCHANGE","code_information":[{"code":"36455","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1590,"discounted_cash":470.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1287.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1287.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1287.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1113,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":318,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":318,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"PRTL EXCHANGE TRANSFUSE NB","code_information":[{"code":"36456","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"TRANSFUSION SERVICE FETAL","code_information":[{"code":"36460","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"BILAT INJ NON-COMP FOAM VEIN","code_information":[{"code":"36465","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7891.02,"maximum":7891.02,"gross_charge":9742,"discounted_cash":2883.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7891.02,"methodology":"fee schedule"}]}]},{"description":"BILAT INJ NON-COMP FOAM VEIN","code_information":[{"code":"36465","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7891.02,"gross_charge":9742,"discounted_cash":2883.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1948.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1948.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"INJECT NON-COMP FOAM SGLE VEIN","code_information":[{"code":"36465","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5295.78,"maximum":5295.78,"gross_charge":6538,"discounted_cash":1935.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5295.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5295.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5295.78,"methodology":"fee schedule"}]}]},{"description":"INJECT NON-COMP FOAM SGLE VEIN","code_information":[{"code":"36465","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"gross_charge":6538,"discounted_cash":1935.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5295.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5295.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5295.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":980.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"INJECT NONCOMP FOAM MULT VEINS","code_information":[{"code":"36466","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7891.02,"maximum":7891.02,"gross_charge":9742,"discounted_cash":2883.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7891.02,"methodology":"fee schedule"}]}]},{"description":"INJECT NONCOMP FOAM MULT VEINS","code_information":[{"code":"36466","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7891.02,"gross_charge":9742,"discounted_cash":2883.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7891.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1850.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1948.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1461.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1948.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"NJX SCLRSNT SPIDER VEINS","code_information":[{"code":"36468","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INJECT OF SCLEROSANT SGLE VEIN","code_information":[{"code":"36470","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1016.55,"maximum":1016.55,"gross_charge":1255,"discounted_cash":371.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1016.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1016.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1016.55,"methodology":"fee schedule"}]}]},{"description":"INJECT OF SCLEROSANT SGLE VEIN","code_information":[{"code":"36470","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1255,"discounted_cash":371.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1016.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1016.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1016.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":878.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":251,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":251,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"INJECT SCLEROSANT MULT VEINS","code_information":[{"code":"36471","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1524.42,"maximum":1524.42,"gross_charge":1882,"discounted_cash":557.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1524.42,"methodology":"fee schedule"}]}]},{"description":"INJECT SCLEROSANT MULT VEINS","code_information":[{"code":"36471","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1882,"discounted_cash":557.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1317.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"ENDOVENOUS MCHNCHEM 1ST VEIN","code_information":[{"code":"36473","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"ENDOVENOUS MCHNCHEM ADD-ON","code_information":[{"code":"36474","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BILAT ENDOVEN ABLAT INCP VEIN","code_information":[{"code":"36475","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11538.45,"maximum":11538.45,"gross_charge":14245,"discounted_cash":4216.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11538.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11538.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11538.45,"methodology":"fee schedule"}]}]},{"description":"BILAT ENDOVEN ABLAT INCP VEIN","code_information":[{"code":"36475","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11538.45,"gross_charge":14245,"discounted_cash":4216.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11538.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11538.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11538.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2706.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2849,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2136.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2849,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"ENDOVEN ABLAT INCOMP 1ST VEIN","code_information":[{"code":"36475","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8483.94,"maximum":8483.94,"gross_charge":10474,"discounted_cash":3100.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8483.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8483.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8483.94,"methodology":"fee schedule"}]}]},{"description":"ENDOVEN ABLAT INCOMP 1ST VEIN","code_information":[{"code":"36475","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9652.34,"gross_charge":10474,"discounted_cash":3100.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8483.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8483.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8483.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1990.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2094.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1571.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2094.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"ENDOVEN ABLAT INCOM 2ND/SUBSQ","code_information":[{"code":"36476","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4241.97,"maximum":4241.97,"gross_charge":5237,"discounted_cash":1550.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4241.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4241.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4241.97,"methodology":"fee schedule"}]}]},{"description":"ENDOVEN ABLAT INCOM 2ND/SUBSQ","code_information":[{"code":"36476","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9652.34,"gross_charge":5237,"discounted_cash":1550.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4241.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4241.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4241.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1047.4,"methodology":"fee schedule"}]}]},{"description":"ENDOVENOUS LASER 1ST VEIN","code_information":[{"code":"36478","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":9652.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"ENDOVENOUS LASER VEIN ADDON","code_information":[{"code":"36479","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10053,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PERC PORTAL VEIN CATH","code_information":[{"code":"36481","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2762.1,"maximum":2762.1,"gross_charge":3410,"discounted_cash":1009.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2762.1,"methodology":"fee schedule"}]}]},{"description":"HC PERC PORTAL VEIN CATH","code_information":[{"code":"36481","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3410,"discounted_cash":1009.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1636.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1909.6,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2387,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":682,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":682,"methodology":"fee schedule"}]}]},{"description":"HC PORTAL VEIN CATHETERIZATION","code_information":[{"code":"36481","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2762.1,"maximum":2762.1,"gross_charge":3410,"discounted_cash":1009.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2762.1,"methodology":"fee schedule"}]}]},{"description":"HC PORTAL VEIN CATHETERIZATION","code_information":[{"code":"36481","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3410,"discounted_cash":1009.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2762.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2387,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":682,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":682,"methodology":"fee schedule"}]}]},{"description":"ENDOVEN THER CHEM ADHES 1ST","code_information":[{"code":"36482","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"ENDOVEN THER CHEM ADHES SBSQ","code_information":[{"code":"36483","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VS CATH ORGAN BLD SAMPLING","code_information":[{"code":"36500","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1718.01,"maximum":1718.01,"gross_charge":2121,"discounted_cash":627.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1718.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1718.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1718.01,"methodology":"fee schedule"}]}]},{"description":"HC VS CATH ORGAN BLD SAMPLING","code_information":[{"code":"36500","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2121,"discounted_cash":627.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1718.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1718.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1718.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1018.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1187.76,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1484.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":318.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.2,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CATHETER VEIN","code_information":[{"code":"36510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC APHERESIS WBC","code_information":[{"code":"36511","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":3590.73,"maximum":3590.73,"gross_charge":4433,"discounted_cash":1312.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3590.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3590.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3590.73,"methodology":"fee schedule"}]}]},{"description":"HC APHERESIS WBC","code_information":[{"code":"36511","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3590.73,"gross_charge":4433,"discounted_cash":1312.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3590.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3590.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3590.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3103.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":842.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"HC APHERESIS RBC","code_information":[{"code":"36512","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":3303.18,"maximum":3303.18,"gross_charge":4078,"discounted_cash":1207.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3303.18,"methodology":"fee schedule"}]}]},{"description":"HC APHERESIS RBC","code_information":[{"code":"36512","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3588.92,"gross_charge":4078,"discounted_cash":1207.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2854.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"HC APHERESIS PLATELETS","code_information":[{"code":"36513","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":3303.18,"maximum":3303.18,"gross_charge":4078,"discounted_cash":1207.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3303.18,"methodology":"fee schedule"}]}]},{"description":"HC APHERESIS PLATELETS","code_information":[{"code":"36513","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3303.18,"gross_charge":4078,"discounted_cash":1207.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3303.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2854.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HC APHERESIS PLASMA","code_information":[{"code":"36514","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":4787.1,"maximum":4787.1,"gross_charge":5910,"discounted_cash":1749.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4787.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4787.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4787.1,"methodology":"fee schedule"}]}]},{"description":"HC APHERESIS PLASMA","code_information":[{"code":"36514","type":"CPT"},{"code":"0391","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4787.1,"gross_charge":5910,"discounted_cash":1749.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4787.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4787.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4787.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"APHERESIS IMMUNOADS SLCTV","code_information":[{"code":"36516","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10257.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10257.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10257.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6752.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7162.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4188.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4481.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4314.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4398.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4607.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4440.05,"methodology":"case rate"}]}]},{"description":"PHOTOPHERESIS","code_information":[{"code":"36522","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10257.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10257.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10257.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6752.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7162.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4188.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4481.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4314.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4398.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4607.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4440.05,"methodology":"case rate"}]}]},{"description":"HC INSERT CENTRAL LINE <5YR","code_information":[{"code":"36555","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4894.02,"maximum":4894.02,"gross_charge":6042,"discounted_cash":1788.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4894.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4894.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4894.02,"methodology":"fee schedule"}]}]},{"description":"HC INSERT CENTRAL LINE <5YR","code_information":[{"code":"36555","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":6042,"discounted_cash":1788.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4894.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4894.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4894.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC INSERT CATH NON-TUN CV >5","code_information":[{"code":"36556","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2375.73,"maximum":2375.73,"gross_charge":2933,"discounted_cash":868.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2375.73,"methodology":"fee schedule"}]}]},{"description":"HC INSERT CATH NON-TUN CV >5","code_information":[{"code":"36556","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":2933,"discounted_cash":868.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT CATH NON-TUNNEL CV","code_information":[{"code":"36556","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2375.73,"maximum":2375.73,"gross_charge":2933,"discounted_cash":868.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2375.73,"methodology":"fee schedule"}]}]},{"description":"INSERT CATH NON-TUNNEL CV","code_information":[{"code":"36556","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":2933,"discounted_cash":868.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36557","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC INSERT CATH TUNNEL >5 YR","code_information":[{"code":"36558","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2831.76,"maximum":2831.76,"gross_charge":3496,"discounted_cash":1034.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2831.76,"methodology":"fee schedule"}]}]},{"description":"HC INSERT CATH TUNNEL >5 YR","code_information":[{"code":"36558","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":3496,"discounted_cash":1034.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT TUNLD CV CATH W/O PORT","code_information":[{"code":"36558","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2831.76,"maximum":2831.76,"gross_charge":3496,"discounted_cash":1034.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2831.76,"methodology":"fee schedule"}]}]},{"description":"INSERT TUNLD CV CATH W/O PORT","code_information":[{"code":"36558","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":3496,"discounted_cash":1034.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2831.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC INSERT TUN CVC W/PRT >5YR","code_information":[{"code":"36561","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4939.38,"maximum":4939.38,"gross_charge":6098,"discounted_cash":1805.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4939.38,"methodology":"fee schedule"}]}]},{"description":"HC INSERT TUN CVC W/PRT >5YR","code_information":[{"code":"36561","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":6098,"discounted_cash":1805.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1158.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36563","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC CENTRAL ACCESS TUNNELED 2CATH","code_information":[{"code":"36565","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4939.38,"maximum":4939.38,"gross_charge":6098,"discounted_cash":1805.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4939.38,"methodology":"fee schedule"}]}]},{"description":"HC CENTRAL ACCESS TUNNELED 2CATH","code_information":[{"code":"36565","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":6098,"discounted_cash":1805.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4939.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1158.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1219.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT TUNNELED CV CATH","code_information":[{"code":"36566","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"INSJ PICC <5 YR W/O IMAGING","code_information":[{"code":"36568","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3400.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC CENTRAL VENOUS CATH ATTEMPTED","code_information":[{"code":"36569","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":5043.87,"maximum":5043.87,"gross_charge":6227,"discounted_cash":1843.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5043.87,"methodology":"fee schedule"}]}]},{"description":"HC CENTRAL VENOUS CATH ATTEMPTED","code_information":[{"code":"36569","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5043.87,"gross_charge":6227,"discounted_cash":1843.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC INSERT PICC >5YR W/O IMG","code_information":[{"code":"36569","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5043.87,"maximum":5043.87,"gross_charge":6227,"discounted_cash":1843.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5043.87,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PICC >5YR W/O IMG","code_information":[{"code":"36569","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5043.87,"gross_charge":6227,"discounted_cash":1843.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC INSERT/MIDLINE PIV/US ASSIST","code_information":[{"code":"36569","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5043.87,"maximum":5043.87,"gross_charge":6227,"discounted_cash":1843.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5043.87,"methodology":"fee schedule"}]}]},{"description":"HC INSERT/MIDLINE PIV/US ASSIST","code_information":[{"code":"36569","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5043.87,"gross_charge":6227,"discounted_cash":1843.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5043.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1183.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"INSERT PICVAD CATH","code_information":[{"code":"36570","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC INSERT PICC DEV W/PRT >5Y","code_information":[{"code":"36571","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5901.66,"maximum":5901.66,"gross_charge":7286,"discounted_cash":2156.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5901.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5901.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5901.66,"methodology":"fee schedule"}]}]},{"description":"HC INSERT PICC DEV W/PRT >5Y","code_information":[{"code":"36571","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":7286,"discounted_cash":2156.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5901.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5901.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5901.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1384.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1457.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1092.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1457.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSJ PICC RSI <5 YR","code_information":[{"code":"36572","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC PICC CEN VEN CATH W/IMAG","code_information":[{"code":"36573","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3581.82,"maximum":3581.82,"gross_charge":4422,"discounted_cash":1308.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3581.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3581.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3581.82,"methodology":"fee schedule"}]}]},{"description":"HC PICC CEN VEN CATH W/IMAG","code_information":[{"code":"36573","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4091,"gross_charge":4422,"discounted_cash":1308.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3581.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3581.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3581.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3322,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4091,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC REPAIR CVC WO PORT","code_information":[{"code":"36575","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1193.94,"maximum":1193.94,"gross_charge":1474,"discounted_cash":436.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1193.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1193.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1193.94,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR CVC WO PORT","code_information":[{"code":"36575","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"gross_charge":1474,"discounted_cash":436.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1193.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1193.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1193.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"REPAIR TUNNELED CV CATH","code_information":[{"code":"36576","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3400.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC REPLACE TUNNELED CV CATH","code_information":[{"code":"36578","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8402.94,"maximum":8402.94,"gross_charge":10374,"discounted_cash":3070.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8402.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8402.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8402.94,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE TUNNELED CV CATH","code_information":[{"code":"36578","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8402.94,"gross_charge":10374,"discounted_cash":3070.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8402.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8402.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8402.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1971.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2074.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1556.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2074.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HB REMOV TUNNELED INTRAPERIT CATH","code_information":[{"code":"36580","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5195.34,"maximum":5195.34,"gross_charge":6414,"discounted_cash":1898.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5195.34,"methodology":"fee schedule"}]}]},{"description":"HB REMOV TUNNELED INTRAPERIT CATH","code_information":[{"code":"36580","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5195.34,"gross_charge":6414,"discounted_cash":1898.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC REPLACE CV NON TUNNL WO PRT","code_information":[{"code":"36580","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5195.34,"maximum":5195.34,"gross_charge":6414,"discounted_cash":1898.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5195.34,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE CV NON TUNNL WO PRT","code_information":[{"code":"36580","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5195.34,"gross_charge":6414,"discounted_cash":1898.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC REPLACE CV TUNNL W/O PRT","code_information":[{"code":"36581","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3736.53,"maximum":3736.53,"gross_charge":4613,"discounted_cash":1365.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3736.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3736.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3736.53,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE CV TUNNL W/O PRT","code_information":[{"code":"36581","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":4613,"discounted_cash":1365.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3736.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3736.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3736.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC REPLACE CV TUNNL W/PORT","code_information":[{"code":"36582","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7809.21,"maximum":7809.21,"gross_charge":9641,"discounted_cash":2853.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7809.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7809.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7809.21,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE CV TUNNL W/PORT","code_information":[{"code":"36582","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7809.21,"gross_charge":9641,"discounted_cash":2853.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7809.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7809.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7809.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1831.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1928.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1446.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1928.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC REPL TUN.CV SAME ACCESS","code_information":[{"code":"36583","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":21634.29,"maximum":21634.29,"gross_charge":26709,"discounted_cash":7905.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21634.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21634.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21634.29,"methodology":"fee schedule"}]}]},{"description":"HC REPL TUN.CV SAME ACCESS","code_information":[{"code":"36583","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":21634.29,"gross_charge":26709,"discounted_cash":7905.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21634.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21634.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21634.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5074.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5341.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4006.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5341.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC REPLACE CV NTUNNL PICC W/IMG","code_information":[{"code":"36584","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1944.81,"maximum":1944.81,"gross_charge":2401,"discounted_cash":710.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1944.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1944.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1944.81,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE CV NTUNNL PICC W/IMG","code_information":[{"code":"36584","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3400.99,"gross_charge":2401,"discounted_cash":710.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1944.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1944.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1944.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"REPLACE PICVAD CATH","code_information":[{"code":"36585","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"CENTRAL VENOUS CATHETER REM","code_information":[{"code":"36589","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2302.02,"maximum":2302.02,"gross_charge":2842,"discounted_cash":841.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2302.02,"methodology":"fee schedule"}]}]},{"description":"CENTRAL VENOUS CATHETER REM","code_information":[{"code":"36589","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2302.02,"gross_charge":2842,"discounted_cash":841.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC REMOVE CVC TUNNEL WO PRT","code_information":[{"code":"36589","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2302.02,"maximum":2302.02,"gross_charge":2842,"discounted_cash":841.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2302.02,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE CVC TUNNEL WO PRT","code_information":[{"code":"36589","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2302.02,"gross_charge":2842,"discounted_cash":841.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"HC REMOVE CVC TUNNEL W PORT","code_information":[{"code":"36590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2708.64,"maximum":2708.64,"gross_charge":3344,"discounted_cash":989.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2708.64,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE CVC TUNNEL W PORT","code_information":[{"code":"36590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3400.99,"gross_charge":3344,"discounted_cash":989.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"REMO TUNNEL CVC W/SUBCUT PORT","code_information":[{"code":"36590","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2708.64,"maximum":2708.64,"gross_charge":3344,"discounted_cash":989.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2708.64,"methodology":"fee schedule"}]}]},{"description":"REMO TUNNEL CVC W/SUBCUT PORT","code_information":[{"code":"36590","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3400.99,"gross_charge":3344,"discounted_cash":989.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2708.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":668.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC BLOOD DRAW VENOUS DEVICE","code_information":[{"code":"36591","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"}]}]},{"description":"HC BLOOD DRAW VENOUS DEVICE","code_information":[{"code":"36591","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":206,"discounted_cash":60.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC COLL/BLOOD SP EST CEN/PERI CAT","code_information":[{"code":"36592","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"}]}]},{"description":"HC COLL/BLOOD SP EST CEN/PERI CAT","code_information":[{"code":"36592","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":206,"discounted_cash":60.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC DECLOT VASCULAR DEVICE","code_information":[{"code":"36593","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1187.46,"maximum":1187.46,"gross_charge":1466,"discounted_cash":433.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1187.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1187.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1187.46,"methodology":"fee schedule"}]}]},{"description":"HC DECLOT VASCULAR DEVICE","code_information":[{"code":"36593","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1466,"discounted_cash":433.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1187.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1187.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1187.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":322.68,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1026.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC REMOVAL MECH OBSTR CVAD","code_information":[{"code":"36595","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3766.5,"maximum":3766.5,"gross_charge":4650,"discounted_cash":1376.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3766.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3766.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3766.5,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL MECH OBSTR CVAD","code_information":[{"code":"36595","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4650,"discounted_cash":1376.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3766.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3766.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3766.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3255,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":930,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":930,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC REMOVAL LUMN OBSTR CVAD","code_information":[{"code":"36596","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":512.73,"maximum":512.73,"gross_charge":633,"discounted_cash":187.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.73,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL LUMN OBSTR CVAD","code_information":[{"code":"36596","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3400.99,"gross_charge":633,"discounted_cash":187.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":443.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC REPOSITIONING CVC","code_information":[{"code":"36597","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5195.34,"maximum":5195.34,"gross_charge":6414,"discounted_cash":1898.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5195.34,"methodology":"fee schedule"}]}]},{"description":"HC REPOSITIONING CVC","code_information":[{"code":"36597","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5195.34,"gross_charge":6414,"discounted_cash":1898.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5195.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4489.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1218.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":962.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC INJ W/FL EVAL CV ACCESS","code_information":[{"code":"36598","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1127.52,"maximum":1127.52,"gross_charge":1392,"discounted_cash":412.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1127.52,"methodology":"fee schedule"}]}]},{"description":"HC INJ W/FL EVAL CV ACCESS","code_information":[{"code":"36598","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1392,"discounted_cash":412.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":204.22,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":322.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":974.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":201.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":194.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":197.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":207.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":199.67,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL PUNCTURE BLD DX","code_information":[{"code":"36600","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":378.27,"maximum":378.27,"gross_charge":467,"discounted_cash":138.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":378.27,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL PUNCTURE BLD DX","code_information":[{"code":"36600","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":467,"discounted_cash":138.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL CATH SAMP/MNTR","code_information":[{"code":"36620","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2459.16,"maximum":2459.16,"gross_charge":3036,"discounted_cash":898.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2459.16,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL CATH SAMP/MNTR","code_information":[{"code":"36620","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6047,"gross_charge":3036,"discounted_cash":898.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2125.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.2,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL CATH INSERT CUTDOWN","code_information":[{"code":"36625","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2238.03,"maximum":2238.03,"gross_charge":2763,"discounted_cash":817.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2238.03,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL CATH INSERT CUTDOWN","code_information":[{"code":"36625","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2763,"discounted_cash":817.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2238.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1934.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.6,"methodology":"fee schedule"}]}]},{"description":"INSERTION CATHETER ARTERY","code_information":[{"code":"36640","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERTION CATHETER ARTERY","code_information":[{"code":"36660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INTRAOSSEOUS INFUSION","code_information":[{"code":"36680","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1168.83,"maximum":1168.83,"gross_charge":1443,"discounted_cash":427.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1168.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1168.83,"methodology":"fee schedule"}]}]},{"description":"HC INTRAOSSEOUS INFUSION","code_information":[{"code":"36680","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1443,"discounted_cash":427.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1168.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1168.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1010.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITH MCC","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":8423,"maximum":24906.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15012,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14192,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9386,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20942,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19635,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23660.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18961,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22606,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17442,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24906.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24801,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15399,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8423,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13836.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14805.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14251.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14528.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14666.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14528.56,"methodology":"case rate"}]}]},{"description":"INSERTION OF CANNULA","code_information":[{"code":"36800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"INSERTION OF CANNULA","code_information":[{"code":"36810","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERTION OF CANNULA","code_information":[{"code":"36815","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC AV FISTULA OPEN TRANSCEPHALIC","code_information":[{"code":"36818","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5557.41,"maximum":5557.41,"gross_charge":6861,"discounted_cash":2030.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5557.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5557.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5557.41,"methodology":"fee schedule"}]}]},{"description":"HC AV FISTULA OPEN TRANSCEPHALIC","code_information":[{"code":"36818","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":6861,"discounted_cash":2030.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5557.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5557.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5557.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1303.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1372.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC AV ANASTOMOSISOPEN; VEIN TRAN","code_information":[{"code":"36819","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6327.72,"maximum":6327.72,"gross_charge":7812,"discounted_cash":2312.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6327.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6327.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6327.72,"methodology":"fee schedule"}]}]},{"description":"HC AV ANASTOMOSISOPEN; VEIN TRAN","code_information":[{"code":"36819","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":7812,"discounted_cash":2312.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6327.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6327.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6327.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1484.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1562.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1171.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1562.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"AV FUSION/FOREARM VEIN","code_information":[{"code":"36820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC AV ANAST.OPEN;DIRECT ANY SITE","code_information":[{"code":"36821","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7816.5,"maximum":7816.5,"gross_charge":9650,"discounted_cash":2856.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7816.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7816.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7816.5,"methodology":"fee schedule"}]}]},{"description":"HC AV ANAST.OPEN;DIRECT ANY SITE","code_information":[{"code":"36821","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7816.5,"gross_charge":9650,"discounted_cash":2856.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7816.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7816.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7816.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1833.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1930,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1447.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1930,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERTION OF CANNULA(S)","code_information":[{"code":"36823","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ARTERY-VEIN AUTOGRAFT","code_information":[{"code":"36825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC CREAT AV FIST W/NON-AUTO.GRAF","code_information":[{"code":"36830","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9830.16,"maximum":9830.16,"gross_charge":12136,"discounted_cash":3592.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9830.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9830.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9830.16,"methodology":"fee schedule"}]}]},{"description":"HC CREAT AV FIST W/NON-AUTO.GRAF","code_information":[{"code":"36830","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":12136,"discounted_cash":3592.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9830.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9830.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9830.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2305.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1820.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC OPEN THROMBECTOMY AV FISTULA","code_information":[{"code":"36831","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6523.74,"maximum":6523.74,"gross_charge":8054,"discounted_cash":2383.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6523.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6523.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6523.74,"methodology":"fee schedule"}]}]},{"description":"HC OPEN THROMBECTOMY AV FISTULA","code_information":[{"code":"36831","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":8054,"discounted_cash":2383.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6523.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6523.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6523.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1530.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1610.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1610.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC OPEN REVISION FISTULA","code_information":[{"code":"36832","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7242.21,"maximum":7242.21,"gross_charge":8941,"discounted_cash":2646.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7242.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7242.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7242.21,"methodology":"fee schedule"}]}]},{"description":"HC OPEN REVISION FISTULA","code_information":[{"code":"36832","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":8941,"discounted_cash":2646.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7242.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7242.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7242.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1698.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1788.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1788.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC REVIS AV FISTULA W/THROMBECTOM","code_information":[{"code":"36833","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7835.94,"maximum":7835.94,"gross_charge":9674,"discounted_cash":2863.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7835.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7835.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7835.94,"methodology":"fee schedule"}]}]},{"description":"HC REVIS AV FISTULA W/THROMBECTOM","code_information":[{"code":"36833","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"gross_charge":9674,"discounted_cash":2863.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7835.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7835.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7835.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1838.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1934.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1451.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1934.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"ARTERY TO VEIN SHUNT","code_information":[{"code":"36835","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"DIST REVAS LIGATION HEMO","code_information":[{"code":"36838","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"EXTERNAL CANNULA DECLOTTING","code_information":[{"code":"36860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3400.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"CANNULA DECLOTTING","code_information":[{"code":"36861","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITH CC","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"minimum":5615,"maximum":17362.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9147,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8648,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5615,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12233,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11469,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16494.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11048,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13172,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10434,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17362.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15112,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9383,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9383,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6853,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9645.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10320.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9935.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10127.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10224.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10127.97,"methodology":"case rate"}]}]},{"description":"AV-FISTULAGRAM","code_information":[{"code":"36901","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1675.08,"maximum":1675.08,"gross_charge":2068,"discounted_cash":612.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.08,"methodology":"fee schedule"}]}]},{"description":"AV-FISTULAGRAM","code_information":[{"code":"36901","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3400.99,"gross_charge":2068,"discounted_cash":612.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC INTRO CATH DIALY CIRC/AV SHUNT","code_information":[{"code":"36901","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1675.08,"maximum":1675.08,"gross_charge":2068,"discounted_cash":612.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.08,"methodology":"fee schedule"}]}]},{"description":"HC INTRO CATH DIALY CIRC/AV SHUNT","code_information":[{"code":"36901","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3400.99,"gross_charge":2068,"discounted_cash":612.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"AV-FISTGRAM W/PTA PERIPH DYLS","code_information":[{"code":"36902","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11959.65,"maximum":11959.65,"gross_charge":14765,"discounted_cash":4370.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"}]}]},{"description":"AV-FISTGRAM W/PTA PERIPH DYLS","code_information":[{"code":"36902","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12482.48,"gross_charge":14765,"discounted_cash":4370.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2214.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC AV SHUNT & BALLN ANGIOPLASTY","code_information":[{"code":"36902","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11959.65,"maximum":11959.65,"gross_charge":14765,"discounted_cash":4370.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"}]}]},{"description":"HC AV SHUNT & BALLN ANGIOPLASTY","code_information":[{"code":"36902","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12482.48,"gross_charge":14765,"discounted_cash":4370.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2214.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"AV-FISTGRAM W/STNT PERIPH DYLS","code_information":[{"code":"36903","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":24158.25,"maximum":24158.25,"gross_charge":29825,"discounted_cash":8828.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"}]}]},{"description":"AV-FISTGRAM W/STNT PERIPH DYLS","code_information":[{"code":"36903","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":29825,"discounted_cash":8828.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4473.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC AV SHUNT & STNT PLMT PERIPH","code_information":[{"code":"36903","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":24158.25,"maximum":24158.25,"gross_charge":29825,"discounted_cash":8828.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"}]}]},{"description":"HC AV SHUNT & STNT PLMT PERIPH","code_information":[{"code":"36903","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":29825,"discounted_cash":8828.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4473.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"AV-THROMBECT/OR THROMBOLYSIS","code_information":[{"code":"36904","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":20929.59,"maximum":20929.59,"gross_charge":25839,"discounted_cash":7648.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20929.59,"methodology":"fee schedule"}]}]},{"description":"AV-THROMBECT/OR THROMBOLYSIS","code_information":[{"code":"36904","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":20929.59,"gross_charge":25839,"discounted_cash":7648.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4909.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5167.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3875.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5167.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC MECH THMB OR LYSIS ANY METH DIAL CIRC","code_information":[{"code":"36904","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":20929.59,"maximum":20929.59,"gross_charge":25839,"discounted_cash":7648.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20929.59,"methodology":"fee schedule"}]}]},{"description":"HC MECH THMB OR LYSIS ANY METH DIAL CIRC","code_information":[{"code":"36904","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":20929.59,"gross_charge":25839,"discounted_cash":7648.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20929.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4909.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5167.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3875.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5167.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"AV-THROMBECT W/PTA PERIPH DYLS","code_information":[{"code":"36905","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":24158.25,"maximum":24158.25,"gross_charge":29825,"discounted_cash":8828.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"}]}]},{"description":"AV-THROMBECT W/PTA PERIPH DYLS","code_information":[{"code":"36905","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":29825,"discounted_cash":8828.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4473.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC THOMBEC/LYSIS & ANGIOPLASTY PERIP","code_information":[{"code":"36905","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":24158.25,"maximum":24158.25,"gross_charge":29825,"discounted_cash":8828.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"}]}]},{"description":"HC THOMBEC/LYSIS & ANGIOPLASTY PERIP","code_information":[{"code":"36905","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":29825,"discounted_cash":8828.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24158.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5666.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4473.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5965,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"AV-THROMBECT W/STNT PERIPH DYL","code_information":[{"code":"36906","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":67332.06,"maximum":67332.06,"gross_charge":83126,"discounted_cash":24605.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67332.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67332.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67332.06,"methodology":"fee schedule"}]}]},{"description":"AV-THROMBECT W/STNT PERIPH DYL","code_information":[{"code":"36906","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":67332.06,"gross_charge":83126,"discounted_cash":24605.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67332.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67332.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67332.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15793.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16625.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12468.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16625.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"AV-ADDL PTA CENTRAL DYLS","code_information":[{"code":"36907","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4292.19,"maximum":4292.19,"gross_charge":5299,"discounted_cash":1568.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4292.19,"methodology":"fee schedule"}]}]},{"description":"AV-ADDL PTA CENTRAL DYLS","code_information":[{"code":"36907","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4292.19,"gross_charge":5299,"discounted_cash":1568.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.8,"methodology":"fee schedule"}]}]},{"description":"HC ADD ON ANGIOPLASTY CNT DIALY CIRCUIT","code_information":[{"code":"36907","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4292.19,"maximum":4292.19,"gross_charge":5299,"discounted_cash":1568.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4292.19,"methodology":"fee schedule"}]}]},{"description":"HC ADD ON ANGIOPLASTY CNT DIALY CIRCUIT","code_information":[{"code":"36907","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4292.19,"gross_charge":5299,"discounted_cash":1568.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4292.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2543.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2967.44,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.8,"methodology":"fee schedule"}]}]},{"description":"AV-ADDL STNT CENTRAL DYLS","code_information":[{"code":"36908","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8677.53,"maximum":8677.53,"gross_charge":10713,"discounted_cash":3171.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8677.53,"methodology":"fee schedule"}]}]},{"description":"AV-ADDL STNT CENTRAL DYLS","code_information":[{"code":"36908","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8677.53,"gross_charge":10713,"discounted_cash":3171.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2035.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1606.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.6,"methodology":"fee schedule"}]}]},{"description":"HC ADD ON STENT IN CENTRAL DIALYSIS SEG","code_information":[{"code":"36908","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8677.53,"maximum":8677.53,"gross_charge":10713,"discounted_cash":3171.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8677.53,"methodology":"fee schedule"}]}]},{"description":"HC ADD ON STENT IN CENTRAL DIALYSIS SEG","code_information":[{"code":"36908","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8677.53,"gross_charge":10713,"discounted_cash":3171.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8677.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5142.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5999.28,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2035.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1606.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2142.6,"methodology":"fee schedule"}]}]},{"description":"AV-EMBOL MAIN CIRCU OR ACCESRY","code_information":[{"code":"36909","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11122.11,"maximum":11122.11,"gross_charge":13731,"discounted_cash":4064.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11122.11,"methodology":"fee schedule"}]}]},{"description":"AV-EMBOL MAIN CIRCU OR ACCESRY","code_information":[{"code":"36909","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11122.11,"gross_charge":13731,"discounted_cash":4064.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2608.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2746.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2746.2,"methodology":"fee schedule"}]}]},{"description":"HC ADD ON EMBOLIZATION IN DIALYSIS CIRC","code_information":[{"code":"36909","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11122.11,"maximum":11122.11,"gross_charge":13731,"discounted_cash":4064.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11122.11,"methodology":"fee schedule"}]}]},{"description":"HC ADD ON EMBOLIZATION IN DIALYSIS CIRC","code_information":[{"code":"36909","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11122.11,"gross_charge":13731,"discounted_cash":4064.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11122.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6590.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7689.36,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2608.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2746.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2059.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2746.2,"methodology":"fee schedule"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"minimum":3457,"maximum":13666.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6274,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5932,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4225,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8140,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7632,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12983.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8093,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9648,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7852,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13666.59,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10366,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6436,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3457,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7592.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8124.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7820.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7972.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8048.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7972.18,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":9929,"maximum":25960,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15713,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14854,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9929,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24645,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23106,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24517.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18287,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21802,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18452,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25808.04,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25960,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16118,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16118,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10199,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14337.8,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15341.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14767.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15054.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15198.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15054.69,"methodology":"case rate"}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF CIRCULATION","code_information":[{"code":"37180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPLICE SPLEEN/KIDNEY VEINS","code_information":[{"code":"37181","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INSERT TIPS","code_information":[{"code":"37182","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8848.44,"maximum":8848.44,"gross_charge":10924,"discounted_cash":3233.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8848.44,"methodology":"fee schedule"}]}]},{"description":"HC INSERT TIPS","code_information":[{"code":"37182","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"gross_charge":10924,"discounted_cash":3233.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7646.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2075.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2184.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1638.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2184.8,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE HEPATIC SHUNT (TIPS)","code_information":[{"code":"37183","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":8848.44,"maximum":8848.44,"gross_charge":10924,"discounted_cash":3233.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8848.44,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE HEPATIC SHUNT (TIPS)","code_information":[{"code":"37183","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12482.48,"gross_charge":10924,"discounted_cash":3233.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8848.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7646.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2075.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2184.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1638.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2184.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC THROMBECTOMY PRIM MECH","code_information":[{"code":"37184","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8540.64,"maximum":8540.64,"gross_charge":10544,"discounted_cash":3121.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8540.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8540.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8540.64,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY PRIM MECH","code_information":[{"code":"37184","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":10544,"discounted_cash":3121.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8540.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8540.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8540.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7380.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2003.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2108.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2108.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC THROMBECTOMY PRM MCH ADD","code_information":[{"code":"37185","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4697.19,"maximum":4697.19,"gross_charge":5799,"discounted_cash":1716.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4697.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4697.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4697.19,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY PRM MCH ADD","code_information":[{"code":"37185","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":5799,"discounted_cash":1716.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4697.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4697.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4697.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4059.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1101.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1159.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1159.8,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY SECNDRY MCH","code_information":[{"code":"37186","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2617.92,"maximum":2617.92,"gross_charge":3232,"discounted_cash":956.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2617.92,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY SECNDRY MCH","code_information":[{"code":"37186","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":3232,"discounted_cash":956.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2262.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.4,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY VEN MECH","code_information":[{"code":"37187","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":12310.38,"maximum":12310.38,"gross_charge":15198,"discounted_cash":4498.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12310.38,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY VEN MECH","code_information":[{"code":"37187","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":15198,"discounted_cash":4498.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10638.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2887.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3039.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2279.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3039.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"VENOUS THROMBECTOMY-MECHANICAL","code_information":[{"code":"37187","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11203.11,"maximum":11203.11,"gross_charge":13831,"discounted_cash":4093.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11203.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11203.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11203.11,"methodology":"fee schedule"}]}]},{"description":"VENOUS THROMBECTOMY-MECHANICAL","code_information":[{"code":"37187","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":13831,"discounted_cash":4093.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11203.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11203.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11203.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9681.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2627.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2766.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2074.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2766.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"VENOUS THROMBECTOMY-MECHANICAL","code_information":[{"code":"37187","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":12310.38,"maximum":12310.38,"gross_charge":15198,"discounted_cash":4498.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12310.38,"methodology":"fee schedule"}]}]},{"description":"VENOUS THROMBECTOMY-MECHANICAL","code_information":[{"code":"37187","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":15198,"discounted_cash":4498.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12310.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10638.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2887.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3039.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2279.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3039.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC THROMBECTOMY VEN MCH ADD","code_information":[{"code":"37188","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":12679.74,"maximum":12679.74,"gross_charge":15654,"discounted_cash":4633.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12679.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12679.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12679.74,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMY VEN MCH ADD","code_information":[{"code":"37188","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12679.74,"gross_charge":15654,"discounted_cash":4633.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12679.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12679.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12679.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10957.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2974.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3130.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2348.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3130.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC INSERT ENDOVAS IVC FILTER","code_information":[{"code":"37191","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":4573.26,"maximum":4573.26,"gross_charge":5646,"discounted_cash":1671.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4573.26,"methodology":"fee schedule"}]}]},{"description":"HC INSERT ENDOVAS IVC FILTER","code_information":[{"code":"37191","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":5646,"discounted_cash":1671.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"IVC FILTER W/S&I","code_information":[{"code":"37191","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4573.26,"maximum":4573.26,"gross_charge":5646,"discounted_cash":1671.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4573.26,"methodology":"fee schedule"}]}]},{"description":"IVC FILTER W/S&I","code_information":[{"code":"37191","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":5646,"discounted_cash":1671.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4573.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1072.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC REPOSI ENDOVAS IVC FILTER","code_information":[{"code":"37192","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3521.07,"maximum":3521.07,"gross_charge":4347,"discounted_cash":1286.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3521.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3521.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3521.07,"methodology":"fee schedule"}]}]},{"description":"HC REPOSI ENDOVAS IVC FILTER","code_information":[{"code":"37192","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4347,"discounted_cash":1286.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3521.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3521.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3521.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3042.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC REMOVE ENDOVAS IVC FILTER","code_information":[{"code":"37193","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3567.24,"maximum":3567.24,"gross_charge":4404,"discounted_cash":1303.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3567.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3567.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3567.24,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE ENDOVAS IVC FILTER","code_information":[{"code":"37193","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4404,"discounted_cash":1303.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3567.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3567.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3567.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3082.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC THROMBOLYSIS CEREBRAL IV INF","code_information":[{"code":"37195","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":984.15,"maximum":984.15,"gross_charge":1215,"discounted_cash":359.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.15,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOLYSIS CEREBRAL IV INF","code_information":[{"code":"37195","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1215,"discounted_cash":359.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":322.68,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":850.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"THROMBOLYSIS","code_information":[{"code":"37195","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":984.96,"maximum":984.96,"gross_charge":1216,"discounted_cash":359.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.96,"methodology":"fee schedule"}]}]},{"description":"THROMBOLYSIS","code_information":[{"code":"37195","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1216,"discounted_cash":359.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":322.68,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":851.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC REMOVE INTRVAS FOREIGN BODY","code_information":[{"code":"37197","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8825.76,"maximum":8825.76,"gross_charge":10896,"discounted_cash":3225.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8825.76,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE INTRVAS FOREIGN BODY","code_information":[{"code":"37197","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8825.76,"gross_charge":10896,"discounted_cash":3225.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7627.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2070.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1634.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"TRANSCATH RETRIEVAL;PERC FB","code_information":[{"code":"37197","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8825.76,"maximum":8825.76,"gross_charge":10896,"discounted_cash":3225.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8825.76,"methodology":"fee schedule"}]}]},{"description":"TRANSCATH RETRIEVAL;PERC FB","code_information":[{"code":"37197","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8825.76,"gross_charge":10896,"discounted_cash":3225.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8825.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7627.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2070.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1634.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2179.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":5922,"maximum":17497.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8747,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15489,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14522,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16622.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11004,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13119,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11005,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17497.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15286,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9491,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9491,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5981,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9720.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10401.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10012.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10206.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10304.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10206.89,"methodology":"case rate"}]}]},{"description":"HC TRANSCATHETER BIOPSY","code_information":[{"code":"37200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2349,"maximum":2349,"gross_charge":2900,"discounted_cash":858.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2349,"methodology":"fee schedule"}]}]},{"description":"HC TRANSCATHETER BIOPSY","code_information":[{"code":"37200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":2900,"discounted_cash":858.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2030,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":551,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":580,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":580,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC THROMBOLYTIC ART THERAPY","code_information":[{"code":"37211","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3763.26,"maximum":3763.26,"gross_charge":4646,"discounted_cash":1375.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOLYTIC ART THERAPY","code_information":[{"code":"37211","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"gross_charge":4646,"discounted_cash":1375.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3252.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC THROMBOLYTIC VENOUS THRPY","code_information":[{"code":"37212","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3763.26,"maximum":3763.26,"gross_charge":4646,"discounted_cash":1375.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"}]}]},{"description":"HC THROMBOLYTIC VENOUS THRPY","code_information":[{"code":"37212","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4646,"discounted_cash":1375.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3252.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC THROMBLYTIC ART/VEN THERAPY","code_information":[{"code":"37213","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3763.26,"maximum":3763.26,"gross_charge":4646,"discounted_cash":1375.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"}]}]},{"description":"HC THROMBLYTIC ART/VEN THERAPY","code_information":[{"code":"37213","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4646,"discounted_cash":1375.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3252.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC CESSJ THERAPY CATH REMOVAL","code_information":[{"code":"37214","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3763.26,"maximum":3763.26,"gross_charge":4646,"discounted_cash":1375.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"}]}]},{"description":"HC CESSJ THERAPY CATH REMOVAL","code_information":[{"code":"37214","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":4646,"discounted_cash":1375.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3763.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3252.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":882.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":929.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"CERVICAL CAROTID STENT","code_information":[{"code":"37215","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3801.33,"maximum":3801.33,"gross_charge":4693,"discounted_cash":1389.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3801.33,"methodology":"fee schedule"}]}]},{"description":"CERVICAL CAROTID STENT","code_information":[{"code":"37215","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3801.33,"gross_charge":4693,"discounted_cash":1389.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3285.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"}]}]},{"description":"HC PLCMT CCA STENT W EMBOL","code_information":[{"code":"37215","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3801.33,"maximum":3801.33,"gross_charge":4693,"discounted_cash":1389.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3801.33,"methodology":"fee schedule"}]}]},{"description":"HC PLCMT CCA STENT W EMBOL","code_information":[{"code":"37215","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3801.33,"gross_charge":4693,"discounted_cash":1389.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3285.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"}]}]},{"description":"CCA STENT W/O EPS","code_information":[{"code":"37216","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3801.33,"maximum":3801.33,"gross_charge":4693,"discounted_cash":1389.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3801.33,"methodology":"fee schedule"}]}]},{"description":"CCA STENT W/O EPS","code_information":[{"code":"37216","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3801.33,"gross_charge":4693,"discounted_cash":1389.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3801.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3285.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.6,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CAROTID STENT OPEN","code_information":[{"code":"37217","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3975.48,"maximum":3975.48,"gross_charge":4908,"discounted_cash":1452.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3975.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3975.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3975.48,"methodology":"fee schedule"}]}]},{"description":"HC PLACE CAROTID STENT OPEN","code_information":[{"code":"37217","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3975.48,"gross_charge":4908,"discounted_cash":1452.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3975.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3975.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3975.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3435.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.6,"methodology":"fee schedule"}]}]},{"description":"STENT PLACEMT ANTE CAROTID","code_information":[{"code":"37218","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REVASC ILIAC INITIAL VESSEL","code_information":[{"code":"37220","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":15298.47,"maximum":15298.47,"gross_charge":18887,"discounted_cash":5590.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15298.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15298.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15298.47,"methodology":"fee schedule"}]}]},{"description":"HC REVASC ILIAC INITIAL VESSEL","code_information":[{"code":"37220","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15298.47,"gross_charge":18887,"discounted_cash":5590.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15298.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15298.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15298.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13220.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3588.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3777.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2833.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3777.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC REVASC ILLIAC ART W/PTABIL","code_information":[{"code":"37220","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":23103.63,"maximum":23103.63,"gross_charge":28523,"discounted_cash":8442.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23103.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23103.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23103.63,"methodology":"fee schedule"}]}]},{"description":"HC REVASC ILLIAC ART W/PTABIL","code_information":[{"code":"37220","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":23103.63,"gross_charge":28523,"discounted_cash":8442.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23103.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23103.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23103.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19966.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5419.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5704.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4278.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5704.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC REVASC ILIAC W/STENT","code_information":[{"code":"37221","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":31221.45,"maximum":31221.45,"gross_charge":38545,"discounted_cash":11409.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31221.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31221.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31221.45,"methodology":"fee schedule"}]}]},{"description":"HC REVASC ILIAC W/STENT","code_information":[{"code":"37221","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":31221.45,"gross_charge":38545,"discounted_cash":11409.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31221.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31221.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31221.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26981.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7323.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7709,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5781.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7709,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC STENT ILIAC W/PTA BIL","code_information":[{"code":"37221","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":46832.58,"maximum":46832.58,"gross_charge":57818,"discounted_cash":17114.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46832.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46832.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46832.58,"methodology":"fee schedule"}]}]},{"description":"HC STENT ILIAC W/PTA BIL","code_information":[{"code":"37221","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":46832.58,"gross_charge":57818,"discounted_cash":17114.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46832.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46832.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46832.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40472.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10985.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11563.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8672.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11563.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC REVASC ILIAC ADDL VESSEL","code_information":[{"code":"37222","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":13113.09,"maximum":13113.09,"gross_charge":16189,"discounted_cash":4791.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13113.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13113.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13113.09,"methodology":"fee schedule"}]}]},{"description":"HC REVASC ILIAC ADDL VESSEL","code_information":[{"code":"37222","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13113.09,"gross_charge":16189,"discounted_cash":4791.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13113.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13113.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13113.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11332.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3237.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2428.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3237.8,"methodology":"fee schedule"}]}]},{"description":"HC REVASC ILIAC W/STENT ADD","code_information":[{"code":"37223","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":12488.58,"maximum":12488.58,"gross_charge":15418,"discounted_cash":4563.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12488.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12488.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12488.58,"methodology":"fee schedule"}]}]},{"description":"HC REVASC ILIAC W/STENT ADD","code_information":[{"code":"37223","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12488.58,"gross_charge":15418,"discounted_cash":4563.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12488.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12488.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12488.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10792.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2929.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3083.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2312.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3083.6,"methodology":"fee schedule"}]}]},{"description":"HC REVASC FEMPOP W/TLA","code_information":[{"code":"37224","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":10002.69,"maximum":10002.69,"gross_charge":12349,"discounted_cash":3655.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10002.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10002.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10002.69,"methodology":"fee schedule"}]}]},{"description":"HC REVASC FEMPOP W/TLA","code_information":[{"code":"37224","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12482.48,"gross_charge":12349,"discounted_cash":3655.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10002.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10002.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10002.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8644.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2346.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2469.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1852.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2469.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC REVASC FEMPOP W/ATHER","code_information":[{"code":"37225","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":21281.94,"maximum":21281.94,"gross_charge":26274,"discounted_cash":7777.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21281.94,"methodology":"fee schedule"}]}]},{"description":"HC REVASC FEMPOP W/ATHER","code_information":[{"code":"37225","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":26274,"discounted_cash":7777.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18391.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4992.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5254.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3941.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5254.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC REVASC FEMPOP W/STENT","code_information":[{"code":"37226","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":21281.94,"maximum":21281.94,"gross_charge":26274,"discounted_cash":7777.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21281.94,"methodology":"fee schedule"}]}]},{"description":"HC REVASC FEMPOP W/STENT","code_information":[{"code":"37226","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":26274,"discounted_cash":7777.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21281.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18391.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4992.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5254.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3941.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5254.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC REVASC FEMPOP STNT/ATHER","code_information":[{"code":"37227","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":43627.41,"maximum":43627.41,"gross_charge":53861,"discounted_cash":15942.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43627.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43627.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43627.41,"methodology":"fee schedule"}]}]},{"description":"HC REVASC FEMPOP STNT/ATHER","code_information":[{"code":"37227","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":43627.41,"gross_charge":53861,"discounted_cash":15942.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43627.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43627.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43627.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37702.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10233.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8079.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10772.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC REVASC TIB/PER W/TLA","code_information":[{"code":"37228","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":13164.93,"maximum":13164.93,"gross_charge":16253,"discounted_cash":4810.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13164.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13164.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13164.93,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIB/PER W/TLA","code_information":[{"code":"37228","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":16253,"discounted_cash":4810.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13164.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13164.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13164.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11377.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3088.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3250.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2437.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3250.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC REVASC TIB/PER W/ATHER","code_information":[{"code":"37229","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":15007.68,"maximum":15007.68,"gross_charge":18528,"discounted_cash":5484.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15007.68,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIB/PER W/ATHER","code_information":[{"code":"37229","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":18528,"discounted_cash":5484.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12969.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3705.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2779.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3705.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC REVASC TIB/PER W/STENT","code_information":[{"code":"37230","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":15007.68,"maximum":15007.68,"gross_charge":18528,"discounted_cash":5484.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15007.68,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIB/PER W/STENT","code_information":[{"code":"37230","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":18528,"discounted_cash":5484.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15007.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12969.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3705.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2779.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3705.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC REVASC TIB/PERSTNT/ATHR","code_information":[{"code":"37231","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":54240.03,"maximum":54240.03,"gross_charge":66963,"discounted_cash":19821.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54240.03,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIB/PERSTNT/ATHR","code_information":[{"code":"37231","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":54240.03,"gross_charge":66963,"discounted_cash":19821.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46874.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12722.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13392.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10044.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13392.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"TIBIAL/PERONEALW/ATHER/STNT","code_information":[{"code":"37231","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":54240.03,"maximum":54240.03,"gross_charge":66963,"discounted_cash":19821.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54240.03,"methodology":"fee schedule"}]}]},{"description":"TIBIAL/PERONEALW/ATHER/STNT","code_information":[{"code":"37231","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":54240.03,"gross_charge":66963,"discounted_cash":19821.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54240.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46874.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12722.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13392.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10044.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13392.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC REVASC TIB/PER ADD-ON","code_information":[{"code":"37232","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":7109.37,"maximum":7109.37,"gross_charge":8777,"discounted_cash":2598,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7109.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7109.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7109.37,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIB/PER ADD-ON","code_information":[{"code":"37232","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7109.37,"gross_charge":8777,"discounted_cash":2598,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7109.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7109.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7109.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6143.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1667.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1316.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1755.4,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIBPER W/ATR ADD","code_information":[{"code":"37233","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":21590.55,"maximum":21590.55,"gross_charge":26655,"discounted_cash":7889.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21590.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21590.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21590.55,"methodology":"fee schedule"}]}]},{"description":"HC REVASC TIBPER W/ATR ADD","code_information":[{"code":"37233","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":21590.55,"gross_charge":26655,"discounted_cash":7889.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21590.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21590.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21590.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18658.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5064.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5331,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3998.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5331,"methodology":"fee schedule"}]}]},{"description":"REVSC OPN/PRQ TIB/PERO STENT","code_information":[{"code":"37234","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TIB/PER REVASC STNT  ATHER","code_information":[{"code":"37235","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OPEN/PERQ PLCMT STENT 1ST","code_information":[{"code":"37236","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":12623.85,"maximum":12623.85,"gross_charge":15585,"discounted_cash":4613.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12623.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12623.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12623.85,"methodology":"fee schedule"}]}]},{"description":"HC OPEN/PERQ PLCMT STENT 1ST","code_information":[{"code":"37236","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":15585,"discounted_cash":4613.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12623.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12623.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12623.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10909.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2961.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3117,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2337.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3117,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC OPEN/PERQ PLCMT STENT EA ADD","code_information":[{"code":"37237","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2146.5,"maximum":2146.5,"gross_charge":2650,"discounted_cash":784.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2146.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2146.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2146.5,"methodology":"fee schedule"}]}]},{"description":"HC OPEN/PERQ PLCMT STENT EA ADD","code_information":[{"code":"37237","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"gross_charge":2650,"discounted_cash":784.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2146.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2146.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2146.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1272,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1484,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1855,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":530,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":530,"methodology":"fee schedule"}]}]},{"description":"HC OPEN/PERQ PLC STENT 1ST VN","code_information":[{"code":"37238","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33635.25,"maximum":33635.25,"gross_charge":41525,"discounted_cash":12291.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33635.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33635.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33635.25,"methodology":"fee schedule"}]}]},{"description":"HC OPEN/PERQ PLC STENT 1ST VN","code_information":[{"code":"37238","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":33635.25,"gross_charge":41525,"discounted_cash":12291.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33635.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33635.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33635.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29067.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7889.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8305,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6228.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8305,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC OPEN/PERQ PLC STENT EA ADD VN","code_information":[{"code":"37239","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2018.52,"maximum":2018.52,"gross_charge":2492,"discounted_cash":737.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2018.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2018.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2018.52,"methodology":"fee schedule"}]}]},{"description":"HC OPEN/PERQ PLC STENT EA ADD VN","code_information":[{"code":"37239","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"gross_charge":2492,"discounted_cash":737.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2018.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2018.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2018.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1196.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1395.52,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1744.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.4,"methodology":"fee schedule"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VEIN","code_information":[{"code":"37241","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":30251.88,"maximum":30251.88,"gross_charge":37348,"discounted_cash":11055.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30251.88,"methodology":"fee schedule"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VEIN","code_information":[{"code":"37241","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":30251.88,"gross_charge":37348,"discounted_cash":11055.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26143.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7096.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7469.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5602.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7469.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"37241","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11664,"maximum":11664,"gross_charge":14400,"discounted_cash":4262.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11664,"methodology":"fee schedule"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE VENOUS","code_information":[{"code":"37241","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":14400,"discounted_cash":4262.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10080,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2736,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2160,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ART","code_information":[{"code":"37242","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11324.61,"maximum":11324.61,"gross_charge":13981,"discounted_cash":4138.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11324.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11324.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11324.61,"methodology":"fee schedule"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ART","code_information":[{"code":"37242","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":13981,"discounted_cash":4138.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11324.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11324.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11324.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9786.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2656.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2796.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2097.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2796.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC ENDO REPR VIS AORTA W/GRAFT","code_information":[{"code":"37243","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11664,"maximum":11664,"gross_charge":14400,"discounted_cash":4262.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11664,"methodology":"fee schedule"}]}]},{"description":"HC ENDO REPR VIS AORTA W/GRAFT","code_information":[{"code":"37243","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":14400,"discounted_cash":4262.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10080,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2736,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2160,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"37243","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11664,"maximum":11664,"gross_charge":14400,"discounted_cash":4262.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11664,"methodology":"fee schedule"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE ORGAN","code_information":[{"code":"37243","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":14400,"discounted_cash":4262.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11664,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10080,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2736,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2160,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"37244","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30839.13,"maximum":30839.13,"gross_charge":38073,"discounted_cash":11269.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30839.13,"methodology":"fee schedule"}]}]},{"description":"HC VASC EMBOLIZE/OCCLUDE BLEED","code_information":[{"code":"37244","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":30839.13,"gross_charge":38073,"discounted_cash":11269.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26651.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7233.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7614.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5710.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7614.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"VASC EMBOLIZE/ARTERIAL BLEED","code_information":[{"code":"37244","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":30839.13,"maximum":30839.13,"gross_charge":38073,"discounted_cash":11269.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30839.13,"methodology":"fee schedule"}]}]},{"description":"VASC EMBOLIZE/ARTERIAL BLEED","code_information":[{"code":"37244","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":30839.13,"gross_charge":38073,"discounted_cash":11269.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30839.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26651.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7233.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7614.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5710.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7614.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC PTA ARTERIAL INIT ARTERY","code_information":[{"code":"37246","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11959.65,"maximum":11959.65,"gross_charge":14765,"discounted_cash":4370.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"}]}]},{"description":"HC PTA ARTERIAL INIT ARTERY","code_information":[{"code":"37246","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12482.48,"gross_charge":14765,"discounted_cash":4370.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2214.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC PTA ARTERIAL EA ADDL ARTERY","code_information":[{"code":"37247","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5980.23,"maximum":5980.23,"gross_charge":7383,"discounted_cash":2185.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5980.23,"methodology":"fee schedule"}]}]},{"description":"HC PTA ARTERIAL EA ADDL ARTERY","code_information":[{"code":"37247","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":7383,"discounted_cash":2185.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.6,"methodology":"fee schedule"}]}]},{"description":"HC PTA VENOUS INIT VEIN","code_information":[{"code":"37248","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11959.65,"maximum":11959.65,"gross_charge":14765,"discounted_cash":4370.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"}]}]},{"description":"HC PTA VENOUS INIT VEIN","code_information":[{"code":"37248","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12482.48,"gross_charge":14765,"discounted_cash":4370.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11959.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2214.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2953,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC PTA VENOUS EA ADDL VEIN","code_information":[{"code":"37249","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5980.23,"maximum":5980.23,"gross_charge":7383,"discounted_cash":2185.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5980.23,"methodology":"fee schedule"}]}]},{"description":"HC PTA VENOUS EA ADDL VEIN","code_information":[{"code":"37249","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":7383,"discounted_cash":2185.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5980.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1107.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRVASC US NONCORONARY 1ST","code_information":[{"code":"37252","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6535.89,"maximum":6535.89,"gross_charge":8069,"discounted_cash":2388.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6535.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6535.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6535.89,"methodology":"fee schedule"}]}]},{"description":"HC INTRVASC US NONCORONARY 1ST","code_information":[{"code":"37252","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6535.89,"gross_charge":8069,"discounted_cash":2388.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6535.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6535.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6535.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1613.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1613.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRVASC US NONCORONARY ADDL","code_information":[{"code":"37253","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3268.35,"maximum":3268.35,"gross_charge":4035,"discounted_cash":1194.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3268.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3268.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3268.35,"methodology":"fee schedule"}]}]},{"description":"HC INTRVASC US NONCORONARY ADDL","code_information":[{"code":"37253","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047,"gross_charge":4035,"discounted_cash":1194.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3268.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3268.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3268.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":807,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":807,"methodology":"fee schedule"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":4071,"maximum":13983.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6521,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6164,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4071,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12846,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12044,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13284.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7847,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9356,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7565,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13983.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10773,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6689,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6689,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4692,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7768.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8312.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8001.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8157,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8234.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8157,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY WITH MCC","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"minimum":9987,"maximum":35405,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18979,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17943,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11925,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35405,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33194,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28509.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21546,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25688,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22161,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30010.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31357,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19469,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19469,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9987,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16672.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17839.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17172.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17505.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17672.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17505.91,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY WITH CC","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":6808,"maximum":21806,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11045,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10441,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6808,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21806,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20445,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18813.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13021,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15524,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12652,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19803.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18247,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11330,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11330,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7690,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11001.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11771.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11331.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11551.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11661.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11551.88,"methodology":"case rate"}]}]},{"description":"ENDOSCOPY LIGATE PERF VEINS","code_information":[{"code":"37500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"VASCULAR ENDOSCOPY PROCEDURE","code_information":[{"code":"37501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"LIGATION OF NECK VEIN","code_information":[{"code":"37565","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"DIGESTIVE MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"minimum":4788,"maximum":20022,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7937,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7504,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5064,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20022,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18772,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15015.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9488,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11312,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9411,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15805.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13113,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8142,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8142,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4788,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8781,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9395.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9044.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9220.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9307.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9220.05,"methodology":"case rate"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC LIGATION ANGIO ACCESS","code_information":[{"code":"37607","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6636.33,"maximum":6636.33,"gross_charge":8193,"discounted_cash":2425.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6636.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6636.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6636.33,"methodology":"fee schedule"}]}]},{"description":"HC LIGATION ANGIO ACCESS","code_information":[{"code":"37607","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":8193,"discounted_cash":2425.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6636.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6636.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6636.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1556.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1638.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1638.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC LIGATIONBIOPSYTEMP ARTERY","code_information":[{"code":"37609","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3269.97,"maximum":3269.97,"gross_charge":4037,"discounted_cash":1194.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3269.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3269.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3269.97,"methodology":"fee schedule"}]}]},{"description":"HC LIGATIONBIOPSYTEMP ARTERY","code_information":[{"code":"37609","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"gross_charge":4037,"discounted_cash":1194.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3269.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3269.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3269.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":807.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"LIGATION OF NECK ARTERY","code_information":[{"code":"37615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATION OF CHEST ARTERY","code_information":[{"code":"37616","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LIGATION OF ABDOMEN ARTERY","code_information":[{"code":"37617","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LIGATION OF EXTREMITY ARTERY","code_information":[{"code":"37618","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LIGATION OF INF VENA CAVA","code_information":[{"code":"37619","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"REVISION OF MAJOR VEIN","code_information":[{"code":"37650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REVISION OF MAJOR VEIN","code_information":[{"code":"37660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITH MCC","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":9662,"maximum":27002,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16344,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15451,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10171,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19029,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17841,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25288.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19218,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22913,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18902,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26619.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27002,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16766,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16766,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9662,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14788.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15823.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15232.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15528.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15676.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15528.2,"methodology":"case rate"}]}]},{"description":"HC LIGATION & DIV LONG SAPH VEIN","code_information":[{"code":"37700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8852.49,"maximum":8852.49,"gross_charge":10929,"discounted_cash":3234.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8852.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8852.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8852.49,"methodology":"fee schedule"}]}]},{"description":"HC LIGATION & DIV LONG SAPH VEIN","code_information":[{"code":"37700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":8852.49,"gross_charge":10929,"discounted_cash":3234.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8852.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8852.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8852.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2076.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2185.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1639.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2185.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATE/STRIP SHORT LEG VEIN","code_information":[{"code":"37718","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC LIG SAPHEN VEIN/JUNC-KNEE-BELO","code_information":[{"code":"37722","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5051.97,"maximum":5051.97,"gross_charge":6237,"discounted_cash":1846.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5051.97,"methodology":"fee schedule"}]}]},{"description":"HC LIG SAPHEN VEIN/JUNC-KNEE-BELO","code_information":[{"code":"37722","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":6237,"discounted_cash":1846.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LEG VEINS/LESION","code_information":[{"code":"37735","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATE LEG VEINS RADICAL","code_information":[{"code":"37760","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATE LEG VEINS OPEN","code_information":[{"code":"37761","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC STAB PHLEBTMY VARI VEINS;1 EXT","code_information":[{"code":"37765","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4450.14,"maximum":4450.14,"gross_charge":5494,"discounted_cash":1626.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4450.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4450.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4450.14,"methodology":"fee schedule"}]}]},{"description":"HC STAB PHLEBTMY VARI VEINS;1 EXT","code_information":[{"code":"37765","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"gross_charge":5494,"discounted_cash":1626.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4450.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4450.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4450.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3845.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1043.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"PHLEB VEINS - EXTREM 20+","code_information":[{"code":"37766","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REVISION OF LEG VEIN","code_information":[{"code":"37780","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"LIGATE/DIVIDE/EXCISE VEIN","code_information":[{"code":"37785","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"REVASCULARIZATION PENIS","code_information":[{"code":"37788","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PENILE VENOUS OCCLUSION","code_information":[{"code":"37790","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC BYPASS AX-BRACHIAL W/GRAFT","code_information":[{"code":"37799","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2106.81,"maximum":2106.81,"gross_charge":2601,"discounted_cash":769.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2106.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2106.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2106.81,"methodology":"fee schedule"}]}]},{"description":"HC BYPASS AX-BRACHIAL W/GRAFT","code_information":[{"code":"37799","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2601,"discounted_cash":769.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2106.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2106.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2106.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1353.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":945.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1820.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":552.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":591.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":569.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":580.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":608.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":585.91,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITH CC","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":5589,"maximum":16995.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8862,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8378,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5589,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11431,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10717,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16145.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10647,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12694,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10387,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16995.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14642,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9091,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9091,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5861,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9442.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10102.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9725.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9914.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10008.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9914.15,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":3597,"maximum":12957.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5723,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3597,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8977,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8417,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12309.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6851,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8168,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6685,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12957.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9456,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5871,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4713,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7198.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7702.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7414.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7558.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7630.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7558.7,"methodology":"case rate"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITH MCC","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"minimum":7556,"maximum":29524,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17297,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16353,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11070,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29524,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27681,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26454.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20581,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24538,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20572,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27846.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28578,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17744,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17744,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7556,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15470.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16553.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15934.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16243.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16398.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16243.88,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3801","type":"APR-DRG"}],"standard_charges":[{"minimum":3977,"maximum":3977,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3977,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3977,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3977,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3802","type":"APR-DRG"}],"standard_charges":[{"minimum":7516,"maximum":7516,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7516,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7516,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7516,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3803","type":"APR-DRG"}],"standard_charges":[{"minimum":11604,"maximum":11604,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11604,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11604,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11604,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS","code_information":[{"code":"3804","type":"APR-DRG"}],"standard_charges":[{"minimum":16442,"maximum":16442,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16442,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16442,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16442,"methodology":"case rate"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITH CC","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"minimum":5773,"maximum":18189,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9790,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9255,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6096,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15161,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14214,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17279.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11409,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13602,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11329,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18189,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16174,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10043,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10043,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5773,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10105,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10812.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10408.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10610.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10711.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10610.25,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SPLEEN TOTAL","code_information":[{"code":"38100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF SPLEEN PARTIAL","code_information":[{"code":"38101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF SPLEEN TOTAL","code_information":[{"code":"38102","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3811","type":"APR-DRG"}],"standard_charges":[{"minimum":2880,"maximum":2880,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2880,"methodology":"case rate"}]}]},{"description":"REPAIR OF RUPTURED SPLEEN","code_information":[{"code":"38115","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3812","type":"APR-DRG"}],"standard_charges":[{"minimum":4583,"maximum":4583,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4583,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4583,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4583,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY SPLENECTOMY","code_information":[{"code":"38120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC SPLEEN","code_information":[{"code":"38129","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3813","type":"APR-DRG"}],"standard_charges":[{"minimum":9175,"maximum":9175,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9175,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9175,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9175,"methodology":"case rate"}]}]},{"description":"MAJOR SKIN DISORDERS","code_information":[{"code":"3814","type":"APR-DRG"}],"standard_charges":[{"minimum":18066,"maximum":18066,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18066,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18066,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18066,"methodology":"case rate"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITHOUT CC/MCC","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"minimum":4301,"maximum":14259.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6735,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6368,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4301,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11267,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10564,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13546.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8321,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9920,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7993,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14259.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11128,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6909,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4329,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7922.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8476.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8159.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8318.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8397.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8318.22,"methodology":"case rate"}]}]},{"description":"INJECTION FOR SPLEEN X-RAY","code_information":[{"code":"38200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BL DONOR SEARCH MANAGEMENT","code_information":[{"code":"38204","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HARVEST ALLOGENEIC STEM CELL","code_information":[{"code":"38205","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HARVEST AUTO STEM CELLS","code_information":[{"code":"38206","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3588.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"CRYOPRESERVE STEM CELLS","code_information":[{"code":"38207","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"THAW PRESERVED STEM CELLS","code_information":[{"code":"38208","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"WASH HARVEST STEM CELLS","code_information":[{"code":"38209","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3821","type":"APR-DRG"}],"standard_charges":[{"minimum":4402,"maximum":4402,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4402,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4402,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4402,"methodology":"case rate"}]}]},{"description":"T-CELL DEPLETION OF HARVEST","code_information":[{"code":"38210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"TUMOR CELL DEPLETE OF HARVST","code_information":[{"code":"38211","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"RBC DEPLETION OF HARVEST","code_information":[{"code":"38212","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"PLATELET DEPLETE OF HARVEST","code_information":[{"code":"38213","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"VOLUME DEPLETE OF HARVEST","code_information":[{"code":"38214","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"HARVEST STEM CELL CONCENTRTE","code_information":[{"code":"38215","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3822","type":"APR-DRG"}],"standard_charges":[{"minimum":5169,"maximum":5169,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5169,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5169,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5169,"methodology":"case rate"}]}]},{"description":"HC DX BONE MARROW ASPIRATION","code_information":[{"code":"38220","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1898.64,"maximum":1898.64,"gross_charge":2344,"discounted_cash":693.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1898.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1898.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1898.64,"methodology":"fee schedule"}]}]},{"description":"HC DX BONE MARROW ASPIRATION","code_information":[{"code":"38220","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":2344,"discounted_cash":693.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1898.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1898.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1898.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1640.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC DX BONE MARROW BIOPSY","code_information":[{"code":"38221","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4995.27,"maximum":4995.27,"gross_charge":6167,"discounted_cash":1825.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4995.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4995.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4995.27,"methodology":"fee schedule"}]}]},{"description":"HC DX BONE MARROW BIOPSY","code_information":[{"code":"38221","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4995.27,"gross_charge":6167,"discounted_cash":1825.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4995.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4995.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4995.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4316.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1171.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":925.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"DX BONE MARROW BX & ASPIRATION","code_information":[{"code":"38222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8091.9,"maximum":8091.9,"gross_charge":9990,"discounted_cash":2957.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8091.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8091.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8091.9,"methodology":"fee schedule"}]}]},{"description":"DX BONE MARROW BX & ASPIRATION","code_information":[{"code":"38222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8091.9,"gross_charge":9990,"discounted_cash":2957.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8091.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8091.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8091.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1898.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1998,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1498.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1998,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"HC BONE MARROW BX AND ASP","code_information":[{"code":"38222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4895.64,"maximum":4895.64,"gross_charge":6044,"discounted_cash":1789.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4895.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4895.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4895.64,"methodology":"fee schedule"}]}]},{"description":"HC BONE MARROW BX AND ASP","code_information":[{"code":"38222","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"gross_charge":6044,"discounted_cash":1789.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4895.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4895.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4895.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3823","type":"APR-DRG"}],"standard_charges":[{"minimum":7435,"maximum":7435,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7435,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7435,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7435,"methodology":"case rate"}]}]},{"description":"BONE MARROW HARVEST ALLOGEN","code_information":[{"code":"38230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3588.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"BONE MARROW HARVEST AUTOLOG","code_information":[{"code":"38232","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10257.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10257.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10257.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6752.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7162.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4188.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4481.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4314.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4398.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4607.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4440.05,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS","code_information":[{"code":"3824","type":"APR-DRG"}],"standard_charges":[{"minimum":8681,"maximum":8681,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8681,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8681,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8681,"methodology":"case rate"}]}]},{"description":"TRANSPLT ALLO HCT/DONOR","code_information":[{"code":"38240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":129481.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129481.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":129481.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79730.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90417.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":52875.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56576.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54461.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55519.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58163.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56048.15,"methodology":"case rate"}]}]},{"description":"TRANSPLT AUTOL HCT/DONOR","code_information":[{"code":"38241","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3588.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"TRANSPLT ALLO LYMPHOCYTES","code_information":[{"code":"38242","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3588.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"TRANSPLJ HEMATOPOIETIC BOOST","code_information":[{"code":"38243","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3588.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3588.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2238.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2506.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1465.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1568.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1509.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1538.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1612.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1553.51,"methodology":"case rate"}]}]},{"description":"UNCOMPLICATED PEPTIC ULCER WITH MCC","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"minimum":6616,"maximum":20946,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11364,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10743,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7944,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20946,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19638,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19203.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14700,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17526,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14762,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20213.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18775,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11657,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11657,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6616,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11229.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12015.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11566.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11791.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11903.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11791.35,"methodology":"case rate"}]}]},{"description":"DRAINAGE LYMPH NODE LESION","code_information":[{"code":"38300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DRAINAGE LYMPH NODE LESION","code_information":[{"code":"38305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"INCISION OF LYMPH CHANNELS","code_information":[{"code":"38308","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3831","type":"APR-DRG"}],"standard_charges":[{"minimum":3974,"maximum":3974,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3974,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3974,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3974,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3832","type":"APR-DRG"}],"standard_charges":[{"minimum":5738,"maximum":5738,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5738,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5738,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5738,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3833","type":"APR-DRG"}],"standard_charges":[{"minimum":10997,"maximum":10997,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10997,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10997,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10997,"methodology":"case rate"}]}]},{"description":"CELLULITIS AND OTHER SKIN INFECTIONS","code_information":[{"code":"3834","type":"APR-DRG"}],"standard_charges":[{"minimum":12101,"maximum":12101,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12101,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12101,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12101,"methodology":"case rate"}]}]},{"description":"THORACIC DUCT PROCEDURE","code_information":[{"code":"38380","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACIC DUCT PROCEDURE","code_information":[{"code":"38381","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORACIC DUCT PROCEDURE","code_information":[{"code":"38382","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UNCOMPLICATED PEPTIC ULCER WITHOUT MCC","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"minimum":4746,"maximum":15650.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7817,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7390,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4975,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8165,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7656,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14868.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9745,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11619,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9246,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15650.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12914,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8019,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8019,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4746,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8694.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9303.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8955.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9129.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9216.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9129.67,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3841","type":"APR-DRG"}],"standard_charges":[{"minimum":5614,"maximum":5614,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5614,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5614,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5614,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3842","type":"APR-DRG"}],"standard_charges":[{"minimum":6890,"maximum":6890,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6890,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6890,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6890,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3843","type":"APR-DRG"}],"standard_charges":[{"minimum":7792,"maximum":7792,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7792,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7792,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7792,"methodology":"case rate"}]}]},{"description":"CONTUSION OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE","code_information":[{"code":"3844","type":"APR-DRG"}],"standard_charges":[{"minimum":14043,"maximum":14043,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14043,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14043,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14043,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITH MCC","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"minimum":6669,"maximum":24383.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14605,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13808,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8902,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18676,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17510,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23164.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17605,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20989,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16543,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24383.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24130,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14982,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14982,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6669,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13546.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14494.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13952.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14223.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14359.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14223.68,"methodology":"case rate"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"BIOPSY LYMPH NODE BY NEEDLE","code_information":[{"code":"38505","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1015.74,"maximum":1015.74,"gross_charge":1254,"discounted_cash":371.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.74,"methodology":"fee schedule"}]}]},{"description":"BIOPSY LYMPH NODE BY NEEDLE","code_information":[{"code":"38505","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":1254,"discounted_cash":371.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BIOPSY NEEDLE LYMPHND SUP","code_information":[{"code":"38505","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1015.74,"maximum":1015.74,"gross_charge":1254,"discounted_cash":371.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.74,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY NEEDLE LYMPHND SUP","code_information":[{"code":"38505","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"gross_charge":1254,"discounted_cash":371.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3851","type":"APR-DRG"}],"standard_charges":[{"minimum":4097,"maximum":4097,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4097,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4097,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4097,"methodology":"case rate"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3852","type":"APR-DRG"}],"standard_charges":[{"minimum":6660,"maximum":6660,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3853","type":"APR-DRG"}],"standard_charges":[{"minimum":6660,"maximum":6660,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"}]}]},{"description":"BIOPSY/REMOVAL LYMPH NODES","code_information":[{"code":"38530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"OPEN BX/EXC INGUINOFEM NODES","code_information":[{"code":"38531","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST DISORDERS","code_information":[{"code":"3854","type":"APR-DRG"}],"standard_charges":[{"minimum":13034,"maximum":13034,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13034,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13034,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13034,"methodology":"case rate"}]}]},{"description":"EXPLORE DEEP NODE(S) NECK","code_information":[{"code":"38542","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVAL NECK/ARMPIT LESION","code_information":[{"code":"38550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8383.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8383.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5561.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5854.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3423.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3663.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3526.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3594.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3765.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3628.94,"methodology":"case rate"}]}]},{"description":"REMOVAL NECK/ARMPIT LESION","code_information":[{"code":"38555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"REMOVAL PELVIC LYMPH NODES","code_information":[{"code":"38562","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL ABDOMEN LYMPH NODES","code_information":[{"code":"38564","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPY LYMPH NODE BIOP","code_information":[{"code":"38570","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY LYMPHADENECTOMY","code_information":[{"code":"38571","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY LYMPHADENECTOMY","code_information":[{"code":"38572","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPS PELVIC LYMPHADEC","code_information":[{"code":"38573","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC LYMPHATIC","code_information":[{"code":"38589","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITH CC","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":5520,"maximum":17071.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8434,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5520,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12355,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11584,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16218.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10699,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12756,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10258,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17071.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14740,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9152,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9152,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6240,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9484.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10148.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9768.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9958.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10053.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9958.66,"methodology":"case rate"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":3887,"maximum":13346.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6025,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5696,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3887,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9277,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8698,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12678.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7476,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8913,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7223,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13346.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6181,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6181,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5034,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7414.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7933.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7637.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7785.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7859.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7785.35,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LYMPH NODES NECK","code_information":[{"code":"38700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LYMPH NODES NECK","code_information":[{"code":"38720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LYMPH NODES NECK","code_information":[{"code":"38724","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE ARMPIT LYMPH NODES","code_information":[{"code":"38740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVE ARMPIT LYMPH NODES","code_information":[{"code":"38745","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVE THORACIC LYMPH NODES","code_information":[{"code":"38746","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE ABDOMINAL LYMPH NODES","code_information":[{"code":"38747","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE GROIN LYMPH NODES","code_information":[{"code":"38760","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14277.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14277.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9514.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9970.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5830.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6238.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6005.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6121.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6413.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6180.28,"methodology":"case rate"}]}]},{"description":"REMOVE GROIN LYMPH NODES","code_information":[{"code":"38765","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PELVIS LYMPH NODES","code_information":[{"code":"38770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE ABDOMEN LYMPH NODES","code_information":[{"code":"38780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INJECT FOR LYMPHATIC X-RAY","code_information":[{"code":"38790","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INJECTION SENTL NDE NO-IMG","code_information":[{"code":"38792","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":796.23,"maximum":796.23,"gross_charge":983,"discounted_cash":290.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":796.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":796.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":796.23,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION SENTL NDE NO-IMG","code_information":[{"code":"38792","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":983,"discounted_cash":290.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":796.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":796.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":796.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":688.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"ACCESS THORACIC LYMPH DUCT","code_information":[{"code":"38794","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITH MCC","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":7330,"maximum":23488,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13213,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12491,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8258,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23488,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22022,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21462.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15861,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18910,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15346,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22592.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21830,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13554,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13554,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7330,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12551.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13429.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12927.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13178.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13304.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13178.84,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITH CC","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":4525,"maximum":14864.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7206,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6812,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4525,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11727,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10995,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14121.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8724,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10401,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8408,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14864.57,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11905,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7392,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7392,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4989,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8258.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8836.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8505.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8671,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8753.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8671,"methodology":"case rate"}]}]},{"description":"IO MAP OF SENT LYMPH NODE","code_information":[{"code":"38900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BLOOD/LYMPH SYSTEM PROCEDURE","code_information":[{"code":"38999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":957.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":633.38,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":668.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":390.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":418.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":402.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":410.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":429.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":414.31,"methodology":"case rate"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":3176,"maximum":11922.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4919,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4650,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3176,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8067,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7563,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11326.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6112,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7288,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5902,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":11922.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8127,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5046,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5046,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3496,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6623.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7087.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6822.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6955.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7021.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6955.01,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF CHEST","code_information":[{"code":"39000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC MEDIAST/TTHRC EXPL OF CHEST IN CCL","code_information":[{"code":"39010","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2243.7,"maximum":2243.7,"gross_charge":2770,"discounted_cash":819.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2243.7,"methodology":"fee schedule"}]}]},{"description":"HC MEDIAST/TTHRC EXPL OF CHEST IN CCL","code_information":[{"code":"39010","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2770,"discounted_cash":819.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1939,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":554,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":554,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGITIS GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":6561,"maximum":20448.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11546,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10916,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7248,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12240,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11475,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19426.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13879,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16547,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13469,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20448.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19076,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11844,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11844,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6561,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11360.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12155.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11701.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11928.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12041.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11928.27,"methodology":"case rate"}]}]},{"description":"ESOPHAGITIS GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":4425,"maximum":14618.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7014,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6631,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4463,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7616,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7141,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13887.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8513,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10150,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8294,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14618.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11588,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7195,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7195,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4425,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8121.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8689.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8364.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8527.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8608.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8527.32,"methodology":"case rate"}]}]},{"description":"RESECT MEDIASTINAL CYST","code_information":[{"code":"39200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT MEDIASTINAL TUMOR","code_information":[{"code":"39220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":7454,"maximum":24744.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14886,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14073,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9202,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22112,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20732,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23507.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17417,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20765,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17100,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24744.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24593,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15270,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15270,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7454,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13746.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14709.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14159.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14434.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14571.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14434.13,"methodology":"case rate"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":5323,"maximum":16479.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8461,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7999,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5323,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14332,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13437,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15655.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10193,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12152,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9892,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16479.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13979,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8680,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8680,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5898,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9155.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9796.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9430.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9613.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9704.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9613.3,"methodology":"case rate"}]}]},{"description":"MEDIASTINOSCPY W/MEDSTNL BX","code_information":[{"code":"39401","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"MEDIASTINOSCPY W/LMPH NOD BX","code_information":[{"code":"39402","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"CHEST PROCEDURE","code_information":[{"code":"39499","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"minimum":3679,"maximum":12954.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5721,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5408,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11809,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11072,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12306.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6971,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8311,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6836,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12954.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9451,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5868,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5868,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3991,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7196.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7700.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7412.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7556.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7628.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7556.68,"methodology":"case rate"}]}]},{"description":"REPAIR DIAPHRAGM LACERATION","code_information":[{"code":"39501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF DIAPHRAGM HERNIA","code_information":[{"code":"39503","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF DIAPHRAGM HERNIA","code_information":[{"code":"39540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF DIAPHRAGM HERNIA","code_information":[{"code":"39541","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF DIAPHRAGM","code_information":[{"code":"39545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT DIAPHRAGM SIMPLE","code_information":[{"code":"39560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT DIAPHRAGM COMPLEX","code_information":[{"code":"39561","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DIAPHRAGM SURGERY PROCEDURE","code_information":[{"code":"39599","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPENDIX PROCEDURES WITH MCC","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"minimum":12764,"maximum":37606,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22273,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21056,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12764,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37606,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35258,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32534.57,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23720,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34246.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36798,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22848,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22848,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19026.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20357.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19596.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19977.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20167.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19977.37,"methodology":"case rate"}]}]},{"description":"APPENDIX PROCEDURES WITH CC","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":8598,"maximum":25331,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13602,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12859,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8598,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25331,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23750,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21938.33,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15977,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23092.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22473,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13953,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13953,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12829.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13727.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13214.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13470.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13599.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13470.91,"methodology":"case rate"}]}]},{"description":"APPENDIX PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":6324,"maximum":18632,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10102,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9550,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6324,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18632,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17469,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17660.73,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11752,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18590.24,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16690,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10363,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10363,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10327.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11050.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10637.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10844.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10947.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10844.31,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4011","type":"APR-DRG"}],"standard_charges":[{"minimum":17293,"maximum":17293,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17293,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17293,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17293,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4012","type":"APR-DRG"}],"standard_charges":[{"minimum":17293,"maximum":17293,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17293,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17293,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17293,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4013","type":"APR-DRG"}],"standard_charges":[{"minimum":21535,"maximum":21535,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21535,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21535,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21535,"methodology":"case rate"}]}]},{"description":"ADRENAL PROCEDURES","code_information":[{"code":"4014","type":"APR-DRG"}],"standard_charges":[{"minimum":36157,"maximum":36157,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36157,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36157,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36157,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"minimum":28240.7,"maximum":65771,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35167,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33246,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65771,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61665,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48291.6,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":50833.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58100,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36074,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36074,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28240.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30217.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29087.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29652.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29935.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29652.74,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4031","type":"APR-DRG"}],"standard_charges":[{"minimum":10084,"maximum":10084,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10084,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10084,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10084,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4032","type":"APR-DRG"}],"standard_charges":[{"minimum":10780,"maximum":10780,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10780,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10780,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10780,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4033","type":"APR-DRG"}],"standard_charges":[{"minimum":13639,"maximum":13639,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13639,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13639,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13639,"methodology":"case rate"}]}]},{"description":"PROCEDURES FOR OBESITY","code_information":[{"code":"4034","type":"APR-DRG"}],"standard_charges":[{"minimum":27418,"maximum":27418,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27418,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27418,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27418,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4041","type":"APR-DRG"}],"standard_charges":[{"minimum":8923,"maximum":8923,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8923,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8923,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8923,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4042","type":"APR-DRG"}],"standard_charges":[{"minimum":10367,"maximum":10367,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10367,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10367,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10367,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4043","type":"APR-DRG"}],"standard_charges":[{"minimum":16092,"maximum":16092,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16092,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16092,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16092,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES","code_information":[{"code":"4044","type":"APR-DRG"}],"standard_charges":[{"minimum":35533,"maximum":35533,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35533,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35533,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35533,"methodology":"case rate"}]}]},{"description":"BIOPSY OF LIP","code_information":[{"code":"40490","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"PANCREAS LIVER AND SHUNT PROCEDURES WITH MCC","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"minimum":23166,"maximum":80622,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48798,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46133,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31277,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50553,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47397,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64950.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59902,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71418,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58124,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":68368.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80622,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50058,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50058,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23166,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37982.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40641.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39122.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39881.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40261.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39881.9,"methodology":"case rate"}]}]},{"description":"PARTIAL EXCISION OF LIP","code_information":[{"code":"40500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4051","type":"APR-DRG"}],"standard_charges":[{"minimum":6988,"maximum":6988,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6988,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6988,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6988,"methodology":"case rate"}]}]},{"description":"PARTIAL EXCISION OF LIP","code_information":[{"code":"40510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4052","type":"APR-DRG"}],"standard_charges":[{"minimum":10916,"maximum":10916,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10916,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10916,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10916,"methodology":"case rate"}]}]},{"description":"PARTIAL EXCISION OF LIP","code_information":[{"code":"40520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT LIP WITH FLAP","code_information":[{"code":"40525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT LIP WITH FLAP","code_information":[{"code":"40527","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4053","type":"APR-DRG"}],"standard_charges":[{"minimum":13905,"maximum":13905,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13905,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13905,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13905,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF LIP","code_information":[{"code":"40530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS","code_information":[{"code":"4054","type":"APR-DRG"}],"standard_charges":[{"minimum":26586,"maximum":26586,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26586,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26586,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26586,"methodology":"case rate"}]}]},{"description":"PANCREAS LIVER AND SHUNT PROCEDURES WITH CC","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"minimum":16404,"maximum":41708,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25245,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23866,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16404,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36208,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33948,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36166.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31667,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37755,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30485,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38069.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41708,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16634,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21149.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22630.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21784.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22207.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22418.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22207.35,"methodology":"case rate"}]}]},{"description":"REPAIR LIP","code_information":[{"code":"40650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"REPAIR LIP","code_information":[{"code":"40652","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"REPAIR LIP","code_information":[{"code":"40654","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"PANCREAS LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"minimum":12221,"maximum":31719,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19199,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18150,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12221,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30847,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28921,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28777.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24058,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28683,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22710,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30292.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31719,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19694,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19694,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12237,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18007.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17333.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17670.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17838.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17670.5,"methodology":"case rate"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40701","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40702","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR CLEFT LIP/NASAL","code_information":[{"code":"40761","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LIP SURGERY PROCEDURE","code_information":[{"code":"40799","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"minimum":18339,"maximum":136354,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31473,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29754,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21147,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":136354,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":127842,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43777.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39664,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47289,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39299,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46081.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51998,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32285,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32285,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18339,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25601.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27393.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26369.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26881.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27137.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26881.13,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"40800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"40801","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"REMOVAL FOREIGN BODY MOUTH","code_information":[{"code":"40804","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"REMOVAL FOREIGN BODY MOUTH","code_information":[{"code":"40805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"INCISION OF LIP FOLD","code_information":[{"code":"40806","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"BIOPSY OF MOUTH LESION","code_information":[{"code":"40808","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"EXCISION OF MOUTH LESION","code_information":[{"code":"40810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISE/REPAIR MOUTH LESION","code_information":[{"code":"40812","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISE/REPAIR MOUTH LESION","code_information":[{"code":"40814","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF MOUTH LESION","code_information":[{"code":"40816","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISE ORAL MUCOSA FOR GRAFT","code_information":[{"code":"40818","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"EXCISE LIP OR CHEEK FOLD","code_information":[{"code":"40819","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"TREATMENT OF MOUTH LESION","code_information":[{"code":"40820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"HC COMP REPAIR VESTIB 2.5CM OR <","code_information":[{"code":"40830","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":688.5,"maximum":688.5,"gross_charge":850,"discounted_cash":251.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":688.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":688.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":688.5,"methodology":"fee schedule"}]}]},{"description":"HC COMP REPAIR VESTIB 2.5CM OR <","code_information":[{"code":"40830","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":850,"discounted_cash":251.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":688.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":688.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":688.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":595,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":170,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":170,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"REPAIR MOUTH LACERATION","code_information":[{"code":"40831","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40842","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40843","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40844","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF MOUTH","code_information":[{"code":"40845","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MOUTH SURGERY PROCEDURE","code_information":[{"code":"40899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"minimum":11120,"maximum":43118,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18845,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17816,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11120,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43118,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40426,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28345.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23038,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27467,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20665,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29837.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19332,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19332,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16576.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17736.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17073.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17405.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17571.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17405.4,"methodology":"case rate"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"minimum":8340,"maximum":24151,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13943,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13181,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8892,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24151,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22643,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22354.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18350,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21878,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16525,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23531.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23035,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14303,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14303,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8340,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13072.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13988.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13465.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13726.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13857.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13726.55,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41006","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41007","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41008","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41009","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"INCISION OF TONGUE FOLD","code_information":[{"code":"41010","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41015","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41016","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41017","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF MOUTH LESION","code_information":[{"code":"41018","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"PLACE NEEDLES HN FOR RT","code_information":[{"code":"41019","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITH MCC","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"minimum":17274,"maximum":57127,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24597,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23254,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17274,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57127,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":53560,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35375.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36515,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43535,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32101,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":37237.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40638,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25232,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25232,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22062,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20687.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22135.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21307.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21721.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21928.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21721.69,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TONGUE","code_information":[{"code":"41100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TONGUE","code_information":[{"code":"41105","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"BIOPSY OF FLOOR OF MOUTH","code_information":[{"code":"41108","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41112","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41113","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF TONGUE LESION","code_information":[{"code":"41114","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF TONGUE FOLD","code_information":[{"code":"41115","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISION OF MOUTH LESION","code_information":[{"code":"41116","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TONGUE","code_information":[{"code":"41120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF TONGUE","code_information":[{"code":"41130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TONGUE AND NECK SURGERY","code_information":[{"code":"41135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF TONGUE","code_information":[{"code":"41140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TONGUE REMOVAL NECK SURGERY","code_information":[{"code":"41145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TONGUE MOUTH JAW SURGERY","code_information":[{"code":"41150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TONGUE MOUTH NECK SURGERY","code_information":[{"code":"41153","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TONGUE JAW  NECK SURGERY","code_information":[{"code":"41155","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITH CC","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"minimum":11268,"maximum":44161,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19161,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18114,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11738,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44161,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41404,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28731.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24814,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29585,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21814,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30243.71,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31657,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19655,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19655,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11268,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16802.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17978.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17306.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17642.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17810.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17642.17,"methodology":"case rate"}]}]},{"description":"REPAIR TONGUE LACERATION","code_information":[{"code":"41250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"REPAIR TONGUE LACERATION","code_information":[{"code":"41251","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"REPR TONGUE LACER 2.6 CM+/COM","code_information":[{"code":"41252","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":638.28,"maximum":638.28,"gross_charge":788,"discounted_cash":233.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":638.28,"methodology":"fee schedule"}]}]},{"description":"REPR TONGUE LACER 2.6 CM+/COM","code_information":[{"code":"41252","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":118.2,"maximum":2469.9,"gross_charge":788,"discounted_cash":233.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"minimum":8319,"maximum":32494,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14944,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14128,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8577,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32494,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30465,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23578.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17515,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20882,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15938,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24819.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24690,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15330,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15330,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8319,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13788.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14753.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14202.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14477.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14615.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14477.97,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"minimum":20028,"maximum":91842,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31496,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29775,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20028,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":91842,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86108,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43805.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38207,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45552,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37219,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46110.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52035,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32309,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32309,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21662,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25617.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27410.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26385.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26897.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27154.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26897.99,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"minimum":10478,"maximum":37905,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17781,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16810,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11225,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37905,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35539,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27045.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21618,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25774,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20860,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28468.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29377,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18240,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18240,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10478,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15815.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16923.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16290.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16606.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16764.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16606.77,"methodology":"case rate"}]}]},{"description":"TONGUE TO LIP SURGERY","code_information":[{"code":"41510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TONGUE SUSPENSION","code_information":[{"code":"41512","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION TONGUE FOLD","code_information":[{"code":"41520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TONGUE BASE VOL REDUCTION","code_information":[{"code":"41530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TONGUE AND MOUTH SURGERY","code_information":[{"code":"41599","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"minimum":5577,"maximum":30457,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12317,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11644,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7608,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30457,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28555,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14878,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17738,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14139,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21439.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20349,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12635,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12635,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5577,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11910.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12744.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12268.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12506.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12625.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12506.33,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":13168,"maximum":37063,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21362,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20195,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13168,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37063,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34750,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31421.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25701,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30641,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24471,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33075.56,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35294,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21914,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21914,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13250,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18375.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19661.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18926.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19294.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19477.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19294.08,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":8988,"maximum":30887,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14907,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14093,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9287,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30887,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28959,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23533.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17954,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21405,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17259,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24771.96,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24629,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15292,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15292,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8988,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13762.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14725.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14175.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14450.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14587.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14450.31,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF GUM LESION","code_information":[{"code":"41800","type":"CPT"}],"standard_charges":[{"minimum":115.24,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"REMOVAL FOREIGN BODY GUM","code_information":[{"code":"41805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVAL FOREIGN BODY JAWBONE","code_information":[{"code":"41806","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISION GUM EACH QUADRANT","code_information":[{"code":"41820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM FLAP","code_information":[{"code":"41821","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41822","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41823","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41826","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41827","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISION OF GUM LESION","code_information":[{"code":"41828","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF GUM TISSUE","code_information":[{"code":"41830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TREATMENT OF GUM LESION","code_information":[{"code":"41850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"GUM GRAFT","code_information":[{"code":"41870","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REPAIR GUM","code_information":[{"code":"41872","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR TOOTH SOCKET","code_information":[{"code":"41874","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"DENTAL SURGERY PROCEDURE","code_information":[{"code":"41899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5257,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":7062,"maximum":20831.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11844,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11197,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7461,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17800,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16689,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19789.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14106,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16818,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13865,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20831.21,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19568,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12150,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12150,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7062,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11572.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12383,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11920.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12151.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12267.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12151.54,"methodology":"case rate"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"minimum":18185,"maximum":52417,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31727,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29994,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18185,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24067,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22565,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44087.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35250,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42027,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33794,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46408,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52417,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32546,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32546,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20289,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25782.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27586.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26555.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27071.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27329.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27071.34,"methodology":"case rate"}]}]},{"description":"DRAINAGE MOUTH ROOF LESION","code_information":[{"code":"42000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4201","type":"APR-DRG"}],"standard_charges":[{"minimum":4016,"maximum":4016,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4016,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4016,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4016,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4202","type":"APR-DRG"}],"standard_charges":[{"minimum":4872,"maximum":4872,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4872,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4872,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4872,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4203","type":"APR-DRG"}],"standard_charges":[{"minimum":7704,"maximum":7704,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7704,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7704,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7704,"methodology":"case rate"}]}]},{"description":"DIABETES","code_information":[{"code":"4204","type":"APR-DRG"}],"standard_charges":[{"minimum":16181,"maximum":16181,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16181,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16181,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16181,"methodology":"case rate"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"minimum":8092,"maximum":24531.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14720,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13916,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9713,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20997,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19687,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23304.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19582,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23346,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18050,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24531.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24320,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15100,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15100,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8092,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13628.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14582.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14037.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14310.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14446.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14310.01,"methodology":"case rate"}]}]},{"description":"BIOPSY ROOF OF MOUTH","code_information":[{"code":"42100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISION LESION MOUTH ROOF","code_information":[{"code":"42104","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION LESION MOUTH ROOF","code_information":[{"code":"42106","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION LESION MOUTH ROOF","code_information":[{"code":"42107","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4211","type":"APR-DRG"}],"standard_charges":[{"minimum":3626,"maximum":3626,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3626,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3626,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3626,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4212","type":"APR-DRG"}],"standard_charges":[{"minimum":6815,"maximum":6815,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6815,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6815,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6815,"methodology":"case rate"}]}]},{"description":"REMOVE PALATE/LESION","code_information":[{"code":"42120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4213","type":"APR-DRG"}],"standard_charges":[{"minimum":11468,"maximum":11468,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11468,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11468,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11468,"methodology":"case rate"}]}]},{"description":"MALNUTRITION FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS","code_information":[{"code":"4214","type":"APR-DRG"}],"standard_charges":[{"minimum":11551,"maximum":11551,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11551,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11551,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11551,"methodology":"case rate"}]}]},{"description":"EXCISION OF UVULA","code_information":[{"code":"42140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR PALATE PHARYNX/UVULA","code_information":[{"code":"42145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TREATMENT MOUTH ROOF LESION","code_information":[{"code":"42160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR PALATE","code_information":[{"code":"42180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"REPAIR PALATE","code_information":[{"code":"42182","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"minimum":7175,"maximum":22586.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12487,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8016,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15686,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14707,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21457.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14977,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17856,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14897,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22586.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21822,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13549,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13549,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7175,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12548.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13426.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12924.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13175.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13300.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13175.47,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4221","type":"APR-DRG"}],"standard_charges":[{"minimum":2996,"maximum":2996,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2996,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2996,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2996,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4222","type":"APR-DRG"}],"standard_charges":[{"minimum":4158,"maximum":4158,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4158,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4158,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4158,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42220","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT CLEFT PALATE","code_information":[{"code":"42225","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LENGTHENING OF PALATE","code_information":[{"code":"42226","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LENGTHENING OF PALATE","code_information":[{"code":"42227","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4223","type":"APR-DRG"}],"standard_charges":[{"minimum":8172,"maximum":8172,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"}]}]},{"description":"REPAIR PALATE","code_information":[{"code":"42235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS","code_information":[{"code":"4224","type":"APR-DRG"}],"standard_charges":[{"minimum":8172,"maximum":8172,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"}]}]},{"description":"REPAIR NOSE TO LIP FISTULA","code_information":[{"code":"42260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PREPARATION PALATE MOLD","code_information":[{"code":"42280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"INSERTION PALATE PROSTHESIS","code_information":[{"code":"42281","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PALATE/UVULA SURGERY","code_information":[{"code":"42299","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"minimum":19146,"maximum":60405,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36562,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":34565,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22219,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50823,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47650,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49996.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42500,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50670,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41291,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":52627.9,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60405,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37505,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37505,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19146,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29237.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31284.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30114.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30699.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30991.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30699.61,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4231","type":"APR-DRG"}],"standard_charges":[{"minimum":3816,"maximum":3816,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3816,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3816,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3816,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4232","type":"APR-DRG"}],"standard_charges":[{"minimum":5883,"maximum":5883,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5883,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5883,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5883,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF SALIVARY GLAND","code_information":[{"code":"42320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4233","type":"APR-DRG"}],"standard_charges":[{"minimum":7127,"maximum":7127,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7127,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7127,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7127,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SALIVARY STONE","code_information":[{"code":"42330","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SALIVARY STONE","code_information":[{"code":"42335","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"INBORN ERRORS OF METABOLISM","code_information":[{"code":"4234","type":"APR-DRG"}],"standard_charges":[{"minimum":16989,"maximum":16989,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16989,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16989,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16989,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SALIVARY STONE","code_information":[{"code":"42340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"minimum":10902,"maximum":33909,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20525,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19403,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12111,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24034,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22533,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30397.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25602,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30524,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22506,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31997.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21054,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21054,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10902,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17776.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19020.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18309.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18665.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18843.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18665.42,"methodology":"case rate"}]}]},{"description":"HC BIOPSY NEEDLE SALIVARY GLND","code_information":[{"code":"42400","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":405,"maximum":405,"gross_charge":500,"discounted_cash":148,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY NEEDLE SALIVARY GLND","code_information":[{"code":"42400","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":500,"discounted_cash":148,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SALIVARY GLAND","code_information":[{"code":"42405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXCISION OF SALIVARY CYST","code_information":[{"code":"42408","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF SALIVARY CYST","code_information":[{"code":"42409","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4241","type":"APR-DRG"}],"standard_charges":[{"minimum":4860,"maximum":4860,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4860,"methodology":"case rate"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4242","type":"APR-DRG"}],"standard_charges":[{"minimum":5191,"maximum":5191,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5191,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5191,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5191,"methodology":"case rate"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42425","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE PAROTID GLAND/LESION","code_information":[{"code":"42426","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4243","type":"APR-DRG"}],"standard_charges":[{"minimum":12654,"maximum":12654,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12654,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12654,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12654,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE DISORDERS","code_information":[{"code":"4244","type":"APR-DRG"}],"standard_charges":[{"minimum":12654,"maximum":12654,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12654,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12654,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12654,"methodology":"case rate"}]}]},{"description":"EXCISE SUBMAXILLARY GLAND","code_information":[{"code":"42440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXCISE SUBLINGUAL GLAND","code_information":[{"code":"42450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"minimum":9101,"maximum":23469.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13895,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13136,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9101,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16237,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15223,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22296.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15463,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18436,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16913,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23469.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14254,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14254,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10715,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13038.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13951.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13430.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13690.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13821.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13690.81,"methodology":"case rate"}]}]},{"description":"REPAIR SALIVARY DUCT","code_information":[{"code":"42500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR SALIVARY DUCT","code_information":[{"code":"42505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PAROTID DUCT DIVERSION","code_information":[{"code":"42507","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PAROTID DUCT DIVERSION","code_information":[{"code":"42509","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4251","type":"APR-DRG"}],"standard_charges":[{"minimum":3982,"maximum":3982,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3982,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3982,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3982,"methodology":"case rate"}]}]},{"description":"PAROTID DUCT DIVERSION","code_information":[{"code":"42510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4252","type":"APR-DRG"}],"standard_charges":[{"minimum":5484,"maximum":5484,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5484,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5484,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5484,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4253","type":"APR-DRG"}],"standard_charges":[{"minimum":8230,"maximum":8230,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8230,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8230,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8230,"methodology":"case rate"}]}]},{"description":"OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS","code_information":[{"code":"4254","type":"APR-DRG"}],"standard_charges":[{"minimum":9559,"maximum":9559,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9559,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9559,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9559,"methodology":"case rate"}]}]},{"description":"INJECTION FOR SALIVARY X-RAY","code_information":[{"code":"42550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"minimum":70402.96,"maximum":175452,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94163,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":89020,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":175452,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":164498,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120389.07,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":126725.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155571,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":96594,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":96594,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70402.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75331.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72515.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":73923.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":74627.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":73923.11,"methodology":"case rate"}]}]},{"description":"CLOSURE OF SALIVARY FISTULA","code_information":[{"code":"42600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4261","type":"APR-DRG"}],"standard_charges":[{"minimum":3942,"maximum":3942,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3942,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3942,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3942,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4262","type":"APR-DRG"}],"standard_charges":[{"minimum":5767,"maximum":5767,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5767,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5767,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5767,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4263","type":"APR-DRG"}],"standard_charges":[{"minimum":10794,"maximum":10794,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10794,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10794,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10794,"methodology":"case rate"}]}]},{"description":"NON-HYPOVOLEMIC SODIUM DISORDERS","code_information":[{"code":"4264","type":"APR-DRG"}],"standard_charges":[{"minimum":17061,"maximum":17061,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17061,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17061,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17061,"methodology":"case rate"}]}]},{"description":"DILATION OF SALIVARY DUCT","code_information":[{"code":"42650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"DILATION OF SALIVARY DUCT","code_information":[{"code":"42660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"LIGATION OF SALIVARY DUCT","code_information":[{"code":"42665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"SALIVARY SURGERY PROCEDURE","code_information":[{"code":"42699","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"minimum":48736.6,"maximum":118825,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63846,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":60359,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":118825,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":111407,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":83339.59,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":87725.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105483,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":65494,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65494,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":48736.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":52148.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":50198.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":51173.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":51660.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":51173.43,"methodology":"case rate"}]}]},{"description":"I&D PERITONSILLAR","code_information":[{"code":"42700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":648,"maximum":648,"gross_charge":800,"discounted_cash":236.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":648,"methodology":"fee schedule"}]}]},{"description":"I&D PERITONSILLAR","code_information":[{"code":"42700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"gross_charge":800,"discounted_cash":236.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4271","type":"APR-DRG"}],"standard_charges":[{"minimum":3567,"maximum":3567,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3567,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3567,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3567,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4272","type":"APR-DRG"}],"standard_charges":[{"minimum":6594,"maximum":6594,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6594,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6594,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6594,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF THROAT ABSCESS","code_information":[{"code":"42720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF THROAT ABSCESS","code_information":[{"code":"42725","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4273","type":"APR-DRG"}],"standard_charges":[{"minimum":6819,"maximum":6819,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6819,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6819,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6819,"methodology":"case rate"}]}]},{"description":"THYROID DISORDERS","code_information":[{"code":"4274","type":"APR-DRG"}],"standard_charges":[{"minimum":12934,"maximum":12934,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12934,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12934,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12934,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"minimum":38467.13,"maximum":92152,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49476,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46774,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":92152,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86399,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65778.8,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":69240.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81742,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50753,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50753,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38467.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41159.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39621.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40390.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40775.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40390.49,"methodology":"case rate"}]}]},{"description":"BIOPSY OF THROAT","code_information":[{"code":"42800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"BIOPSY OF UPPER NOSE/THROAT","code_information":[{"code":"42804","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"BIOPSY OF UPPER NOSE/THROAT","code_information":[{"code":"42806","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISE PHARYNX LESION","code_information":[{"code":"42808","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVE PHARYNX FOREIGN BODY","code_information":[{"code":"42809","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"EXCISION OF NECK CYST","code_information":[{"code":"42810","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF NECK CYST","code_information":[{"code":"42815","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE TONSILS AND ADENOIDS","code_information":[{"code":"42820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE TONSILS AND ADENOIDS","code_information":[{"code":"42821","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TONSILS","code_information":[{"code":"42825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TONSILS","code_information":[{"code":"42826","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42830","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42831","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42835","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ADENOIDS","code_information":[{"code":"42836","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXTENSIVE SURGERY OF THROAT","code_information":[{"code":"42842","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXTENSIVE SURGERY OF THROAT","code_information":[{"code":"42844","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXTENSIVE SURGERY OF THROAT","code_information":[{"code":"42845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF TONSIL TAGS","code_information":[{"code":"42860","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXCISION OF LINGUAL TONSIL","code_information":[{"code":"42870","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF PHARYNX","code_information":[{"code":"42890","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION OF PHARYNGEAL WALLS","code_information":[{"code":"42892","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISION OF PHARYNGEAL WALLS","code_information":[{"code":"42894","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"minimum":56688.92,"maximum":139603,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74973,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":70878,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":139603,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":130888,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":96938.06,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":102040.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123867,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":76909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":76909,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":56688.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":60657.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":58389.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":59523.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":60090.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":59523.37,"methodology":"case rate"}]}]},{"description":"REPAIR THROAT WOUND","code_information":[{"code":"42900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF THROAT","code_information":[{"code":"42950","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR THROAT ESOPHAGUS","code_information":[{"code":"42953","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL OPENING OF THROAT","code_information":[{"code":"42955","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"CONTROL THROAT BLEEDING","code_information":[{"code":"42960","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"CONTROL THROAT BLEEDING","code_information":[{"code":"42961","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONTROL THROAT BLEEDING","code_information":[{"code":"42962","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"CONTROL NOSE/THROAT BLEEDING","code_information":[{"code":"42970","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"CONTROL NOSE/THROAT BLEEDING","code_information":[{"code":"42971","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONTROL NOSE/THROAT BLEEDING","code_information":[{"code":"42972","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"THROAT SURGERY PROCEDURE","code_information":[{"code":"42999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"minimum":38251.29,"maximum":91564,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49174,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46488,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":91564,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":85848,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65409.71,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":68852.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81243,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50443,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50443,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38251.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40928.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39398.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40163.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40546.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40163.86,"methodology":"case rate"}]}]},{"description":"INCISION OF ESOPHAGUS","code_information":[{"code":"43020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"THROAT MUSCLE SURGERY","code_information":[{"code":"43030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"INCISION OF ESOPHAGUS","code_information":[{"code":"43045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF ESOPHAGUS LESION","code_information":[{"code":"43100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF ESOPHAGUS LESION","code_information":[{"code":"43101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43107","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43108","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESPHG TOT W/THRCM","code_information":[{"code":"43112","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43113","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43116","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43117","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43118","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43121","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43122","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF ESOPHAGUS","code_information":[{"code":"43123","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF ESOPHAGUS","code_information":[{"code":"43124","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF ESOPHAGUS POUCH","code_information":[{"code":"43130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ESOPHAGUS POUCH","code_information":[{"code":"43135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPHAGOSCOPY RIGID TRNSO","code_information":[{"code":"43180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY RIGID TRNSO DX","code_information":[{"code":"43191","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCP RIG TRNSO INJECT","code_information":[{"code":"43192","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCP RIG TRNSO BIOPSY","code_information":[{"code":"43193","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCP RIG TRNSO REM FB","code_information":[{"code":"43194","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY RIGID BALLOON","code_information":[{"code":"43195","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCP GUIDE WIRE DILAT","code_information":[{"code":"43196","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY FLEX DX BRUSH","code_information":[{"code":"43197","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSC FLEX TRNSN BIOPSY","code_information":[{"code":"43198","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":10885,"maximum":29095,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17610,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16648,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10885,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18277,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17136,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26836.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20410,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24333,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20229,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28249.04,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18065,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18065,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11133,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15693.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16792.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16164.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16478.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16635.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16478.61,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY FLEXIBLE BRUSH","code_information":[{"code":"43200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2052.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"ESOPH SCOPE W/SUBMUCOUS INJ","code_information":[{"code":"43201","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY FLEX BIOPSY","code_information":[{"code":"43202","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPH SCOPE W/SCLEROSIS INJ","code_information":[{"code":"43204","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGUS ENDOSCOPY/LIGATION","code_information":[{"code":"43205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPH OPTICAL ENDOMICROSCOPY","code_information":[{"code":"43206","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD ESOPHAGOGASTRC FNDOPLSTY","code_information":[{"code":"43210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOP MUCOSAL RESECT","code_information":[{"code":"43211","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOP STENT PLACEMENT","code_information":[{"code":"43212","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY RETRO BALLOON","code_information":[{"code":"43213","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSC DILATE BALLOON 30","code_information":[{"code":"43214","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY FLEX REMOVE FB","code_information":[{"code":"43215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY LESION REMOVAL","code_information":[{"code":"43216","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY SNARE LES REMV","code_information":[{"code":"43217","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY BALLOON <30MM","code_information":[{"code":"43220","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPH ENDOSCOPY DILATION","code_information":[{"code":"43226","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY CONTROL BLEED","code_information":[{"code":"43227","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY LESION ABLATE","code_information":[{"code":"43229","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOP ULTRASOUND EXAM","code_information":[{"code":"43231","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY W/US NEEDLE BX","code_information":[{"code":"43232","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD BALLOON DIL ESOPH30 MM/>","code_information":[{"code":"43233","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD DIAGNOSTIC BRUSH WASH","code_information":[{"code":"43235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2052.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"UPPR GI SCOPE W/SUBMUC INJ","code_information":[{"code":"43236","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"ENDOSCOPIC US EXAM ESOPH","code_information":[{"code":"43237","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD US FINE NEEDLE BX/ASPIR","code_information":[{"code":"43238","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"43239","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"EGD W/TRANSMURAL DRAIN CYST","code_information":[{"code":"43240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"EGD TUBE/CATH INSERTION","code_information":[{"code":"43241","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD US FINE NEEDLE BX/ASPIR","code_information":[{"code":"43242","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD INJECTION VARICES","code_information":[{"code":"43243","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD VARICES LIGATION","code_information":[{"code":"43244","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD DILATE STRICTURE","code_information":[{"code":"43245","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD PLACE GASTROSTOMY TUBE","code_information":[{"code":"43246","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD REMOVE FOREIGN BODY","code_information":[{"code":"43247","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"EGD GUIDE WIRE INSERTION","code_information":[{"code":"43248","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"ESOPH EGD DILATION <30 MM","code_information":[{"code":"43249","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD CAUTERY TUMOR POLYP","code_information":[{"code":"43250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD REMOVE LESION SNARE","code_information":[{"code":"43251","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD OPTICAL ENDOMICROSCOPY","code_information":[{"code":"43252","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD US TRANSMURAL INJXN/MARK","code_information":[{"code":"43253","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD ENDO MUCOSAL RESECTION","code_information":[{"code":"43254","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD CONTROL BLEEDING ANY","code_information":[{"code":"43255","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"EGD W/THRML TXMNT GERD","code_information":[{"code":"43257","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"EGD US EXAM DUODENUM/JEJUNUM","code_information":[{"code":"43259","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ERCP W/SPECIMEN COLLECTION","code_information":[{"code":"43260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ENDO CHOLANGIOPANCREATOGRAPH","code_information":[{"code":"43261","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ENDO CHOLANGIOPANCREATOGRAPH","code_information":[{"code":"43262","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ERCP SPHINCTER PRESSURE MEAS","code_information":[{"code":"43263","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ERCP REMOVE DUCT CALCULI","code_information":[{"code":"43264","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ERCP LITHOTRIPSY CALCULI","code_information":[{"code":"43265","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8025,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12869,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"EGD ENDOSCOPIC STENT PLACE","code_information":[{"code":"43266","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"EGD LESION ABLATION","code_information":[{"code":"43270","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ENDOSCOPIC PANCREATOSCOPY","code_information":[{"code":"43273","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ERCP DUCT STENT PLACEMENT","code_information":[{"code":"43274","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"ERCP REMOVE FORGN BODY DUCT","code_information":[{"code":"43275","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ERCP STENT EXCHANGE W/DILATE","code_information":[{"code":"43276","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"ERCP EA DUCT/AMPULLA DILATE","code_information":[{"code":"43277","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"ERCP LESION ABLATE W/DILATE","code_information":[{"code":"43278","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"LAP MYOTOMY HELLER","code_information":[{"code":"43279","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPY FUNDOPLASTY","code_information":[{"code":"43280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAP PARAESOPHAG HERN REPAIR","code_information":[{"code":"43281","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAP PARAESOPH HER RPR W/MESH","code_information":[{"code":"43282","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAP ESOPH LENGTHENING","code_information":[{"code":"43283","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPS ESOPHGL SPHNCTR AGMNTJ","code_information":[{"code":"43284","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"RMVL ESOPHGL SPHNCTR DEV","code_information":[{"code":"43285","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"ESPHG TOT W/LAPS MOBLJ","code_information":[{"code":"43286","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESPHG DSTL 2/3 W/LAPS MOBLJ","code_information":[{"code":"43287","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESPHG THRSC MOBLJ","code_information":[{"code":"43288","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPE PROC ESOPH","code_information":[{"code":"43289","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"minimum":5603,"maximum":17965.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9616,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9091,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5857,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11361,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10652,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17067.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11239,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13400,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10885,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17965.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15888,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9865,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5603,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9981.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10679.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10280.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10480.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10579.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10480.07,"methodology":"case rate"}]}]},{"description":"REPAIR OF ESOPHAGUS","code_information":[{"code":"43300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ESOPHAGUS AND FISTULA","code_information":[{"code":"43305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF ESOPHAGUS","code_information":[{"code":"43310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ESOPHAGUS AND FISTULA","code_information":[{"code":"43312","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPHAGOPLASTY CONGENITAL","code_information":[{"code":"43313","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRACHEO-ESOPHAGOPLASTY CONG","code_information":[{"code":"43314","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE ESOPHAGUS  STOMACH","code_information":[{"code":"43320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4409,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":4409,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE ESOPHAGUS  STOMACH","code_information":[{"code":"43325","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPH FUNDOPLASTY LAP","code_information":[{"code":"43327","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPH FUNDOPLASTY THOR","code_information":[{"code":"43328","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPHAGOMYOTOMY ABDOMINAL","code_information":[{"code":"43330","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPHAGOMYOTOMY THORACIC","code_information":[{"code":"43331","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSAB ESOPH HIAT HERN RPR","code_information":[{"code":"43332","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSAB ESOPH HIAT HERN RPR","code_information":[{"code":"43333","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSTHOR DIAPHRAG HERN RPR","code_information":[{"code":"43334","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSTHOR DIAPHRAG HERN RPR","code_information":[{"code":"43335","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORABD DIAPHR HERN REPAIR","code_information":[{"code":"43336","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"THORABD DIAPHR HERN REPAIR","code_information":[{"code":"43337","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPH LENGTHENING","code_information":[{"code":"43338","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE ESOPHAGUS  INTESTINE","code_information":[{"code":"43340","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE ESOPHAGUS  INTESTINE","code_information":[{"code":"43341","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL OPENING ESOPHAGUS","code_information":[{"code":"43351","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL OPENING ESOPHAGUS","code_information":[{"code":"43352","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROINTESTINAL REPAIR","code_information":[{"code":"43360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROINTESTINAL REPAIR","code_information":[{"code":"43361","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"minimum":3804,"maximum":13649.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6261,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5919,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3804,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7640,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7163,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12966.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6785,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8089,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7069,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13649.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10344,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6422,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6422,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3898,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7582.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8113.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7810.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7962.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8037.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7962.07,"methodology":"case rate"}]}]},{"description":"LIGATE ESOPHAGUS VEINS","code_information":[{"code":"43400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LIGATE/STAPLE ESOPHAGUS","code_information":[{"code":"43405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ESOPHAGUS WOUND","code_information":[{"code":"43410","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ESOPHAGUS WOUND","code_information":[{"code":"43415","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR ESOPHAGUS OPENING","code_information":[{"code":"43420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR ESOPHAGUS OPENING","code_information":[{"code":"43425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DILATE ESOPHAGUS 1/MULT PASS","code_information":[{"code":"43450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2052.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"DILATE ESOPHAGUS","code_information":[{"code":"43453","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"PRESSURE TREATMENT ESOPHAGUS","code_information":[{"code":"43460","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FREE JEJUNUM FLAP MICROVASC","code_information":[{"code":"43496","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESOPHAGUS SURGERY PROCEDURE","code_information":[{"code":"43499","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"minimum":8501,"maximum":27097,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16401,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15505,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9999,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21414,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20077,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25359.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18896,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22529,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18581,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26693.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27097,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16825,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16825,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8501,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14829.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15867.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15274.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15571.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15719.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15571.38,"methodology":"case rate"}]}]},{"description":"SURGICAL OPENING OF STOMACH","code_information":[{"code":"43500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL REPAIR OF STOMACH","code_information":[{"code":"43501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL REPAIR OF STOMACH","code_information":[{"code":"43502","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL OPENING OF STOMACH","code_information":[{"code":"43510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"INCISION OF PYLORIC MUSCLE","code_information":[{"code":"43520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"minimum":6253,"maximum":18635.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10137,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9583,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6253,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15641,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14664,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17703.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11894,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14181,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11621,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18635.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16748,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10399,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6259,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10352.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11077.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10663.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10870.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10974.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10870.61,"methodology":"case rate"}]}]},{"description":"BIOPSY OF STOMACH","code_information":[{"code":"43605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF STOMACH LESION","code_information":[{"code":"43610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF STOMACH LESION","code_information":[{"code":"43611","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH","code_information":[{"code":"43620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH","code_information":[{"code":"43621","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH","code_information":[{"code":"43622","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43631","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43633","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43634","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF STOMACH PARTIAL","code_information":[{"code":"43635","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAGOTOMY  PYLORUS REPAIR","code_information":[{"code":"43640","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAGOTOMY  PYLORUS REPAIR","code_information":[{"code":"43641","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP GASTRIC BYPASS/ROUX-EN-Y","code_information":[{"code":"43644","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP GASTR BYPASS INCL SMLL I","code_information":[{"code":"43645","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP IMPL ELECTRODE ANTRUM","code_information":[{"code":"43647","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":27301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19874.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19064.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11148.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11929.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11483.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11706.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12263.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11817.9,"methodology":"case rate"}]}]},{"description":"LAP REVISE/REMV ELTRD ANTRUM","code_information":[{"code":"43648","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY VAGUS NERVE","code_information":[{"code":"43651","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY VAGUS NERVE","code_information":[{"code":"43652","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY GASTROSTOMY","code_information":[{"code":"43653","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC STOM","code_information":[{"code":"43659","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"minimum":4722,"maximum":14674.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7058,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6673,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13229,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12403,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13941.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9143,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8775,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14674.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11661,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7240,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7240,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4916,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8152.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8723.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8397.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8560.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8641.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8560.37,"methodology":"case rate"}]}]},{"description":"HC NASO GASTRIC CATH PLC/FLUOR","code_information":[{"code":"43752","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1030.32,"maximum":1030.32,"gross_charge":1272,"discounted_cash":376.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1030.32,"methodology":"fee schedule"}]}]},{"description":"HC NASO GASTRIC CATH PLC/FLUOR","code_information":[{"code":"43752","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1272,"discounted_cash":376.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":890.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"TX GASTRO INTUB W/ASP","code_information":[{"code":"43753","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"DX GASTR INTUB W/ASP SPEC","code_information":[{"code":"43754","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"DX GASTR INTUB W/ASP SPECS","code_information":[{"code":"43755","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"DX DUOD INTUB W/ASP SPEC","code_information":[{"code":"43756","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"DX DUOD INTUB W/ASP SPECS","code_information":[{"code":"43757","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC REPOS NASO/ORO-GAST FEEDING TUBE","code_information":[{"code":"43761","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":963.9,"maximum":963.9,"gross_charge":1190,"discounted_cash":352.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.9,"methodology":"fee schedule"}]}]},{"description":"HC REPOS NASO/ORO-GAST FEEDING TUBE","code_information":[{"code":"43761","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":1190,"discounted_cash":352.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":238,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"HC RPLC GTUBE PERC NO REVJ TRC","code_information":[{"code":"43762","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":692.55,"maximum":692.55,"gross_charge":855,"discounted_cash":253.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":692.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":692.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":692.55,"methodology":"fee schedule"}]}]},{"description":"HC RPLC GTUBE PERC NO REVJ TRC","code_information":[{"code":"43762","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":855,"discounted_cash":253.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":692.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":692.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":692.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"RPLC GTUBE REVJ GSTRST TRC","code_information":[{"code":"43763","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"LAP PLACE GASTR ADJ DEVICE","code_information":[{"code":"43770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAP REVISE GASTR ADJ DEVICE","code_information":[{"code":"43771","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP RMVL GASTR ADJ DEVICE","code_information":[{"code":"43772","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"LAP REPLACE GASTR ADJ DEVICE","code_information":[{"code":"43773","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP RMVL GASTR ADJ ALL PARTS","code_information":[{"code":"43774","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"LAP SLEEVE GASTRECTOMY","code_information":[{"code":"43775","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":9481,"maximum":24833.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14955,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14138,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9481,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21459,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20120,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23591.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17915,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21359,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17619,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24833.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24708,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15341,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15341,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10515,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13796.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14761.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14210.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14486.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14624.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14486.07,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF PYLORUS","code_information":[{"code":"43800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF STOMACH AND BOWEL","code_information":[{"code":"43810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF STOMACH AND BOWEL","code_information":[{"code":"43820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF STOMACH AND BOWEL","code_information":[{"code":"43825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLACE GASTROSTOMY TUBE","code_information":[{"code":"43830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"PLACE GASTROSTOMY TUBE","code_information":[{"code":"43831","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"PLACE GASTROSTOMY TUBE","code_information":[{"code":"43832","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF STOMACH LESION","code_information":[{"code":"43840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"V-BAND GASTROPLASTY","code_information":[{"code":"43842","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":19799,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19799,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROPLASTY W/O V-BAND","code_information":[{"code":"43843","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":19799,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19799,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTROPLASTY DUODENAL SWITCH","code_information":[{"code":"43845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTRIC BYPASS FOR OBESITY","code_information":[{"code":"43846","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASTRIC BYPASS INCL SMALL I","code_information":[{"code":"43847","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION GASTROPLASTY","code_information":[{"code":"43848","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE STOMACH-BOWEL FUSION","code_information":[{"code":"43850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE STOMACH-BOWEL FUSION","code_information":[{"code":"43855","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE STOMACH-BOWEL FUSION","code_information":[{"code":"43860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE STOMACH-BOWEL FUSION","code_information":[{"code":"43865","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR STOMACH OPENING","code_information":[{"code":"43870","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8329.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8329.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5587.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5816.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3401.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3639.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3503.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3571.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3741.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3605.48,"methodology":"case rate"}]}]},{"description":"REPAIR STOMACH-BOWEL FISTULA","code_information":[{"code":"43880","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPL/REDO ELECTRD ANTRUM","code_information":[{"code":"43881","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE/REMOVE ELECTRD ANTRUM","code_information":[{"code":"43882","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE GASTRIC PORT OPEN","code_information":[{"code":"43886","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REMOVE GASTRIC PORT OPEN","code_information":[{"code":"43887","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"CHANGE GASTRIC PORT OPEN","code_information":[{"code":"43888","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":4859,"maximum":15542.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7732,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7310,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4859,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12571,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11786,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14765.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9402,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11209,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9029,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15542.16,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12775,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7932,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7932,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5339,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8634.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9238.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8893.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9066.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9152.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9066.26,"methodology":"case rate"}]}]},{"description":"STOMACH SURGERY PROCEDURE","code_information":[{"code":"43999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":3497,"maximum":12708,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5529,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5227,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3497,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8187,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7676,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12072.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6555,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7815,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6500,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12708,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5672,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5672,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3910,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7060,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7554.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7271.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7413,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7483.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7413,"methodology":"case rate"}]}]},{"description":"HC ENTEROLYSIS (FREE INTES ADH)","code_information":[{"code":"44005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":10615.05,"maximum":10615.05,"gross_charge":13105,"discounted_cash":3879.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10615.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10615.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10615.05,"methodology":"fee schedule"}]}]},{"description":"HC ENTEROLYSIS (FREE INTES ADH)","code_information":[{"code":"44005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10615.05,"gross_charge":13105,"discounted_cash":3879.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10615.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10615.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10615.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9173.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2489.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2621,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2621,"methodology":"fee schedule"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4401","type":"APR-DRG"}],"standard_charges":[{"minimum":29109,"maximum":29109,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29109,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29109,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29109,"methodology":"case rate"}]}]},{"description":"HC 44010 DUODENAL BIOPSY","code_information":[{"code":"44010","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":850.5,"maximum":850.5,"gross_charge":1050,"discounted_cash":310.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":850.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":850.5,"methodology":"fee schedule"}]}]},{"description":"HC 44010 DUODENAL BIOPSY","code_information":[{"code":"44010","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1050,"discounted_cash":310.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":850.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":850.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":850.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":735,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210,"methodology":"fee schedule"}]}]},{"description":"INSERT NEEDLE CATH BOWEL","code_information":[{"code":"44015","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4402","type":"APR-DRG"}],"standard_charges":[{"minimum":31428,"maximum":31428,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31428,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31428,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31428,"methodology":"case rate"}]}]},{"description":"EXPLORE SMALL INTESTINE","code_information":[{"code":"44020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DECOMPRESS SMALL BOWEL","code_information":[{"code":"44021","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF LARGE BOWEL","code_information":[{"code":"44025","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4403","type":"APR-DRG"}],"standard_charges":[{"minimum":49334,"maximum":49334,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49334,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49334,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49334,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"4404","type":"APR-DRG"}],"standard_charges":[{"minimum":51651,"maximum":51651,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51651,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51651,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51651,"methodology":"case rate"}]}]},{"description":"REDUCE BOWEL OBSTRUCTION","code_information":[{"code":"44050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORRECT MALROTATION OF BOWEL","code_information":[{"code":"44055","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"minimum":10387,"maximum":28074,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16993,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16065,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10387,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18410,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17260,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26081.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20481,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24418,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19302,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27454.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28074,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17431,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17431,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10801,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15252.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16320.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15710.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16015.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16167.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16015.21,"methodology":"case rate"}]}]},{"description":"BIOPSY OF BOWEL","code_information":[{"code":"44100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2052.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4411","type":"APR-DRG"}],"standard_charges":[{"minimum":12061,"maximum":12061,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12061,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12061,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12061,"methodology":"case rate"}]}]},{"description":"EXCISE INTESTINE LESION(S)","code_information":[{"code":"44110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF BOWEL LESION(S)","code_information":[{"code":"44111","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4412","type":"APR-DRG"}],"standard_charges":[{"minimum":14497,"maximum":14497,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14497,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14497,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14497,"methodology":"case rate"}]}]},{"description":"HC ENTERECTOMY SM INTESTINE","code_information":[{"code":"44120","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9582.3,"maximum":9582.3,"gross_charge":11830,"discounted_cash":3501.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9582.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9582.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9582.3,"methodology":"fee schedule"}]}]},{"description":"HC ENTERECTOMY SM INTESTINE","code_information":[{"code":"44120","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9582.3,"gross_charge":11830,"discounted_cash":3501.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9582.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9582.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9582.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8281,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2247.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2366,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1774.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2366,"methodology":"fee schedule"}]}]},{"description":"HC ENTERECTOMY; EA ADDL ANAS","code_information":[{"code":"44121","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1602.18,"maximum":1602.18,"gross_charge":1978,"discounted_cash":585.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1602.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1602.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1602.18,"methodology":"fee schedule"}]}]},{"description":"HC ENTERECTOMY; EA ADDL ANAS","code_information":[{"code":"44121","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1978,"discounted_cash":585.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1602.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1602.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1602.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1384.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.6,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF SMALL INTESTINE","code_information":[{"code":"44125","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENTERECTOMY W/O TAPER CONG","code_information":[{"code":"44126","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENTERECTOMY W/TAPER CONG","code_information":[{"code":"44127","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENTERECTOMY CONG ADD-ON","code_information":[{"code":"44128","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4413","type":"APR-DRG"}],"standard_charges":[{"minimum":25133,"maximum":25133,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25133,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25133,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25133,"methodology":"case rate"}]}]},{"description":"BOWEL TO BOWEL FUSION","code_information":[{"code":"44130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENTERECTOMY CADAVER DONOR","code_information":[{"code":"44132","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENTERECTOMY LIVE DONOR","code_information":[{"code":"44133","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTESTINE TRANSPLNT CADAVER","code_information":[{"code":"44135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTESTINE TRANSPLANT LIVE","code_information":[{"code":"44136","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE INTESTINAL ALLOGRAFT","code_information":[{"code":"44137","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOBILIZATION OF COLON","code_information":[{"code":"44139","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR BLADDER PROCEDURES","code_information":[{"code":"4414","type":"APR-DRG"}],"standard_charges":[{"minimum":31396,"maximum":31396,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31396,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31396,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31396,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44143","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44144","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF COLON","code_information":[{"code":"44147","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC COLECTOMYTOTAL ABD.W/ILEO","code_information":[{"code":"44150","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6219.99,"maximum":6219.99,"gross_charge":7679,"discounted_cash":2272.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6219.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6219.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6219.99,"methodology":"fee schedule"}]}]},{"description":"HC COLECTOMYTOTAL ABD.W/ILEO","code_information":[{"code":"44150","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6219.99,"gross_charge":7679,"discounted_cash":2272.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6219.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6219.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6219.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5375.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1459.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1535.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1151.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1535.8,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF COLON/ILEOSTOMY","code_information":[{"code":"44151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF COLON/ILEOSTOMY","code_information":[{"code":"44155","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF COLON/ILEOSTOMY","code_information":[{"code":"44156","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COLECTOMY W/ILEOANAL ANAST","code_information":[{"code":"44157","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COLECTOMY W/NEO-RECTUM POUCH","code_information":[{"code":"44158","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF COLON","code_information":[{"code":"44160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP ENTEROLYSIS","code_information":[{"code":"44180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP JEJUNOSTOMY","code_information":[{"code":"44186","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP ILEO/JEJUNO-STOMY","code_information":[{"code":"44187","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP COLOSTOMY","code_information":[{"code":"44188","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":5406,"maximum":16767.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8685,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8211,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5406,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11039,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10350,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15929.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10225,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12191,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10046,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16767.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14349,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8909,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8909,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6508,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9315.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9967.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9594.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9781.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9874.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9781.26,"methodology":"case rate"}]}]},{"description":"LAP ENTERECTOMY","code_information":[{"code":"44202","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP RESECT S/INTESTINE ADDL","code_information":[{"code":"44203","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO PARTIAL COLECTOMY","code_information":[{"code":"44204","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP COLECTOMY PART W/ILEUM","code_information":[{"code":"44205","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP PART COLECTOMY W/STOMA","code_information":[{"code":"44206","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"L COLECTOMY/COLOPROCTOSTOMY","code_information":[{"code":"44207","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"L COLECTOMY/COLOPROCTOSTOMY","code_information":[{"code":"44208","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4421","type":"APR-DRG"}],"standard_charges":[{"minimum":8826,"maximum":8826,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8826,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8826,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8826,"methodology":"case rate"}]}]},{"description":"LAPARO TOTAL PROCTOCOLECTOMY","code_information":[{"code":"44210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP COLECTOMY W/PROCTECTOMY","code_information":[{"code":"44211","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO TOTAL PROCTOCOLECTOMY","code_information":[{"code":"44212","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP MOBIL SPLENIC FL ADD-ON","code_information":[{"code":"44213","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4422","type":"APR-DRG"}],"standard_charges":[{"minimum":11270,"maximum":11270,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11270,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11270,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11270,"methodology":"case rate"}]}]},{"description":"LAP CLOSE ENTEROSTOMY","code_information":[{"code":"44227","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4423","type":"APR-DRG"}],"standard_charges":[{"minimum":15991,"maximum":15991,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15991,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15991,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15991,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC INTESTINE","code_information":[{"code":"44238","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY","code_information":[{"code":"4424","type":"APR-DRG"}],"standard_charges":[{"minimum":29720,"maximum":29720,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29720,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29720,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29720,"methodology":"case rate"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"minimum":4048,"maximum":13720.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6317,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5972,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4060,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7765,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7280,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13034.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7046,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8401,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7546,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13720.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6480,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6480,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7622.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8156.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7851.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8003.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8080.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8003.89,"methodology":"case rate"}]}]},{"description":"OPEN BOWEL TO SKIN","code_information":[{"code":"44300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4431","type":"APR-DRG"}],"standard_charges":[{"minimum":8377,"maximum":8377,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8377,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8377,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8377,"methodology":"case rate"}]}]},{"description":"ILEOSTOMY/JEJUNOSTOMY","code_information":[{"code":"44310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF ILEOSTOMY","code_information":[{"code":"44312","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REVISION OF ILEOSTOMY","code_information":[{"code":"44314","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DEVISE BOWEL POUCH","code_information":[{"code":"44316","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4432","type":"APR-DRG"}],"standard_charges":[{"minimum":11816,"maximum":11816,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11816,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11816,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11816,"methodology":"case rate"}]}]},{"description":"COLOSTOMY","code_information":[{"code":"44320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COLOSTOMY WITH BIOPSIES","code_information":[{"code":"44322","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4433","type":"APR-DRG"}],"standard_charges":[{"minimum":22013,"maximum":22013,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22013,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22013,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22013,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY","code_information":[{"code":"4434","type":"APR-DRG"}],"standard_charges":[{"minimum":24698,"maximum":24698,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24698,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24698,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24698,"methodology":"case rate"}]}]},{"description":"REVISION OF COLOSTOMY","code_information":[{"code":"44340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8015.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8015.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5234.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5596.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3273.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3502.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3371.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3436.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3600.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3469.43,"methodology":"case rate"}]}]},{"description":"REVISION OF COLOSTOMY","code_information":[{"code":"44345","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF COLOSTOMY","code_information":[{"code":"44346","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY/BIOPSY","code_information":[{"code":"44361","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44363","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"HC ENTEROSCOPYREM BY SNARE","code_information":[{"code":"44364","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4893.21,"maximum":4893.21,"gross_charge":6041,"discounted_cash":1788.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4893.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4893.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4893.21,"methodology":"fee schedule"}]}]},{"description":"HC ENTEROSCOPYREM BY SNARE","code_information":[{"code":"44364","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4893.21,"gross_charge":6041,"discounted_cash":1788.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4893.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4893.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4893.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":906.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1208.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44365","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44366","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44369","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY/STENT","code_information":[{"code":"44370","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44372","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44373","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44376","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY/BIOPSY","code_information":[{"code":"44377","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44378","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"S BOWEL ENDOSCOPE W/STENT","code_information":[{"code":"44379","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY BR/WA","code_information":[{"code":"44380","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2052.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY BR/WA","code_information":[{"code":"44381","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44382","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2052.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"SMALL BOWEL ENDOSCOPY","code_information":[{"code":"44384","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"ENDOSCOPY OF BOWEL POUCH","code_information":[{"code":"44385","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"ENDOSCOPY BOWEL POUCH/BIOP","code_information":[{"code":"44386","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY THRU STOMA SPX","code_information":[{"code":"44388","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY WITH BIOPSY","code_information":[{"code":"44389","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY FOR FOREIGN BODY","code_information":[{"code":"44390","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY FOR BLEEDING","code_information":[{"code":"44391","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY  POLYPECTOMY","code_information":[{"code":"44392","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/SNARE","code_information":[{"code":"44394","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH MCC","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"minimum":9080,"maximum":25072.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15141,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14314,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9279,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20314,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19046,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23818.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17994,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21453,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17243,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25072.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25015,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15532,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15532,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9080,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13929.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14904.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14347.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14625.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14764.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14625.7,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY WITH ABLATION","code_information":[{"code":"44401","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"44402","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/RESECTION","code_information":[{"code":"44403","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/INJECTION","code_information":[{"code":"44404","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/DILATION","code_information":[{"code":"44405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/ULTRASOUND","code_information":[{"code":"44406","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/NDL ASPIR/BX","code_information":[{"code":"44407","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"44408","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4441","type":"APR-DRG"}],"standard_charges":[{"minimum":6145,"maximum":6145,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6145,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6145,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6145,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4442","type":"APR-DRG"}],"standard_charges":[{"minimum":9856,"maximum":9856,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9856,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9856,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9856,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4443","type":"APR-DRG"}],"standard_charges":[{"minimum":23158,"maximum":23158,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23158,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23158,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23158,"methodology":"case rate"}]}]},{"description":"RENAL DIALYSIS ACCESS DEVICE PROCEDURES AND VESSEL REPAIR","code_information":[{"code":"4444","type":"APR-DRG"}],"standard_charges":[{"minimum":24415,"maximum":24415,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24415,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24415,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24415,"methodology":"case rate"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH CC","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"minimum":6174,"maximum":18135.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9749,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9216,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6174,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16369,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15347,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17229.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11886,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14171,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11474,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18135.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16106,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10000,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10000,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6596,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10075.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10780.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10377.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10579.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10679.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10579.23,"methodology":"case rate"}]}]},{"description":"HC INTROD LONG GI TUBE","code_information":[{"code":"44500","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":912.87,"maximum":912.87,"gross_charge":1127,"discounted_cash":333.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":912.87,"methodology":"fee schedule"}]}]},{"description":"HC INTROD LONG GI TUBE","code_information":[{"code":"44500","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1127,"discounted_cash":333.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":788.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4451","type":"APR-DRG"}],"standard_charges":[{"minimum":8065,"maximum":8065,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8065,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8065,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8065,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4452","type":"APR-DRG"}],"standard_charges":[{"minimum":8985,"maximum":8985,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8985,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8985,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8985,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4453","type":"APR-DRG"}],"standard_charges":[{"minimum":11468,"maximum":11468,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11468,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11468,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11468,"methodology":"case rate"}]}]},{"description":"OTHER BLADDER PROCEDURES","code_information":[{"code":"4454","type":"APR-DRG"}],"standard_charges":[{"minimum":20300,"maximum":20300,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20300,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20300,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20300,"methodology":"case rate"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"minimum":4186,"maximum":14814.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7167,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6775,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4554,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12429,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11653,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14074.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8774,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10460,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8462,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14814.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11841,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7352,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7352,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4186,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8230.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8806.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8477.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8641.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8724.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8641.99,"methodology":"case rate"}]}]},{"description":"SUTURE SMALL INTESTINE","code_information":[{"code":"44602","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SUTURE SMALL INTESTINE","code_information":[{"code":"44603","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SUTURE LARGE INTESTINE","code_information":[{"code":"44604","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF BOWEL LESION","code_information":[{"code":"44605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4461","type":"APR-DRG"}],"standard_charges":[{"minimum":5490,"maximum":5490,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5490,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5490,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5490,"methodology":"case rate"}]}]},{"description":"INTESTINAL STRICTUROPLASTY","code_information":[{"code":"44615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4462","type":"APR-DRG"}],"standard_charges":[{"minimum":8502,"maximum":8502,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8502,"methodology":"case rate"}]}]},{"description":"REPAIR BOWEL OPENING","code_information":[{"code":"44620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BOWEL OPENING","code_information":[{"code":"44625","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BOWEL OPENING","code_information":[{"code":"44626","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4463","type":"APR-DRG"}],"standard_charges":[{"minimum":12911,"maximum":12911,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12911,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12911,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12911,"methodology":"case rate"}]}]},{"description":"URETHRAL AND TRANSURETHRAL PROCEDURES","code_information":[{"code":"4464","type":"APR-DRG"}],"standard_charges":[{"minimum":22119,"maximum":22119,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22119,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22119,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22119,"methodology":"case rate"}]}]},{"description":"REPAIR BOWEL-SKIN FISTULA","code_information":[{"code":"44640","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BOWEL FISTULA","code_information":[{"code":"44650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BOWEL-BLADDER FISTULA","code_information":[{"code":"44660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BOWEL-BLADDER FISTULA","code_information":[{"code":"44661","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL REVISION INTESTINE","code_information":[{"code":"44680","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"minimum":46179.84,"maximum":112222,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60268,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":56976,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":112222,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105216,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":78967.53,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":83123.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99572,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":61824,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61824,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46179.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49412.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47565.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48488.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48950.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":48488.84,"methodology":"case rate"}]}]},{"description":"SUSPEND BOWEL W/PROSTHESIS","code_information":[{"code":"44700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTRAOP COLON LAVAGE ADD-ON","code_information":[{"code":"44701","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREPARE FECAL MICROBIOTA","code_information":[{"code":"44705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":436.47,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4471","type":"APR-DRG"}],"standard_charges":[{"minimum":8194,"maximum":8194,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8194,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8194,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8194,"methodology":"case rate"}]}]},{"description":"PREPARE DONOR INTESTINE","code_information":[{"code":"44715","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4472","type":"APR-DRG"}],"standard_charges":[{"minimum":9658,"maximum":9658,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9658,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9658,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9658,"methodology":"case rate"}]}]},{"description":"PREP DONOR INTESTINE/VENOUS","code_information":[{"code":"44720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR INTESTINE/ARTERY","code_information":[{"code":"44721","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4473","type":"APR-DRG"}],"standard_charges":[{"minimum":13160,"maximum":13160,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13160,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13160,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13160,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY URINARY TRACT AND RELATED PROCEDURES","code_information":[{"code":"4474","type":"APR-DRG"}],"standard_charges":[{"minimum":28021,"maximum":28021,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28021,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28021,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28021,"methodology":"case rate"}]}]},{"description":"UNLISTED SMALL INTESTINE","code_information":[{"code":"44799","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2513.43,"maximum":2513.43,"gross_charge":3103,"discounted_cash":918.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2513.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2513.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2513.43,"methodology":"fee schedule"}]}]},{"description":"UNLISTED SMALL INTESTINE","code_information":[{"code":"44799","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3103,"discounted_cash":918.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2513.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2513.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2513.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2172.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"minimum":29341.14,"maximum":68349,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36706,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":34702,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68349,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64082,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50173.35,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":52814.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60644,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37654,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37654,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29341.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31395.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30221.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30808.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31101.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30808.2,"methodology":"case rate"}]}]},{"description":"EXCISION OF BOWEL POUCH","code_information":[{"code":"44800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF MESENTERY LESION","code_information":[{"code":"44820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF MESENTERY","code_information":[{"code":"44850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BOWEL SURGERY PROCEDURE","code_information":[{"code":"44899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAIN APPENDIX ABSCESS OPEN","code_information":[{"code":"44900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPENDECTOMY","code_information":[{"code":"44950","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13660.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"APPENDECTOMY ADD-ON","code_information":[{"code":"44955","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPENDECTOMY","code_information":[{"code":"44960","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPY APPENDECTOMY","code_information":[{"code":"44970","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC APP","code_information":[{"code":"44979","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"minimum":36193.02,"maximum":86201,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46294,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":43765,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":86201,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":80819,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61890.07,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":65147.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76484,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":47489,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47489,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36193.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38726.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":37278.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38002.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38364.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38002.68,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PELVIC ABSCESS","code_information":[{"code":"45000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF RECTAL ABSCESS","code_information":[{"code":"45005","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF RECTAL ABSCESS","code_information":[{"code":"45020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"minimum":22933.16,"maximum":51653,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27740,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26225,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51653,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48429,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39215.71,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41279.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45830,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28456,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28456,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22933.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24538.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23621.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24079.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24309.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24079.82,"methodology":"case rate"}]}]},{"description":"BIOPSY OF RECTUM","code_information":[{"code":"45100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ANORECTAL LESION","code_information":[{"code":"45108","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVAL OF RECTUM","code_information":[{"code":"45110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF RECTUM","code_information":[{"code":"45111","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF RECTUM","code_information":[{"code":"45112","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL PROCTECTOMY","code_information":[{"code":"45113","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF RECTUM","code_information":[{"code":"45114","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF RECTUM","code_information":[{"code":"45116","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE RECTUM W/RESERVOIR","code_information":[{"code":"45119","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF RECTUM","code_information":[{"code":"45120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF RECTUM AND COLON","code_information":[{"code":"45121","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL PROCTECTOMY","code_information":[{"code":"45123","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PELVIC EXENTERATION","code_information":[{"code":"45126","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF RECTAL PROLAPSE","code_information":[{"code":"45130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF RECTAL PROLAPSE","code_information":[{"code":"45135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISE ILEOANAL RESERVIOR","code_information":[{"code":"45136","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF RECTAL STRICTURE","code_information":[{"code":"45150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"EXCISION OF RECTAL LESION","code_information":[{"code":"45160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"EXC RECT TUM TRANSANAL PART","code_information":[{"code":"45171","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"EXC RECT TUM TRANSANAL FULL","code_information":[{"code":"45172","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"DESTRUCTION RECTAL TUMOR","code_information":[{"code":"45190","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"minimum":50345,"maximum":117978,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":50345,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":98954,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":117978,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93559,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54251,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY DX","code_information":[{"code":"45300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY DILATE","code_information":[{"code":"45303","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY W/BX","code_information":[{"code":"45305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY FB","code_information":[{"code":"45307","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY REMOVAL","code_information":[{"code":"45308","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY REMOVAL","code_information":[{"code":"45309","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY REMOVAL","code_information":[{"code":"45315","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY BLEED","code_information":[{"code":"45317","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY ABLATE","code_information":[{"code":"45320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY VOLVUL","code_information":[{"code":"45321","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"PROCTOSIGMOIDOSCOPY W/STENT","code_information":[{"code":"45327","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"DIAGNOSTIC SIGMOIDOSCOPY","code_information":[{"code":"45330","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY AND BIOPSY","code_information":[{"code":"45331","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/FB REMOVAL","code_information":[{"code":"45332","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY  POLYPECTOMY","code_information":[{"code":"45333","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY FOR BLEEDING","code_information":[{"code":"45334","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/SUBMUC INJ","code_information":[{"code":"45335","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY  DECOMPRESS","code_information":[{"code":"45337","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/TUMR REMOVE","code_information":[{"code":"45338","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SIG W/TNDSC BALLOON DILATION","code_information":[{"code":"45340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/ULTRASOUND","code_information":[{"code":"45341","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/US GUIDE BX","code_information":[{"code":"45342","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/ABLATION","code_information":[{"code":"45346","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/PLCMT STENT","code_information":[{"code":"45347","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"SIGMOIDOSCOPY W/RESECTION","code_information":[{"code":"45349","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"SGMDSC W/BAND LIGATION","code_information":[{"code":"45350","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"DIAGNOSTIC COLONOSCOPY","code_information":[{"code":"45378","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/FB REMOVAL","code_information":[{"code":"45379","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY AND BIOPSY","code_information":[{"code":"45380","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY SUBMUCOUS NJX","code_information":[{"code":"45381","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/CONTROL BLEED","code_information":[{"code":"45382","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/LESION REMOVAL","code_information":[{"code":"45384","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/LESION REMOVAL","code_information":[{"code":"45385","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/BALLOON DILAT","code_information":[{"code":"45386","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/ABLATION","code_information":[{"code":"45388","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/STENT PLCMT","code_information":[{"code":"45389","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":13032.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13032.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8315.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9100.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5322.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5694.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5481.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5588.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5854.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5641.37,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/RESECTION","code_information":[{"code":"45390","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/ENDOSCOPE US","code_information":[{"code":"45391","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/ENDOSCOPIC FNB","code_information":[{"code":"45392","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"COLONOSCOPY W/DECOMPRESSION","code_information":[{"code":"45393","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"LAP REMOVAL OF RECTUM","code_information":[{"code":"45395","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP REMOVE RECTUM W/POUCH","code_information":[{"code":"45397","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COLONOSCOPY W/BAND LIGATION","code_information":[{"code":"45398","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"UNLISTED PROCEDURE COLON","code_information":[{"code":"45399","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3492,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"minimum":31689,"maximum":78493,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34749,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65837,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78493,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64576,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31689,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC PROC","code_information":[{"code":"45400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP PROCTOPEXY W/SIG RESECT","code_information":[{"code":"45402","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPE PROC RECTUM","code_information":[{"code":"45499","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"minimum":26166,"maximum":61703,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26166,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51753,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61703,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48626,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29167,"methodology":"case rate"}]}]},{"description":"REPAIR OF RECTUM","code_information":[{"code":"45500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR OF RECTUM","code_information":[{"code":"45505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RECTAL PROLAPSE","code_information":[{"code":"45520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"CORRECT RECTAL PROLAPSE","code_information":[{"code":"45540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORRECT RECTAL PROLAPSE","code_information":[{"code":"45541","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR RECTUM/REMOVE SIGMOID","code_information":[{"code":"45550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF RECTOCELE","code_information":[{"code":"45560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"EXPLORATION/REPAIR OF RECTUM","code_information":[{"code":"45562","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION/REPAIR OF RECTUM","code_information":[{"code":"45563","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE MALIGNANCY INFECTION OR EXTENSIVE FUSIONS WITH MCC","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"minimum":47890,"maximum":206961,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76129,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":71971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":47890,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":206961,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":194041,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":98350.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":91327,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":108885,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":88998,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":103527.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125777,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":78094,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78094,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66591,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":57515.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":61541.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":59240.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":60390.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":60965.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":60390.81,"methodology":"case rate"}]}]},{"description":"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE MALIGNANCY INFECTION OR EXTENSIVE FUSIONS WITH CC","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"minimum":34516,"maximum":129726,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51591,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":48773,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34516,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129726,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":121627,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":68363.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65252,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":77796,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64143,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":71961.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85236,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":52923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52923,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46717,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":39978.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":42777.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":41178.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":41977.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42377.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":41977.65,"methodology":"case rate"}]}]},{"description":"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE MALIGNANCY INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"minimum":25742,"maximum":108770,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38814,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":36694,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25742,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":108770,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":101980,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52749.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52025,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62026,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47838,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":55525.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64127,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":39816,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39816,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44830,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30847.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33006.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31773.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32389.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32698.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32389.96,"methodology":"case rate"}]}]},{"description":"REPAIR RECT/BLADDER FISTULA","code_information":[{"code":"45800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR FISTULA W/COLOSTOMY","code_information":[{"code":"45805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR RECTOURETHRAL FISTULA","code_information":[{"code":"45820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR FISTULA W/COLOSTOMY","code_information":[{"code":"45825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"minimum":37680,"maximum":85479,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37680,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":71696,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85479,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":70024,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53469,"methodology":"case rate"}]}]},{"description":"REDUCTION OF RECTAL PROLAPSE","code_information":[{"code":"45900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"DILATION OF ANAL SPHINCTER","code_information":[{"code":"45905","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"DILATION OF RECTAL NARROWING","code_information":[{"code":"45910","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"REMOVE RECTAL OBSTRUCTION","code_information":[{"code":"45915","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"SURG DX EXAM ANORECTAL","code_information":[{"code":"45990","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"RECTUM SURGERY PROCEDURE","code_information":[{"code":"45999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"minimum":20782,"maximum":48532,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40707,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48532,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38620,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23879,"methodology":"case rate"}]}]},{"description":"PLACEMENT OF SETON","code_information":[{"code":"46020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVAL OF RECTAL MARKER","code_information":[{"code":"46030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"INCISION OF RECTAL ABSCESS","code_information":[{"code":"46040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"INCISION OF RECTAL ABSCESS","code_information":[{"code":"46045","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"I&D PERIANAL ABSCESS","code_information":[{"code":"46050","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2519.91,"maximum":2519.91,"gross_charge":3111,"discounted_cash":920.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2519.91,"methodology":"fee schedule"}]}]},{"description":"I&D PERIANAL ABSCESS","code_information":[{"code":"46050","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2519.91,"gross_charge":3111,"discounted_cash":920.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"INCISION OF RECTAL ABSCESS","code_information":[{"code":"46060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"INCISION OF ANAL SEPTUM","code_information":[{"code":"46070","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"INCISION OF ANAL SPHINCTER","code_information":[{"code":"46080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"INCIS/ENGORG EXTER HEMORRHOID","code_information":[{"code":"46083","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":749.25,"maximum":749.25,"gross_charge":925,"discounted_cash":273.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":749.25,"methodology":"fee schedule"}]}]},{"description":"INCIS/ENGORG EXTER HEMORRHOID","code_information":[{"code":"46083","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":925,"discounted_cash":273.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":647.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":185,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"minimum":23737,"maximum":91136,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55163,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":52150,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38738,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":64186,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60179,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":72727.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69342,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":82673,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":71990,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":76555.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91136,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":56587,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56587,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23737,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42530.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45508.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43806.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44657.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45082.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44657.53,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4611","type":"APR-DRG"}],"standard_charges":[{"minimum":4603,"maximum":4603,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4603,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4603,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4603,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4612","type":"APR-DRG"}],"standard_charges":[{"minimum":5258,"maximum":5258,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5258,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5258,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5258,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4613","type":"APR-DRG"}],"standard_charges":[{"minimum":8115,"maximum":8115,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT MALIGNANCY","code_information":[{"code":"4614","type":"APR-DRG"}],"standard_charges":[{"minimum":10439,"maximum":10439,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10439,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10439,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10439,"methodology":"case rate"}]}]},{"description":"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"minimum":16171,"maximum":51879,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25743,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24337,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16171,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51879,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48640,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36774.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32271,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38475,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30051,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38710.34,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42530,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26407,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23737,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21505.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23011.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22150.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22581.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22796.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22581.03,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ANAL FISSURE","code_information":[{"code":"46200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4621","type":"APR-DRG"}],"standard_charges":[{"minimum":4469,"maximum":4469,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4469,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4469,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4469,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4622","type":"APR-DRG"}],"standard_charges":[{"minimum":5833,"maximum":5833,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5833,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5833,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5833,"methodology":"case rate"}]}]},{"description":"EXCISE ANAL EXT TAG/PAPILLA","code_information":[{"code":"46220","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2581.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"HC HEMORR INTBY LIGATION","code_information":[{"code":"46221","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2553.12,"maximum":2553.12,"gross_charge":3152,"discounted_cash":933,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2553.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2553.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2553.12,"methodology":"fee schedule"}]}]},{"description":"HC HEMORR INTBY LIGATION","code_information":[{"code":"46221","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3152,"discounted_cash":933,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2553.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2553.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2553.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2206.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4623","type":"APR-DRG"}],"standard_charges":[{"minimum":8022,"maximum":8022,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8022,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8022,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8022,"methodology":"case rate"}]}]},{"description":"REMOVAL OF ANAL TAGS","code_information":[{"code":"46230","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"NEPHRITIS AND NEPHROSIS","code_information":[{"code":"4624","type":"APR-DRG"}],"standard_charges":[{"minimum":19147,"maximum":19147,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19147,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19147,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19147,"methodology":"case rate"}]}]},{"description":"REMOVE EXT HEM GROUPS 2+","code_information":[{"code":"46250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE INT/EXT HEM 1 GROUP","code_information":[{"code":"46255","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE IN/EX HEM GRP  FISS","code_information":[{"code":"46257","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE IN/EX HEM GRP W/FISTU","code_information":[{"code":"46258","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE IN/EX HEM GROUPS 2+","code_information":[{"code":"46260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE IN/EX HEM GRPS  FISS","code_information":[{"code":"46261","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE IN/EX HEM GRPS W/FIST","code_information":[{"code":"46262","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE ANAL FIST SUBQ","code_information":[{"code":"46270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE ANAL FIST INTER","code_information":[{"code":"46275","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE ANAL FIST COMPLEX","code_information":[{"code":"46280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVE ANAL FIST 2 STAGE","code_information":[{"code":"46285","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR ANAL FISTULA","code_information":[{"code":"46288","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"minimum":32177,"maximum":80211,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48549,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":45898,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32177,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":70861,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":66437,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64646.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56656,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67548,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59797,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":68048.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80211,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49803,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49803,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34325,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37804.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40451.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38938.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39695.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40073.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39695.07,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4631","type":"APR-DRG"}],"standard_charges":[{"minimum":3957,"maximum":3957,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3957,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3957,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3957,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4632","type":"APR-DRG"}],"standard_charges":[{"minimum":5598,"maximum":5598,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5598,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5598,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5598,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HEMORRHOID CLOT","code_information":[{"code":"46320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4633","type":"APR-DRG"}],"standard_charges":[{"minimum":8738,"maximum":8738,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8738,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8738,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8738,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS","code_information":[{"code":"4634","type":"APR-DRG"}],"standard_charges":[{"minimum":9500,"maximum":9500,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9500,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9500,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9500,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"minimum":17052,"maximum":47033,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26505,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":25057,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17052,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47033,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44097,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37706.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32289,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38496,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31689,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39690.9,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43790,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27189,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17891,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22050.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23594.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22712.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23153.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23373.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23153.03,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"minimum":8719,"maximum":37472,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15606,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14753,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10629,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37472,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35133,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24386.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21539,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25680,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19752,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25670.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25783,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16009,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16009,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8719,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14261.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15259.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14689.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14974.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15117.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14974.42,"methodology":"case rate"}]}]},{"description":"INJECTION INTO HEMORRHOID(S)","code_information":[{"code":"46500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"CHEMODENERVATION ANAL MUSC","code_information":[{"code":"46505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4651","type":"APR-DRG"}],"standard_charges":[{"minimum":4673,"maximum":4673,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4673,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4673,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4673,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4652","type":"APR-DRG"}],"standard_charges":[{"minimum":5443,"maximum":5443,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5443,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5443,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5443,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4653","type":"APR-DRG"}],"standard_charges":[{"minimum":7269,"maximum":7269,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7269,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7269,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7269,"methodology":"case rate"}]}]},{"description":"URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION","code_information":[{"code":"4654","type":"APR-DRG"}],"standard_charges":[{"minimum":9107,"maximum":9107,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9107,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9107,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9107,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"minimum":19296,"maximum":75660,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45795,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":43294,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29467,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59269,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55569,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61280.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56694,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67594,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54760,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":64505.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75660,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46977,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46977,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19296,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35836.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38345.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36911.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37628.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37986.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37628.32,"methodology":"case rate"}]}]},{"description":"DIAGNOSTIC ANOSCOPY SPX","code_information":[{"code":"46600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"DIAGNOSTIC ANOSCOPY","code_information":[{"code":"46601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"ANOSCOPY AND DILATION","code_information":[{"code":"46604","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"ANOSCOPY AND BIOPSY","code_information":[{"code":"46606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"DIAGNOSTIC ANOSCOPY  BIOPSY","code_information":[{"code":"46607","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"ANOSCOPY REMOVE FOR BODY","code_information":[{"code":"46608","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4661","type":"APR-DRG"}],"standard_charges":[{"minimum":3658,"maximum":3658,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3658,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3658,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3658,"methodology":"case rate"}]}]},{"description":"ANOSCOPY REMOVE LESION","code_information":[{"code":"46610","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"ANOSCOPY","code_information":[{"code":"46611","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1996.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"ANOSCOPY REMOVE LESIONS","code_information":[{"code":"46612","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"ANOSCOPY CONTROL BLEEDING","code_information":[{"code":"46614","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"ANOSCOPY","code_information":[{"code":"46615","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4662","type":"APR-DRG"}],"standard_charges":[{"minimum":6246,"maximum":6246,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6246,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6246,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6246,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4663","type":"APR-DRG"}],"standard_charges":[{"minimum":9262,"maximum":9262,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9262,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9262,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9262,"methodology":"case rate"}]}]},{"description":"MALFUNCTION REACTION COMPLICATION OF GENITOURINARY DEVICE OR PROCEDURE","code_information":[{"code":"4664","type":"APR-DRG"}],"standard_charges":[{"minimum":17194,"maximum":17194,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17194,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17194,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17194,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITH CC","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"minimum":17492,"maximum":51208,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30789,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29107,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19807,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51208,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48011,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42941.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39192,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46727,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36808,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45201.96,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50868,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31584,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31584,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17492,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25112.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26870.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25865.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26367.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26618.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26367.81,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANAL STRICTURE","code_information":[{"code":"46700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANAL STRICTURE","code_information":[{"code":"46705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPR OF ANAL FISTULA W/GLUE","code_information":[{"code":"46706","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR ANORECTAL FIST W/PLUG","code_information":[{"code":"46707","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPR PER/VAG POUCH SNGL PROC","code_information":[{"code":"46710","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPR PER/VAG POUCH DBL PROC","code_information":[{"code":"46712","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REP PERF ANOPER FISTU","code_information":[{"code":"46715","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REP PERF ANOPER/VESTIB FISTU","code_information":[{"code":"46716","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONSTRUCTION OF ABSENT ANUS","code_information":[{"code":"46730","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONSTRUCTION OF ABSENT ANUS","code_information":[{"code":"46735","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONSTRUCTION OF ABSENT ANUS","code_information":[{"code":"46740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF IMPERFORATED ANUS","code_information":[{"code":"46742","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF CLOACAL ANOMALY","code_information":[{"code":"46744","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF CLOACAL ANOMALY","code_information":[{"code":"46746","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF CLOACAL ANOMALY","code_information":[{"code":"46748","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46751","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCTION OF ANUS","code_information":[{"code":"46753","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SUTURE FROM ANUS","code_information":[{"code":"46754","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46760","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REPAIR OF ANAL SPHINCTER","code_information":[{"code":"46761","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"minimum":14041,"maximum":46134,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23581,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22293,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15167,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46134,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43254,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34132.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30150,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35946,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28186,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35929.37,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38959,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24189,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14041,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19960.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21358.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20559.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20958.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21158.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20958.8,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4681","type":"APR-DRG"}],"standard_charges":[{"minimum":3722,"maximum":3722,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3722,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3722,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3722,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4682","type":"APR-DRG"}],"standard_charges":[{"minimum":6098,"maximum":6098,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6098,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6098,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6098,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4683","type":"APR-DRG"}],"standard_charges":[{"minimum":11003,"maximum":11003,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11003,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11003,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11003,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES SIGNS AND SYMPTOMS","code_information":[{"code":"4684","type":"APR-DRG"}],"standard_charges":[{"minimum":11118,"maximum":11118,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11118,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11118,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11118,"methodology":"case rate"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"minimum":17113,"maximum":53192,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29382,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27777,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18918,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53192,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49871,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41222.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34928,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41643,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35156,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":43392.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48544,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30141,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30141,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17113,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24106.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25794.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24830.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25312.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25553.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25312.18,"methodology":"case rate"}]}]},{"description":"DESTRUCTION ANAL LESION(S)","code_information":[{"code":"46900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4691","type":"APR-DRG"}],"standard_charges":[{"minimum":4055,"maximum":4055,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4055,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4055,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4055,"methodology":"case rate"}]}]},{"description":"DESTRUCTION ANAL LESION(S)","code_information":[{"code":"46910","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"CRYOSURGERY ANAL LESION(S)","code_information":[{"code":"46916","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"LASER SURGERY ANAL LESIONS","code_information":[{"code":"46917","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4692","type":"APR-DRG"}],"standard_charges":[{"minimum":5987,"maximum":5987,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5987,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5987,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5987,"methodology":"case rate"}]}]},{"description":"EXCISION OF ANAL LESION(S)","code_information":[{"code":"46922","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"DESTRUCTION ANAL LESION(S)","code_information":[{"code":"46924","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4693","type":"APR-DRG"}],"standard_charges":[{"minimum":11074,"maximum":11074,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11074,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11074,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11074,"methodology":"case rate"}]}]},{"description":"DESTROY INTERNAL HEMORRHOIDS","code_information":[{"code":"46930","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3492,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"ACUTE KIDNEY INJURY","code_information":[{"code":"4694","type":"APR-DRG"}],"standard_charges":[{"minimum":27186,"maximum":27186,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27186,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27186,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27186,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANAL FISSURE","code_information":[{"code":"46940","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"TREATMENT OF ANAL FISSURE","code_information":[{"code":"46942","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"INT HRHC LIG 1 HROID W/O IMG","code_information":[{"code":"46945","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"HC HEMORRINT 2 OR MORE","code_information":[{"code":"46946","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":7588.08,"maximum":7588.08,"gross_charge":9368,"discounted_cash":2772.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7588.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7588.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7588.08,"methodology":"fee schedule"}]}]},{"description":"HC HEMORRINT 2 OR MORE","code_information":[{"code":"46946","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7588.08,"gross_charge":9368,"discounted_cash":2772.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7588.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7588.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7588.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1779.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1873.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1405.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1873.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"HEMORRHOIDOPEXY BY STAPLING","code_information":[{"code":"46947","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"INT HRHC TRANAL DARTLZJ 2+","code_information":[{"code":"46948","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6003.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6003.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4096.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4192.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2451.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2623.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2525.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2574.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2696.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2598.92,"methodology":"case rate"}]}]},{"description":"ANUS SURGERY PROCEDURE","code_information":[{"code":"46999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1996.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1333.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1393.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":815.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":872.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":839.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":855.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":896.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":864.02,"methodology":"case rate"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"minimum":10691,"maximum":44757,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16949,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16023,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10691,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44757,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41963,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26028.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20666,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24639,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19867,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27397.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28002,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17386,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17386,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12883,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15221.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16286.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15677.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15982.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16134.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15982.16,"methodology":"case rate"}]}]},{"description":"HC NEEDLE BX PERCUT LIVER","code_information":[{"code":"47000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2324.7,"maximum":2324.7,"gross_charge":2870,"discounted_cash":849.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2324.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2324.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2324.7,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BX PERCUT LIVER","code_information":[{"code":"47000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"gross_charge":2870,"discounted_cash":849.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2324.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2324.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2324.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":574,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":574,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"NEEDLE BIOPSY LIVER ADD-ON","code_information":[{"code":"47001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4701","type":"APR-DRG"}],"standard_charges":[{"minimum":3575,"maximum":3575,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3575,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3575,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3575,"methodology":"case rate"}]}]},{"description":"OPEN DRAINAGE LIVER LESION","code_information":[{"code":"47010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INJECT/ASPIRATE LIVER CYST","code_information":[{"code":"47015","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4702","type":"APR-DRG"}],"standard_charges":[{"minimum":7070,"maximum":7070,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7070,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7070,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7070,"methodology":"case rate"}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4703","type":"APR-DRG"}],"standard_charges":[{"minimum":9358,"maximum":9358,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9358,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9358,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9358,"methodology":"case rate"}]}]},{"description":"CHRONIC KIDNEY DISEASE","code_information":[{"code":"4704","type":"APR-DRG"}],"standard_charges":[{"minimum":18298,"maximum":18298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18298,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18298,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18298,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION WITH MCC","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"minimum":20090,"maximum":101726,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43662,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":41277,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27947,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":101726,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":95376,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":58673.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54445,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64912,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51935,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":61761.71,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72136,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":44789,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44789,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20090,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":34312.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36713.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":35341.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36027.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36370.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":36027.67,"methodology":"case rate"}]}]},{"description":"WEDGE BIOPSY OF LIVER","code_information":[{"code":"47100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LIVER","code_information":[{"code":"47120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE REMOVAL OF LIVER","code_information":[{"code":"47122","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LIVER","code_information":[{"code":"47125","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF LIVER","code_information":[{"code":"47130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF DONOR LIVER","code_information":[{"code":"47133","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION OF LIVER","code_information":[{"code":"47135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL DONOR LIVER","code_information":[{"code":"47140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL DONOR LIVER","code_information":[{"code":"47141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL DONOR LIVER","code_information":[{"code":"47142","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR LIVER WHOLE","code_information":[{"code":"47143","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR LIVER 3-SEGMENT","code_information":[{"code":"47144","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR LIVER LOBE SPLIT","code_information":[{"code":"47145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR LIVER/VENOUS","code_information":[{"code":"47146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR LIVER/ARTERIAL","code_information":[{"code":"47147","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CERVICAL SPINAL FUSION WITH CC","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"minimum":15519,"maximum":61641,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26043,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24620,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16791,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61641,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57793,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37141.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33194,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39576,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31203,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39096.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43026,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26715,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26715,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15519,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21720.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23240.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22371.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22806.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23023.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22806.32,"methodology":"case rate"}]}]},{"description":"CERVICAL SPINAL FUSION WITHOUT CC/MCC","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"minimum":12034,"maximum":40882,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21281,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20118,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13980,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40882,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38329,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31321.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27402,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32670,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25979,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32970.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35158,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21830,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21830,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12034,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18316.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19599.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18866.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19232.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19415.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19232.7,"methodology":"case rate"}]}]},{"description":"SURGERY FOR LIVER LESION","code_information":[{"code":"47300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47350","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47361","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR LIVER WOUND","code_information":[{"code":"47362","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO ABLATE LIVER TUMOR RF","code_information":[{"code":"47370","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO ABLATE LIVER CRYOSURG","code_information":[{"code":"47371","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROCEDURE LIVER","code_information":[{"code":"47379","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"OPEN ABLATE LIVER TUMOR RF","code_information":[{"code":"47380","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN ABLATE LIVER TUMOR CRYO","code_information":[{"code":"47381","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PERC ABLATE 1+ LIVER TUMOR","code_information":[{"code":"47382","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5335.47,"maximum":5335.47,"gross_charge":6587,"discounted_cash":1949.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5335.47,"methodology":"fee schedule"}]}]},{"description":"HC PERC ABLATE 1+ LIVER TUMOR","code_information":[{"code":"47382","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"gross_charge":6587,"discounted_cash":1949.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4610.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1251.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"PERQ ABLTJ LVR CRYOABLATION","code_information":[{"code":"47383","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LIVER SURGERY PROCEDURE","code_information":[{"code":"47399","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"minimum":20766,"maximum":88638,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40313,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38111,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24446,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88638,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":83104,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":54580.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44283,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52797,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45429,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":57453.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66603,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41353,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41353,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20766,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31918.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34152.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32876.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":33514.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":33833.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":33514.4,"methodology":"case rate"}]}]},{"description":"INCISION OF LIVER DUCT","code_information":[{"code":"47400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF BILE DUCT","code_information":[{"code":"47420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF BILE DUCT","code_information":[{"code":"47425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE BILE DUCT SPHINCTER","code_information":[{"code":"47460","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF GALLBLADDER","code_information":[{"code":"47480","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PERC CHOLECYSTOSTOMY","code_information":[{"code":"47490","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5386.5,"maximum":5386.5,"gross_charge":6650,"discounted_cash":1968.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5386.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5386.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5386.5,"methodology":"fee schedule"}]}]},{"description":"HC PERC CHOLECYSTOSTOMY","code_information":[{"code":"47490","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":6650,"discounted_cash":1968.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5386.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5386.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5386.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4655,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1263.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1330,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":997.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1330,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"minimum":12185,"maximum":53622,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19392,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18333,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12185,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53622,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50274,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29013.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24009,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28625,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22644,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30540.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32038,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19892,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19892,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13149,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16967.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18154.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17476.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17815.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17985.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17815.52,"methodology":"case rate"}]}]},{"description":"HC INJ FOR CHOLEANGIOGRAM EXIST ACCESS","code_information":[{"code":"47531","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1180.98,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"}]}]},{"description":"HC INJ FOR CHOLEANGIOGRAM EXIST ACCESS","code_information":[{"code":"47531","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":1458,"discounted_cash":431.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC INJ FOR CHOLEANGIOGRAM NEW ACCESS","code_information":[{"code":"47532","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":6084.72,"maximum":6084.72,"gross_charge":7512,"discounted_cash":2223.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6084.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6084.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6084.72,"methodology":"fee schedule"}]}]},{"description":"HC INJ FOR CHOLEANGIOGRAM NEW ACCESS","code_information":[{"code":"47532","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":7512,"discounted_cash":2223.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6084.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6084.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6084.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1427.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1502.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1126.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1502.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC PLMT BILIARY DRAINAGE CATH EXT","code_information":[{"code":"47533","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5317.65,"maximum":5317.65,"gross_charge":6565,"discounted_cash":1943.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5317.65,"methodology":"fee schedule"}]}]},{"description":"HC PLMT BILIARY DRAINAGE CATH EXT","code_information":[{"code":"47533","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":6565,"discounted_cash":1943.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC PLMT BILIARY DRAINAGE CATH INT","code_information":[{"code":"47534","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5317.65,"maximum":5317.65,"gross_charge":6565,"discounted_cash":1943.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5317.65,"methodology":"fee schedule"}]}]},{"description":"HC PLMT BILIARY DRAINAGE CATH INT","code_information":[{"code":"47534","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":6565,"discounted_cash":1943.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5317.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC CONVERSION EXT BIL DRG CATH","code_information":[{"code":"47535","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7292.43,"maximum":7292.43,"gross_charge":9003,"discounted_cash":2664.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7292.43,"methodology":"fee schedule"}]}]},{"description":"HC CONVERSION EXT BIL DRG CATH","code_information":[{"code":"47535","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":9003,"discounted_cash":2664.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1710.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC EXCHANGE BIL DRG CATH","code_information":[{"code":"47536","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7292.43,"maximum":7292.43,"gross_charge":9003,"discounted_cash":2664.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7292.43,"methodology":"fee schedule"}]}]},{"description":"HC EXCHANGE BIL DRG CATH","code_information":[{"code":"47536","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"gross_charge":9003,"discounted_cash":2664.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7292.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1710.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC REMOVE BIL DRG CATH","code_information":[{"code":"47537","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1604.61,"maximum":1604.61,"gross_charge":1981,"discounted_cash":586.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1604.61,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE BIL DRG CATH","code_information":[{"code":"47537","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1981,"discounted_cash":586.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC PERQ PLMT BILE DUCT STNT EXIST ACCESS","code_information":[{"code":"47538","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11494.71,"maximum":11494.71,"gross_charge":14191,"discounted_cash":4200.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11494.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11494.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11494.71,"methodology":"fee schedule"}]}]},{"description":"HC PERQ PLMT BILE DUCT STNT EXIST ACCESS","code_information":[{"code":"47538","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"gross_charge":14191,"discounted_cash":4200.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11494.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11494.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11494.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2696.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2838.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2128.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2838.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"HC PERQ PLMT BILE DUCT STNT NEW ACCESS WO CATH","code_information":[{"code":"47539","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4597.56,"maximum":4597.56,"gross_charge":5676,"discounted_cash":1680.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"}]}]},{"description":"HC PERQ PLMT BILE DUCT STNT NEW ACCESS WO CATH","code_information":[{"code":"47539","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"gross_charge":5676,"discounted_cash":1680.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"HC PERQ PLMT BILE DUCT STNT NEW ACCESS W CATH","code_information":[{"code":"47540","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4597.56,"maximum":4597.56,"gross_charge":5676,"discounted_cash":1680.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"}]}]},{"description":"HC PERQ PLMT BILE DUCT STNT NEW ACCESS W CATH","code_information":[{"code":"47540","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"gross_charge":5676,"discounted_cash":1680.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4597.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1135.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"HC BIL ACCESS FOR RENDEZVOUS","code_information":[{"code":"47541","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9899.01,"maximum":9899.01,"gross_charge":12221,"discounted_cash":3617.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9899.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9899.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9899.01,"methodology":"fee schedule"}]}]},{"description":"HC BIL ACCESS FOR RENDEZVOUS","code_information":[{"code":"47541","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13660.85,"gross_charge":12221,"discounted_cash":3617.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9899.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9899.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9899.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2321.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2444.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1833.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2444.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"HC DILATE BILIARY DUCT/AMPULLA","code_information":[{"code":"47542","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":507.06,"maximum":507.06,"gross_charge":626,"discounted_cash":185.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"}]}]},{"description":"HC DILATE BILIARY DUCT/AMPULLA","code_information":[{"code":"47542","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":626,"discounted_cash":185.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":300.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":350.56,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"}]}]},{"description":"HC ENDOLUMINAL BX BILARY TREE","code_information":[{"code":"47543","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":507.06,"maximum":507.06,"gross_charge":626,"discounted_cash":185.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"}]}]},{"description":"HC ENDOLUMINAL BX BILARY TREE","code_information":[{"code":"47543","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":626,"discounted_cash":185.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":300.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":350.56,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.2,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE DUCT GLBLDR CALCULI","code_information":[{"code":"47544","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":695.79,"maximum":695.79,"gross_charge":859,"discounted_cash":254.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":695.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":695.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":695.79,"methodology":"fee schedule"}]}]},{"description":"HC REMOVE DUCT GLBLDR CALCULI","code_information":[{"code":"47544","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":859,"discounted_cash":254.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":695.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":695.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":695.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":412.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":481.04,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.8,"methodology":"fee schedule"}]}]},{"description":"BILE DUCT ENDOSCOPY ADD-ON","code_information":[{"code":"47550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BILIARY ENDO PERQ DX W/SPECI","code_information":[{"code":"47552","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13660.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47553","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13660.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47554","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"BILIARY ENDOSCOPY THRU SKIN","code_information":[{"code":"47556","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY","code_information":[{"code":"47562","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6716,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7802,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6757,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO CHOLECYSTECTOMY/GRAPH","code_information":[{"code":"47563","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6716,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7802,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6757,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO CHOLECYSTECTOMY/EXPLR","code_information":[{"code":"47564","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6716,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7802,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6757,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO CHOLECYSTOENTEROSTOMY","code_information":[{"code":"47570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPE PROC BILIARY","code_information":[{"code":"47579","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"minimum":5700,"maximum":28120,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10455,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9884,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6686,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28120,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26364,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18092.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13268,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15819,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12426,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19044.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17273,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10725,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10725,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5700,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10580.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11321.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10897.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11109.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11215.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11109.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF GALLBLADDER","code_information":[{"code":"47620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"minimum":16717,"maximum":71122,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30913,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29225,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19140,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":71122,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":66682,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43093.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36781,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43852,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35570,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45361.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51073,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31711,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31711,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16717,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25200.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26964.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25956.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26460.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26712.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26460.9,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF BILE DUCTS","code_information":[{"code":"47700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BILE DUCT REVISION","code_information":[{"code":"47701","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF BILE DUCT TUMOR","code_information":[{"code":"47711","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF BILE DUCT TUMOR","code_information":[{"code":"47712","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF BILE DUCT CYST","code_information":[{"code":"47715","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE GALLBLADDER  BOWEL","code_information":[{"code":"47720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE UPPER GI STRUCTURES","code_information":[{"code":"47721","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE GALLBLADDER  BOWEL","code_information":[{"code":"47740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE GALLBLADDER  BOWEL","code_information":[{"code":"47741","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE BILE DUCTS AND BOWEL","code_information":[{"code":"47760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE LIVER DUCTS  BOWEL","code_information":[{"code":"47765","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE BILE DUCTS AND BOWEL","code_information":[{"code":"47780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE BILE DUCTS AND BOWEL","code_information":[{"code":"47785","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"minimum":13376,"maximum":53126,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21022,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19873,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13543,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53126,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49810,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31005.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25389,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30270,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25167,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32637.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34731,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21564,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21564,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13376,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18131.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19401.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18675.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19038.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19219.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19038.43,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF BILE DUCTS","code_information":[{"code":"47800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PLACE INTERNAL DILE DUCT STENT","code_information":[{"code":"47801","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4900.5,"maximum":4900.5,"gross_charge":6050,"discounted_cash":1790.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4900.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4900.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4900.5,"methodology":"fee schedule"}]}]},{"description":"HC PLACE INTERNAL DILE DUCT STENT","code_information":[{"code":"47801","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4900.5,"gross_charge":6050,"discounted_cash":1790.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4900.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4900.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4900.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4235,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1149.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":907.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1210,"methodology":"fee schedule"}]}]},{"description":"FUSE LIVER DUCT  INTESTINE","code_information":[{"code":"47802","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"minimum":10053,"maximum":29683,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15963,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15091,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10590,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29683,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27830,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24823.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19115,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22789,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19680,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26129.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26373,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16375,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16375,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14516.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15532.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14951.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15242.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15387.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15242.21,"methodology":"case rate"}]}]},{"description":"SUTURE BILE DUCT INJURY","code_information":[{"code":"47900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BILE TRACT SURGERY PROCEDURE","code_information":[{"code":"47999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"minimum":16754,"maximum":46059,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26437,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24993,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16754,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46059,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43184,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37622.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32059,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38223,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31134,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39603.03,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43677,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27119,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27119,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22863,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22001.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23541.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22661.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23101.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23321.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23101.77,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF ABDOMEN","code_information":[{"code":"48000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLACEMENT OF DRAIN PANCREAS","code_information":[{"code":"48001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4801","type":"APR-DRG"}],"standard_charges":[{"minimum":9148,"maximum":9148,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9148,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9148,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9148,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4802","type":"APR-DRG"}],"standard_charges":[{"minimum":9921,"maximum":9921,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9921,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9921,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9921,"methodology":"case rate"}]}]},{"description":"REMOVAL OF PANCREATIC STONE","code_information":[{"code":"48020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4803","type":"APR-DRG"}],"standard_charges":[{"minimum":16718,"maximum":16718,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16718,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16718,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16718,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES","code_information":[{"code":"4804","type":"APR-DRG"}],"standard_charges":[{"minimum":27457,"maximum":27457,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27457,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27457,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27457,"methodology":"case rate"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":11788,"maximum":40949,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18651,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17632,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11788,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40949,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38392,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28108.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22833,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27222,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21907,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29588.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30814,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19133,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19133,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13903,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16437.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17588.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16930.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17259.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17424.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17259.72,"methodology":"case rate"}]}]},{"description":"BIOPSY OF PANCREAS OPEN","code_information":[{"code":"48100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BIOPSY NEEDLEPANCREAS","code_information":[{"code":"48102","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4557.87,"maximum":4557.87,"gross_charge":5627,"discounted_cash":1665.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4557.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4557.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4557.87,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY NEEDLEPANCREAS","code_information":[{"code":"48102","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4557.87,"gross_charge":5627,"discounted_cash":1665.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4557.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4557.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4557.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":844.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1125.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"RESECT/DEBRIDE PANCREAS","code_information":[{"code":"48105","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PANCREAS LESION","code_information":[{"code":"48120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF PANCREAS","code_information":[{"code":"48140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF PANCREAS","code_information":[{"code":"48145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PANCREATIC DUCT","code_information":[{"code":"48148","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF PANCREAS","code_information":[{"code":"48150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48152","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48153","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PANCREATECTOMY","code_information":[{"code":"48154","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PANCREAS","code_information":[{"code":"48155","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PANCREAS REMOVAL/TRANSPLANT","code_information":[{"code":"48160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":9024,"maximum":30947,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14260,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13481,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9024,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30947,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29015,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22742.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17793,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21213,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16770,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23939.41,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23560,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14628,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14628,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9854,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13299.67,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14230.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13698.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13964.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14097.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13964.66,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4821","type":"APR-DRG"}],"standard_charges":[{"minimum":6382,"maximum":6382,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6382,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6382,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6382,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4822","type":"APR-DRG"}],"standard_charges":[{"minimum":7745,"maximum":7745,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7745,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7745,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7745,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4823","type":"APR-DRG"}],"standard_charges":[{"minimum":12238,"maximum":12238,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12238,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12238,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12238,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY","code_information":[{"code":"4824","type":"APR-DRG"}],"standard_charges":[{"minimum":19875,"maximum":19875,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19875,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19875,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19875,"methodology":"case rate"}]}]},{"description":"MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"minimum":13722,"maximum":40517,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22906,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21655,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14114,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40517,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37987,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33307.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25483,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30382,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26228,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35060.96,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37843,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23497,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23497,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13722,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19478.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20841.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20062.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20452.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20647.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20452.23,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4831","type":"APR-DRG"}],"standard_charges":[{"minimum":8172,"maximum":8172,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8172,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4832","type":"APR-DRG"}],"standard_charges":[{"minimum":11003,"maximum":11003,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11003,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11003,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11003,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4833","type":"APR-DRG"}],"standard_charges":[{"minimum":15808,"maximum":15808,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15808,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15808,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15808,"methodology":"case rate"}]}]},{"description":"PENIS TESTES AND SCROTAL PROCEDURES","code_information":[{"code":"4834","type":"APR-DRG"}],"standard_charges":[{"minimum":25055,"maximum":25055,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25055,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25055,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25055,"methodology":"case rate"}]}]},{"description":"INJECTION INTRAOP ADD-ON","code_information":[{"code":"48400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4841","type":"APR-DRG"}],"standard_charges":[{"minimum":9075,"maximum":9075,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9075,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9075,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9075,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4842","type":"APR-DRG"}],"standard_charges":[{"minimum":10768,"maximum":10768,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10768,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4843","type":"APR-DRG"}],"standard_charges":[{"minimum":13700,"maximum":13700,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13700,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13700,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13700,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"4844","type":"APR-DRG"}],"standard_charges":[{"minimum":27849,"maximum":27849,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27849,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27849,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27849,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"minimum":12088,"maximum":47810,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28938,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27358,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18714,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42279,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39640,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40680.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35140,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41896,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34778,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42821.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47810,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29685,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29685,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12088,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23789.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25454.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24503.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24978.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25216.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24978.97,"methodology":"case rate"}]}]},{"description":"SURGERY OF PANCREATIC CYST","code_information":[{"code":"48500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAIN PANCREATIC PSEUDOCYST","code_information":[{"code":"48510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE PANCREAS CYST AND BOWEL","code_information":[{"code":"48520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE PANCREAS CYST AND BOWEL","code_information":[{"code":"48540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PANCREATORRHAPHY","code_information":[{"code":"48545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DUODENAL EXCLUSION","code_information":[{"code":"48547","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSE PANCREAS AND BOWEL","code_information":[{"code":"48548","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DONOR PANCREATECTOMY","code_information":[{"code":"48550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR PANCREAS","code_information":[{"code":"48551","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR PANCREAS/VENOUS","code_information":[{"code":"48552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPL ALLOGRAFT PANCREAS","code_information":[{"code":"48554","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL ALLOGRAFT PANCREAS","code_information":[{"code":"48556","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"minimum":11212,"maximum":31498,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19065,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18023,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11410,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24380,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22858,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28613.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22548,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26882,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21204,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30119.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31498,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19557,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19557,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11212,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16733.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17904.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17235.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17569.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17737.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17569.99,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"minimum":6151,"maximum":23867.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14204,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13429,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8777,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19233,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18032,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22674.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17338,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20671,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16311,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23867.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23468,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14571,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14571,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6151,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13259.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14188.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13657.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13922.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14055.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13922.84,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"minimum":8980,"maximum":33115,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17667,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16702,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11968,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33115,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31047,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26905.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24528,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29243,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22241,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28321.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29188,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18123,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18123,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8980,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15734.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16835.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16206.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16521.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16678.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16521.1,"methodology":"case rate"}]}]},{"description":"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"minimum":7032,"maximum":23343,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11132,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10524,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7032,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23343,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21885,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18919.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14371,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17133,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13068,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19915.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18392,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11419,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11419,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8021,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11064.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11838.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11396.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11617.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11727.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11617.32,"methodology":"case rate"}]}]},{"description":"PANCREAS SURGERY PROCEDURE","code_information":[{"code":"48999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC EXPLORLAP CELRAC ARTERY","code_information":[{"code":"49000","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6450.84,"maximum":6450.84,"gross_charge":7964,"discounted_cash":2357.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6450.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6450.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6450.84,"methodology":"fee schedule"}]}]},{"description":"HC EXPLORLAP CELRAC ARTERY","code_information":[{"code":"49000","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6450.84,"gross_charge":7964,"discounted_cash":2357.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6450.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6450.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6450.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5574.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1513.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1194.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1592.8,"methodology":"fee schedule"}]}]},{"description":"REOPENING OF ABDOMEN","code_information":[{"code":"49002","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION BEHIND ABDOMEN","code_information":[{"code":"49010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRPERTL PEL PACK HEMRRG TRMA","code_information":[{"code":"49013","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REEXPLORATION PELVIC WOUND","code_information":[{"code":"49014","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAINAGE ABDOM ABSCESS OPEN","code_information":[{"code":"49020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAIN OPEN ABDOM ABSCESS","code_information":[{"code":"49040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAIN OPEN RETROPERI ABSCESS","code_information":[{"code":"49060","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAIN TO PERITONEAL CAVITY","code_information":[{"code":"49062","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PARACENTESIS ABD","code_information":[{"code":"49082","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2080.08,"maximum":2080.08,"gross_charge":2568,"discounted_cash":760.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.08,"methodology":"fee schedule"}]}]},{"description":"HC PARACENTESIS ABD","code_information":[{"code":"49082","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2568,"discounted_cash":760.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1797.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC ABD PARACENTESIS W/IMAGING","code_information":[{"code":"49083","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3999.78,"maximum":3999.78,"gross_charge":4938,"discounted_cash":1461.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3999.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3999.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3999.78,"methodology":"fee schedule"}]}]},{"description":"HC ABD PARACENTESIS W/IMAGING","code_information":[{"code":"49083","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3999.78,"gross_charge":4938,"discounted_cash":1461.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3999.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3999.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3999.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3456.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":987.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":987.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"PERITONEAL LAVAGE","code_information":[{"code":"49084","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC BIOPSY NDLE ABD/RETROPERITO","code_information":[{"code":"49180","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3231.09,"maximum":3231.09,"gross_charge":3989,"discounted_cash":1180.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3231.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3231.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3231.09,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY NDLE ABD/RETROPERITO","code_information":[{"code":"49180","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"gross_charge":3989,"discounted_cash":1180.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3231.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3231.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3231.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC SCLEROTX FLUID COLLECTION","code_information":[{"code":"49185","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1780.38,"maximum":1780.38,"gross_charge":2198,"discounted_cash":650.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1780.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1780.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1780.38,"methodology":"fee schedule"}]}]},{"description":"HC SCLEROTX FLUID COLLECTION","code_information":[{"code":"49185","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"gross_charge":2198,"discounted_cash":650.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1780.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1780.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1780.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITH MCC","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"minimum":18879,"maximum":52739,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30178,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19669,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52540,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49260,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44325.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37679,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44923,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36553,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46658.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52739,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32746,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32746,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18879,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25921.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27736.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26699.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27217.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27476.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27217.72,"methodology":"case rate"}]}]},{"description":"EXC ABD TUM 5 CM OR LESS","code_information":[{"code":"49203","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXC ABD TUM OVER 5 CM","code_information":[{"code":"49204","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXC ABD TUM OVER 10 CM","code_information":[{"code":"49205","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISE SACRAL SPINE TUMOR","code_information":[{"code":"49215","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MULTIPLE SURGERY ABDOMEN","code_information":[{"code":"49220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF UMBILICUS","code_information":[{"code":"49250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF OMENTUM","code_information":[{"code":"49255","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITH CC","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":12719,"maximum":35657,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21583,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20404,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13645,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34825,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32651,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31690.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25680,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30617,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25357,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33358.85,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35657,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22140,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22140,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12719,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18532.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19829.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19088.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19459.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19644.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19459.33,"methodology":"case rate"}]}]},{"description":"HC LAPAROSOPY DIAGNOSTIC","code_information":[{"code":"49320","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15407.01,"maximum":15407.01,"gross_charge":19021,"discounted_cash":5630.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15407.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15407.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15407.01,"methodology":"fee schedule"}]}]},{"description":"HC LAPAROSOPY DIAGNOSTIC","code_information":[{"code":"49320","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":15407.01,"gross_charge":19021,"discounted_cash":5630.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15407.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15407.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15407.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3613.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3804.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2853.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3804.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY BIOPSY","code_information":[{"code":"49321","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY ASPIRATION","code_information":[{"code":"49322","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO DRAIN LYMPHOCELE","code_information":[{"code":"49323","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP INSERT TUNNEL IP CATH","code_information":[{"code":"49324","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP REVISION PERM IP CATH","code_information":[{"code":"49325","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP W/OMENTOPEXY ADD-ON","code_information":[{"code":"49326","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP INS DEVICE FOR RT","code_information":[{"code":"49327","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO PROC ABDM/PER/OMENT","code_information":[{"code":"49329","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITHOUT CC/MCC","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"minimum":9310,"maximum":28000,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16948,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16022,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10620,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23773,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22289,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26026.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20416,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24341,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19735,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27396.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28000,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17385,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17385,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9310,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15220.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16285.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15677.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15981.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16133.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15981.49,"methodology":"case rate"}]}]},{"description":"AIR INJECTION INTO ABDOMEN","code_information":[{"code":"49400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE FOREIGN BODY ADBOMEN","code_information":[{"code":"49402","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC IMAGE CATH FLUID COLXN VISC","code_information":[{"code":"49405","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1416.69,"maximum":1416.69,"gross_charge":1749,"discounted_cash":517.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1416.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1416.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1416.69,"methodology":"fee schedule"}]}]},{"description":"HC IMAGE CATH FLUID COLXN VISC","code_information":[{"code":"49405","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"gross_charge":1749,"discounted_cash":517.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1416.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1416.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1416.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1224.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC IMAGE CATH FLUID PERI/RETRO","code_information":[{"code":"49406","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3662.82,"maximum":3662.82,"gross_charge":4522,"discounted_cash":1338.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3662.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3662.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3662.82,"methodology":"fee schedule"}]}]},{"description":"HC IMAGE CATH FLUID PERI/RETRO","code_information":[{"code":"49406","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"gross_charge":4522,"discounted_cash":1338.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3662.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3662.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3662.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3165.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":859.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":904.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":904.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"IMAGE CATH FLUID TRNS/VGNL","code_information":[{"code":"49407","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC FIDUCIAL MARKER ABD/PEL PER","code_information":[{"code":"49411","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2440.53,"maximum":2440.53,"gross_charge":3013,"discounted_cash":891.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2440.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2440.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2440.53,"methodology":"fee schedule"}]}]},{"description":"HC FIDUCIAL MARKER ABD/PEL PER","code_information":[{"code":"49411","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3013,"discounted_cash":891.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2440.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2440.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2440.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2091.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2109.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":602.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1223.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1308.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1259.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1284.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1345.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1296.68,"methodology":"case rate"}]}]},{"description":"HC PLACMENT/FIDUCIALS RAD THERPY","code_information":[{"code":"49412","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":254.34,"maximum":254.34,"gross_charge":314,"discounted_cash":92.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"}]}]},{"description":"HC PLACMENT/FIDUCIALS RAD THERPY","code_information":[{"code":"49412","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":314,"discounted_cash":92.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRAPERITONEAL PERM CATH","code_information":[{"code":"49418","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":11418.57,"maximum":11418.57,"gross_charge":14097,"discounted_cash":4172.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11418.57,"methodology":"fee schedule"}]}]},{"description":"HC INTRAPERITONEAL PERM CATH","code_information":[{"code":"49418","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11418.57,"gross_charge":14097,"discounted_cash":4172.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9867.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2678.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2819.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2114.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2819.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC PLCMNT INTRAPERI CUFFED CATH","code_information":[{"code":"49418","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11418.57,"maximum":11418.57,"gross_charge":14097,"discounted_cash":4172.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11418.57,"methodology":"fee schedule"}]}]},{"description":"HC PLCMNT INTRAPERI CUFFED CATH","code_information":[{"code":"49418","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11418.57,"gross_charge":14097,"discounted_cash":4172.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11418.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9867.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2678.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2819.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2114.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2819.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"INSERT TUN IP CATH W/PORT","code_information":[{"code":"49419","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11834.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"INS TUN IP CATH FOR DIAL OPN","code_information":[{"code":"49421","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC REM PERITONEAL CATH","code_information":[{"code":"49422","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2576.61,"maximum":2576.61,"gross_charge":3181,"discounted_cash":941.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2576.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2576.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2576.61,"methodology":"fee schedule"}]}]},{"description":"HC REM PERITONEAL CATH","code_information":[{"code":"49422","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":6890.9,"gross_charge":3181,"discounted_cash":941.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2576.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2576.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2576.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC EXCHANGE PREV DRAIN CATH","code_information":[{"code":"49423","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":789.75,"maximum":789.75,"gross_charge":975,"discounted_cash":288.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":789.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":789.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":789.75,"methodology":"fee schedule"}]}]},{"description":"HC EXCHANGE PREV DRAIN CATH","code_information":[{"code":"49423","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"gross_charge":975,"discounted_cash":288.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":789.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":789.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":789.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":682.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":195,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":195,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"HC INJ CONTR TUBE/CATH ABSCESS","code_information":[{"code":"49424","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":867.51,"maximum":867.51,"gross_charge":1071,"discounted_cash":317.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":867.51,"methodology":"fee schedule"}]}]},{"description":"HC INJ CONTR TUBE/CATH ABSCESS","code_information":[{"code":"49424","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1071,"discounted_cash":317.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":514.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":599.76,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":749.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"}]}]},{"description":"INSERT ABDOMEN-VENOUS DRAIN","code_information":[{"code":"49425","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE ABDOMEN-VENOUS SHUNT","code_information":[{"code":"49426","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"HC INJ PROC SHUNT EVALUATION","code_information":[{"code":"49427","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1058.67,"maximum":1058.67,"gross_charge":1307,"discounted_cash":386.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1058.67,"methodology":"fee schedule"}]}]},{"description":"HC INJ PROC SHUNT EVALUATION","code_information":[{"code":"49427","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1307,"discounted_cash":386.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":914.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.4,"methodology":"fee schedule"}]}]},{"description":"LIGATION OF SHUNT","code_information":[{"code":"49428","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF SHUNT","code_information":[{"code":"49429","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6890.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INSERT SUBQ EXTEN TO IP CATH","code_information":[{"code":"49435","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EMBEDDED IP CATH EXIT-SITE","code_information":[{"code":"49436","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"HC INSERT G TUBE W/FLUORO","code_information":[{"code":"49440","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3295.89,"maximum":3295.89,"gross_charge":4069,"discounted_cash":1204.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3295.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3295.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3295.89,"methodology":"fee schedule"}]}]},{"description":"HC INSERT G TUBE W/FLUORO","code_information":[{"code":"49440","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"gross_charge":4069,"discounted_cash":1204.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3295.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3295.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3295.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2848.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":773.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"HC INSERT DUOD/J TUBE W/FLUOR","code_information":[{"code":"49441","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7117.47,"maximum":7117.47,"gross_charge":8787,"discounted_cash":2600.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7117.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7117.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7117.47,"methodology":"fee schedule"}]}]},{"description":"HC INSERT DUOD/J TUBE W/FLUOR","code_information":[{"code":"49441","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7117.47,"gross_charge":8787,"discounted_cash":2600.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7117.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7117.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7117.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6150.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1669.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1757.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1318.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1757.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"INSERTION OF CECOSTOMY TUBE","code_information":[{"code":"49442","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3821.58,"maximum":3821.58,"gross_charge":4718,"discounted_cash":1396.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3821.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3821.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3821.58,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CECOSTOMY TUBE","code_information":[{"code":"49442","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3821.58,"gross_charge":4718,"discounted_cash":1396.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3821.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3821.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3821.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2581.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1721.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1802.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3302.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1054.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1127.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1085.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1106.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1159.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1117.39,"methodology":"case rate"}]}]},{"description":"HC CHANGE G-TUBE TO G-J W/FLUOR","code_information":[{"code":"49446","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3678.21,"maximum":3678.21,"gross_charge":4541,"discounted_cash":1344.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3678.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3678.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3678.21,"methodology":"fee schedule"}]}]},{"description":"HC CHANGE G-TUBE TO G-J W/FLUOR","code_information":[{"code":"49446","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4153.13,"gross_charge":4541,"discounted_cash":1344.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3678.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3678.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3678.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4153.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2776.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2900.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3178.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1695.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1814.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1746.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1780.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1865.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1797.74,"methodology":"case rate"}]}]},{"description":"HC REPLACE G-TUBE W/FLUORO","code_information":[{"code":"49450","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1592.46,"maximum":1592.46,"gross_charge":1966,"discounted_cash":581.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1592.46,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE G-TUBE W/FLUORO","code_information":[{"code":"49450","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1966,"discounted_cash":581.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1376.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC REPLACE DUOD/JTUBE W/FLUORO","code_information":[{"code":"49451","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1592.46,"maximum":1592.46,"gross_charge":1966,"discounted_cash":581.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1592.46,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE DUOD/JTUBE W/FLUORO","code_information":[{"code":"49451","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1966,"discounted_cash":581.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1376.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC REPLACE G-J TUBE W/FLUORO","code_information":[{"code":"49452","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1592.46,"maximum":1592.46,"gross_charge":1966,"discounted_cash":581.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1592.46,"methodology":"fee schedule"}]}]},{"description":"HC REPLACE G-J TUBE W/FLUORO","code_information":[{"code":"49452","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1966,"discounted_cash":581.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1592.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1376.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC MECH REM OF MATANY GI TUBE","code_information":[{"code":"49460","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2499.66,"maximum":2499.66,"gross_charge":3086,"discounted_cash":913.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2499.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2499.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2499.66,"methodology":"fee schedule"}]}]},{"description":"HC MECH REM OF MATANY GI TUBE","code_information":[{"code":"49460","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3086,"discounted_cash":913.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2499.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2499.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2499.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2160.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":462.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"HC INJ&EVAL EXIST ANY GI TUBE","code_information":[{"code":"49465","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1274.13,"maximum":1274.13,"gross_charge":1573,"discounted_cash":465.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1274.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1274.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1274.13,"methodology":"fee schedule"}]}]},{"description":"HC INJ&EVAL EXIST ANY GI TUBE","code_information":[{"code":"49465","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1573,"discounted_cash":465.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1274.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1274.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1274.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1101.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"RPR HERN PREEMIE REDUC","code_information":[{"code":"49491","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"RPR ING HERN PREMIE BLOCKED","code_information":[{"code":"49492","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"RPR ING HERNIA BABY REDUC","code_information":[{"code":"49495","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"RPR ING HERNIA BABY BLOCKED","code_information":[{"code":"49496","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"minimum":15242,"maximum":69375,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31647,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29918,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20346,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69375,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":65044,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43989.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40149,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47867,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37810,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46305.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52285,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32463,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32463,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15242,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25725.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27525.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26496.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27011.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27268.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27011.31,"methodology":"case rate"}]}]},{"description":"RPR ING HERNIA INIT REDUCE","code_information":[{"code":"49500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13660.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"RPR ING HERNIA INIT BLOCKED","code_information":[{"code":"49501","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"PRP I/HERN INIT REDUC >5 YR","code_information":[{"code":"49505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"PRP I/HERN INIT BLOCK >5 YR","code_information":[{"code":"49507","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REREPAIR ING HERNIA REDUCE","code_information":[{"code":"49520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REREPAIR ING HERNIA BLOCKED","code_information":[{"code":"49521","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13660.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"REPAIR ING HERNIA SLIDING","code_information":[{"code":"49525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REPAIR LUMBAR HERNIA","code_information":[{"code":"49540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"RPR REM HERNIA INIT REDUCE","code_information":[{"code":"49550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"RPR FEM HERNIA INIT BLOCKED","code_information":[{"code":"49553","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REREPAIR FEM HERNIA REDUCE","code_information":[{"code":"49555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REREPAIR FEM HERNIA BLOCKED","code_information":[{"code":"49557","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"RPR VENTRAL HERN INIT REDUC","code_information":[{"code":"49560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR VENTRAL HERN INIT BLOCK","code_information":[{"code":"49561","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REREPAIR VENTRL HERN REDUCE","code_information":[{"code":"49565","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REREPAIR VENTRL HERN BLOCK","code_information":[{"code":"49566","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HERNIA REPAIR W/MESH","code_information":[{"code":"49568","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR EPIGASTRIC HERN REDUCE","code_information":[{"code":"49570","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR EPIGASTRIC HERN BLOCKED","code_information":[{"code":"49572","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR UMBIL HERN REDUC < 5 YR","code_information":[{"code":"49580","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR UMBIL HERN BLOCK < 5 YR","code_information":[{"code":"49582","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR UMBIL HERN REDUC > 5 YR","code_information":[{"code":"49585","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RPR UMBIL HERN BLOCK > 5 YR","code_information":[{"code":"49587","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SPIGELIAN HERNIA","code_information":[{"code":"49590","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"minimum":8547,"maximum":36596,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17735,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16767,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11292,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36596,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34312,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26989.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22696,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27059,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20984,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28409.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29301,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18193,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18193,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8547,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15783.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16888.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16256.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16572.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16730.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16572.38,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR UMBILICAL LESION","code_information":[{"code":"49611","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP ING HERNIA REPAIR INIT","code_information":[{"code":"49650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP ING HERNIA REPAIR RECUR","code_information":[{"code":"49651","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAP VENT/ABD HERNIA REPAIR","code_information":[{"code":"49652","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP VENT/ABD HERN PROC COMP","code_information":[{"code":"49653","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP INC HERNIA REPAIR","code_information":[{"code":"49654","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP INC HERN REPAIR COMP","code_information":[{"code":"49655","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP INC HERNIA REPAIR RECUR","code_information":[{"code":"49656","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAP INC HERN RECUR COMP","code_information":[{"code":"49657","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO PROC HERNIA REPAIR","code_information":[{"code":"49659","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"minimum":6805,"maximum":32988,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12069,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11409,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8110,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32988,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30928,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20064.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16448,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19610,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15070,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21120.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19939,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12380,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12380,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6805,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11733.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12554.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12085.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12320.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12437.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12320.17,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"minimum":11053,"maximum":39119,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22696,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21457,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14834,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39119,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36677,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33051.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27705,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33031,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27567,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34791.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37497,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23282,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23282,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11053,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19328.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20681.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19908.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20295.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20488.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20295.07,"methodology":"case rate"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"minimum":5931,"maximum":30050,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10434,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9864,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7328,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30050,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28174,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18067.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14254,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16994,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13618,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19018.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17239,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10704,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10704,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5931,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10565.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11305.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10882.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11093.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11199.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11093.88,"methodology":"case rate"}]}]},{"description":"HC SUTR SECON ABD/EVISC OR DEF","code_information":[{"code":"49900","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":12709.71,"maximum":12709.71,"gross_charge":15691,"discounted_cash":4644.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12709.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12709.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12709.71,"methodology":"fee schedule"}]}]},{"description":"HC SUTR SECON ABD/EVISC OR DEF","code_information":[{"code":"49900","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12709.71,"gross_charge":15691,"discounted_cash":4644.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12709.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12709.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12709.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10983.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2981.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3138.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2353.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3138.2,"methodology":"fee schedule"}]}]},{"description":"OMENTAL FLAP EXTRA-ABDOM","code_information":[{"code":"49904","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OMENTAL FLAP INTRA-ABDOM","code_information":[{"code":"49905","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FREE OMENTAL FLAP MICROVASC","code_information":[{"code":"49906","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABDOMEN SURGERY PROCEDURE","code_information":[{"code":"49999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2052.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1322.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1433.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":838.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":896.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":863.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":880.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":922.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":888.51,"methodology":"case rate"}]}]},{"description":"SOFT TISSUE PROCEDURES WITH MCC","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"minimum":13784,"maximum":50793,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28483,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26928,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18423,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50793,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47622,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40124.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34637,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41296,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34237,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42235.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47059,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29219,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29219,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13784,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23464.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25106.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24168.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24637.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24872.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24637.66,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5001","type":"APR-DRG"}],"standard_charges":[{"minimum":3696,"maximum":3696,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3696,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3696,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3696,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5002","type":"APR-DRG"}],"standard_charges":[{"minimum":5297,"maximum":5297,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5297,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5297,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5297,"methodology":"case rate"}]}]},{"description":"RENAL ABSCESS OPEN DRAIN","code_information":[{"code":"50020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5003","type":"APR-DRG"}],"standard_charges":[{"minimum":7992,"maximum":7992,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7992,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7992,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7992,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM","code_information":[{"code":"5004","type":"APR-DRG"}],"standard_charges":[{"minimum":13875,"maximum":13875,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13875,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13875,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13875,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF KIDNEY","code_information":[{"code":"50040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF KIDNEY","code_information":[{"code":"50065","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF KIDNEY","code_information":[{"code":"50070","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50075","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50080","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50081","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"SOFT TISSUE PROCEDURES WITH CC","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":9861,"maximum":26505,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16043,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15166,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9861,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23401,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21940,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24920.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19000,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22653,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18326,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26232.41,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26505,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16457,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16457,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10546,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14573.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15593.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15010.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15302.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15447.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15302.24,"methodology":"case rate"}]}]},{"description":"REVISE KIDNEY BLOOD VESSELS","code_information":[{"code":"50100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5011","type":"APR-DRG"}],"standard_charges":[{"minimum":3773,"maximum":3773,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3773,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3773,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3773,"methodology":"case rate"}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5012","type":"APR-DRG"}],"standard_charges":[{"minimum":5768,"maximum":5768,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORE AND DRAIN KIDNEY","code_information":[{"code":"50125","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5013","type":"APR-DRG"}],"standard_charges":[{"minimum":5768,"maximum":5768,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5768,"methodology":"case rate"}]}]},{"description":"REMOVAL OF KIDNEY STONE","code_information":[{"code":"50130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION OF KIDNEY","code_information":[{"code":"50135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY","code_information":[{"code":"5014","type":"APR-DRG"}],"standard_charges":[{"minimum":13523,"maximum":13523,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13523,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13523,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13523,"methodology":"case rate"}]}]},{"description":"SOFT TISSUE PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"minimum":7840,"maximum":21751.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12559,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11873,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7856,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18779,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17607,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20664.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14857,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17713,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14599,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21751.64,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12884,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12884,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7840,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12084.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12930.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12446.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12688.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12809.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12688.46,"methodology":"case rate"}]}]},{"description":"HC BIOPSY PERCUTANEOUS RENAL","code_information":[{"code":"50200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4646.16,"maximum":4646.16,"gross_charge":5736,"discounted_cash":1697.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4646.16,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY PERCUTANEOUS RENAL","code_information":[{"code":"50200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4646.16,"gross_charge":5736,"discounted_cash":1697.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1089.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC BIOPSY SITE KIDNEY BILAT","code_information":[{"code":"50200","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4646.16,"maximum":4646.16,"gross_charge":5736,"discounted_cash":1697.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4646.16,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY SITE KIDNEY BILAT","code_information":[{"code":"50200","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4646.16,"gross_charge":5736,"discounted_cash":1697.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4646.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1089.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"RENAL BIOPSY OPEN","code_information":[{"code":"50205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE KIDNEY OPEN","code_information":[{"code":"50220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL KIDNEY OPEN COMPLEX","code_information":[{"code":"50225","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL KIDNEY OPEN RADICAL","code_information":[{"code":"50230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY  URETER","code_information":[{"code":"50234","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY  URETER","code_information":[{"code":"50236","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF KIDNEY","code_information":[{"code":"50240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRYOABLATE RENAL MASS OPEN","code_information":[{"code":"50250","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY LESION","code_information":[{"code":"50280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY LESION","code_information":[{"code":"50290","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FOOT PROCEDURES WITH MCC","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"minimum":10230,"maximum":39305,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23790,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22491,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15237,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31066,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29126,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34388.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27382,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32647,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28316,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36198.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24404,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10230,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20110.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21518.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20713.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21115.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21317.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21115.97,"methodology":"case rate"}]}]},{"description":"REMOVE CADAVER DONOR KIDNEY","code_information":[{"code":"50300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE KIDNEY LIVING DONOR","code_information":[{"code":"50320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP CADAVER RENAL ALLOGRAFT","code_information":[{"code":"50323","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP DONOR RENAL GRAFT","code_information":[{"code":"50325","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP RENAL GRAFT/VENOUS","code_information":[{"code":"50327","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP RENAL GRAFT/ARTERIAL","code_information":[{"code":"50328","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PREP RENAL GRAFT/URETERAL","code_information":[{"code":"50329","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF KIDNEY","code_information":[{"code":"50340","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION OF KIDNEY","code_information":[{"code":"50360","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANTATION OF KIDNEY","code_information":[{"code":"50365","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE TRANSPLANTED KIDNEY","code_information":[{"code":"50370","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REIMPLANTATION OF KIDNEY","code_information":[{"code":"50380","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC REM&REP URETERAL STENT","code_information":[{"code":"50382","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4094.55,"maximum":4094.55,"gross_charge":5055,"discounted_cash":1496.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4094.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4094.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4094.55,"methodology":"fee schedule"}]}]},{"description":"HC REM&REP URETERAL STENT","code_information":[{"code":"50382","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"gross_charge":5055,"discounted_cash":1496.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4094.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4094.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4094.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3538.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1011,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1011,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC REMOVAL URETERAL STENT","code_information":[{"code":"50384","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":6016.68,"maximum":6016.68,"gross_charge":7428,"discounted_cash":2198.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6016.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6016.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6016.68,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL URETERAL STENT","code_information":[{"code":"50384","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6016.68,"gross_charge":7428,"discounted_cash":2198.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6016.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6016.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6016.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5199.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1485.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1485.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CHANGE STENT VIA TRANSURETH","code_information":[{"code":"50385","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVE STENT VIA TRANSURETH","code_information":[{"code":"50386","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC BI-NEPH URET STNT CHG 50387-50","code_information":[{"code":"50387","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6047.46,"maximum":6047.46,"gross_charge":7466,"discounted_cash":2209.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6047.46,"methodology":"fee schedule"}]}]},{"description":"HC BI-NEPH URET STNT CHG 50387-50","code_information":[{"code":"50387","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047.46,"gross_charge":7466,"discounted_cash":2209.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5226.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1493.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1493.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC REM&REP EXT URETER STENT","code_information":[{"code":"50387","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":6047.46,"maximum":6047.46,"gross_charge":7466,"discounted_cash":2209.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6047.46,"methodology":"fee schedule"}]}]},{"description":"HC REM&REP EXT URETER STENT","code_information":[{"code":"50387","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6047.46,"gross_charge":7466,"discounted_cash":2209.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6047.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5226.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1418.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1493.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1493.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC REM W/FLUOR NEPH. TUBE","code_information":[{"code":"50389","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":993.06,"maximum":993.06,"gross_charge":1226,"discounted_cash":362.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":993.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":993.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":993.06,"methodology":"fee schedule"}]}]},{"description":"HC REM W/FLUOR NEPH. TUBE","code_information":[{"code":"50389","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1226,"discounted_cash":362.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":993.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":993.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":993.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":858.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HC ASPIRATION RENAL CYST BIL","code_information":[{"code":"50390","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1916.46,"maximum":1916.46,"gross_charge":2366,"discounted_cash":700.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1916.46,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION RENAL CYST BIL","code_information":[{"code":"50390","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1916.46,"gross_charge":2366,"discounted_cash":700.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"HC ASPIRATION/INJ RNL CYST","code_information":[{"code":"50390","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1916.46,"maximum":1916.46,"gross_charge":2366,"discounted_cash":700.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1916.46,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION/INJ RNL CYST","code_information":[{"code":"50390","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1916.46,"gross_charge":2366,"discounted_cash":700.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1916.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"INSTLL RX AGNT INTO RNAL TUB","code_information":[{"code":"50391","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"MEASURE KIDNEY PRESSURE","code_information":[{"code":"50396","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"FOOT PROCEDURES WITH CC","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"minimum":8913,"maximum":26064,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15776,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14914,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9812,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24901,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23346,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24594.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19184,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22872,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18235,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25888.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26064,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16183,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16183,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8913,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14382.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15389.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14814.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15101.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15245.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15101.91,"methodology":"case rate"}]}]},{"description":"REVISION OF KIDNEY/URETER","code_information":[{"code":"50400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF KIDNEY/URETER","code_information":[{"code":"50405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM NEW ACC","code_information":[{"code":"50430","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1466.1,"maximum":1466.1,"gross_charge":1810,"discounted_cash":535.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1466.1,"methodology":"fee schedule"}]}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM NEW ACC","code_information":[{"code":"50430","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1810,"discounted_cash":535.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":362,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":362,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM EXIST ACC","code_information":[{"code":"50431","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1466.1,"maximum":1466.1,"gross_charge":1810,"discounted_cash":535.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1466.1,"methodology":"fee schedule"}]}]},{"description":"HC NJX PX NFROSGRM &/URTRGRM EXIST ACC","code_information":[{"code":"50431","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1810,"discounted_cash":535.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1466.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":362,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":362,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"50432","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5282.01,"maximum":5282.01,"gross_charge":6521,"discounted_cash":1930.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5282.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5282.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5282.01,"methodology":"fee schedule"}]}]},{"description":"HC PLMT NEPHROSTOMY CATHETER","code_information":[{"code":"50432","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5282.01,"gross_charge":6521,"discounted_cash":1930.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5282.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5282.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5282.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1238.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1304.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC PLMT NEPHROURETERAL CATHETER","code_information":[{"code":"50433","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5788.26,"maximum":5788.26,"gross_charge":7146,"discounted_cash":2115.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5788.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5788.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5788.26,"methodology":"fee schedule"}]}]},{"description":"HC PLMT NEPHROURETERAL CATHETER","code_information":[{"code":"50433","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"gross_charge":7146,"discounted_cash":2115.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5788.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5788.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5788.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1357.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1429.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1429.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC CONVERT NEPHROSTOMY CATHETER","code_information":[{"code":"50434","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2059.83,"maximum":2059.83,"gross_charge":2543,"discounted_cash":752.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2059.83,"methodology":"fee schedule"}]}]},{"description":"HC CONVERT NEPHROSTOMY CATHETER","code_information":[{"code":"50434","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"gross_charge":2543,"discounted_cash":752.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC EXCHANGE NEPHROSTOMY CATHETER","code_information":[{"code":"50435","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2059.83,"maximum":2059.83,"gross_charge":2543,"discounted_cash":752.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2059.83,"methodology":"fee schedule"}]}]},{"description":"HC EXCHANGE NEPHROSTOMY CATHETER","code_information":[{"code":"50435","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"gross_charge":2543,"discounted_cash":752.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2059.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":483.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"DILAT XST TRC NDURLGC PX","code_information":[{"code":"50436","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DILAT XST TRC NEW ACCESS RCS","code_information":[{"code":"50437","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"FOOT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"minimum":8596,"maximum":26064,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15776,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14914,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9691,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15360,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14401,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24594.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19097,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22769,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18009,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25888.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26064,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16183,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16183,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8596,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14382.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15389.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14814.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15101.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15245.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15101.91,"methodology":"case rate"}]}]},{"description":"REPAIR OF KIDNEY WOUND","code_information":[{"code":"50500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE KIDNEY-SKIN FISTULA","code_information":[{"code":"50520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE NEPHROVISCERAL FISTULA","code_information":[{"code":"50525","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSE NEPHROVISCERAL FISTULA","code_information":[{"code":"50526","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF HORSESHOE KIDNEY","code_information":[{"code":"50540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO ABLATE RENAL CYST","code_information":[{"code":"50541","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO ABLATE RENAL MASS","code_information":[{"code":"50542","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO PARTIAL NEPHRECTOMY","code_information":[{"code":"50543","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY PYELOPLASTY","code_information":[{"code":"50544","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO RADICAL NEPHRECTOMY","code_information":[{"code":"50545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPIC NEPHRECTOMY","code_information":[{"code":"50546","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO REMOVAL DONOR KIDNEY","code_information":[{"code":"50547","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO REMOVE W/URETER","code_information":[{"code":"50548","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPE PROC RENAL","code_information":[{"code":"50549","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50551","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50553","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY  BIOPSY","code_information":[{"code":"50555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50557","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50561","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RENAL SCOPE W/TUMOR RESECT","code_information":[{"code":"50562","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50572","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY  BIOPSY","code_information":[{"code":"50574","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY","code_information":[{"code":"50575","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50576","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"KIDNEY ENDOSCOPY  TREATMENT","code_information":[{"code":"50580","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"HC LITHOTRIPSY MOBILE","code_information":[{"code":"50590","type":"CPT"},{"code":"0790","type":"RC"}],"standard_charges":[{"minimum":16191.09,"maximum":16191.09,"gross_charge":19989,"discounted_cash":5916.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16191.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16191.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16191.09,"methodology":"fee schedule"}]}]},{"description":"HC LITHOTRIPSY MOBILE","code_information":[{"code":"50590","type":"CPT"},{"code":"0790","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":16191.09,"gross_charge":19989,"discounted_cash":5916.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16191.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16191.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16191.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8025,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6585,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7650,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":12391,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12869,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13992.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3797.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3997.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2998.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3997.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC ABLATION KIDNEY BILAT","code_information":[{"code":"50592","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":23898.24,"maximum":23898.24,"gross_charge":29504,"discounted_cash":8733.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23898.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23898.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23898.24,"methodology":"fee schedule"}]}]},{"description":"HC ABLATION KIDNEY BILAT","code_information":[{"code":"50592","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":23898.24,"gross_charge":29504,"discounted_cash":8733.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23898.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23898.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23898.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20652.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5605.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5900.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4425.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5900.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"HC ABLATION RENAL RADIOFREQ","code_information":[{"code":"50592","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":15935.94,"maximum":15935.94,"gross_charge":19674,"discounted_cash":5823.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15935.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15935.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15935.94,"methodology":"fee schedule"}]}]},{"description":"HC ABLATION RENAL RADIOFREQ","code_information":[{"code":"50592","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":15935.94,"gross_charge":19674,"discounted_cash":5823.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15935.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15935.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15935.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13771.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3738.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3934.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2951.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3934.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"PERC CRYO ABLATE RENAL TUM","code_information":[{"code":"50593","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"MAJOR THUMB OR JOINT PROCEDURES","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"minimum":6263,"maximum":25755,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13475,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12739,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8310,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25755,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24147,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21783.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15239,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18168,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15442,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22929.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22263,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13823,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6263,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12738.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13630.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13121.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13375.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13503.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13375.8,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF URETER","code_information":[{"code":"50600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSERT URETERAL SUPPORT","code_information":[{"code":"50605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ENDOLUM.BX URET/RENAL W S&I","code_information":[{"code":"50606","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6874.47,"maximum":6874.47,"gross_charge":8487,"discounted_cash":2512.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6874.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6874.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6874.47,"methodology":"fee schedule"}]}]},{"description":"ENDOLUM.BX URET/RENAL W S&I","code_information":[{"code":"50606","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6874.47,"gross_charge":8487,"discounted_cash":2512.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6874.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6874.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6874.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1612.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1697.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1273.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1697.4,"methodology":"fee schedule"}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"50610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"50620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"50630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF URETER","code_information":[{"code":"50650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF URETER","code_information":[{"code":"50660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INJECT URETERO EXIST CATH","code_information":[{"code":"50684","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"}]}]},{"description":"INJECT URETERO EXIST CATH","code_information":[{"code":"50684","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.9,"maximum":1753,"gross_charge":206,"discounted_cash":60.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":98.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"}]}]},{"description":"MEASURE URETER PRESSURE","code_information":[{"code":"50686","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC URETER TUBE CHANGE","code_information":[{"code":"50688","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5714.55,"maximum":5714.55,"gross_charge":7055,"discounted_cash":2088.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5714.55,"methodology":"fee schedule"}]}]},{"description":"HC URETER TUBE CHANGE","code_information":[{"code":"50688","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5714.55,"gross_charge":7055,"discounted_cash":2088.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1340.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC INJ ILEAL CONDUIT/URTROPYEL","code_information":[{"code":"50690","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":361.26,"maximum":361.26,"gross_charge":446,"discounted_cash":132.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":361.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":361.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":361.26,"methodology":"fee schedule"}]}]},{"description":"HC INJ ILEAL CONDUIT/URTROPYEL","code_information":[{"code":"50690","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":66.9,"maximum":1753,"gross_charge":446,"discounted_cash":132.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":361.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":361.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":361.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":214.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":249.76,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.2,"methodology":"fee schedule"}]}]},{"description":"HC PLMT URETERAL STENT PRQ EXIST","code_information":[{"code":"50693","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2505.33,"maximum":2505.33,"gross_charge":3093,"discounted_cash":915.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2505.33,"methodology":"fee schedule"}]}]},{"description":"HC PLMT URETERAL STENT PRQ EXIST","code_information":[{"code":"50693","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"gross_charge":3093,"discounted_cash":915.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC PLMT URETERAL STENT PRQ NEW","code_information":[{"code":"50694","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2505.33,"maximum":2505.33,"gross_charge":3093,"discounted_cash":915.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2505.33,"methodology":"fee schedule"}]}]},{"description":"HC PLMT URETERAL STENT PRQ NEW","code_information":[{"code":"50694","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"gross_charge":3093,"discounted_cash":915.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC PLMT URTRAL STENT PRQ NEW W SEP CATH","code_information":[{"code":"50695","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2505.33,"maximum":2505.33,"gross_charge":3093,"discounted_cash":915.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2505.33,"methodology":"fee schedule"}]}]},{"description":"HC PLMT URTRAL STENT PRQ NEW W SEP CATH","code_information":[{"code":"50695","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"gross_charge":3093,"discounted_cash":915.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2505.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"minimum":8892,"maximum":32542,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17422,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16471,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12111,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32542,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30511,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26607.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20049,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23903,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22506,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28007.37,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28784,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17872,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17872,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8892,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15559.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16648.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16026.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16337.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16493.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16337.64,"methodology":"case rate"}]}]},{"description":"REVISION OF URETER","code_information":[{"code":"50700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"URETERAL EMBOLIZATION/OCCL","code_information":[{"code":"50705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BALLOON DILATION/URETER S&I","code_information":[{"code":"50706","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2456.73,"maximum":2456.73,"gross_charge":3033,"discounted_cash":897.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2456.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2456.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2456.73,"methodology":"fee schedule"}]}]},{"description":"BALLOON DILATION/URETER S&I","code_information":[{"code":"50706","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3033,"discounted_cash":897.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2456.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2456.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2456.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.6,"methodology":"fee schedule"}]}]},{"description":"RELEASE OF URETER","code_information":[{"code":"50715","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE OF URETER","code_information":[{"code":"50722","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE/REVISE URETER","code_information":[{"code":"50725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE URETER","code_information":[{"code":"50727","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISE URETER","code_information":[{"code":"50728","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF URETER  KIDNEY","code_information":[{"code":"50740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF URETER  KIDNEY","code_information":[{"code":"50750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF URETERS","code_information":[{"code":"50760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPLICING OF URETERS","code_information":[{"code":"50770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50780","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50782","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50783","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REIMPLANT URETER IN BLADDER","code_information":[{"code":"50785","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"minimum":7495,"maximum":20954,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11601,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10968,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8147,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20954,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19646,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19493.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15654,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18663,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15140,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19167,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7495,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11399.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12197.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11741.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11969.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12083.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11969.42,"methodology":"case rate"}]}]},{"description":"IMPLANT URETER IN BOWEL","code_information":[{"code":"50800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF URETER  BOWEL","code_information":[{"code":"50810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"URINE SHUNT TO INTESTINE","code_information":[{"code":"50815","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONSTRUCT BOWEL BLADDER","code_information":[{"code":"50820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONSTRUCT BOWEL BLADDER","code_information":[{"code":"50825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE URINE FLOW","code_information":[{"code":"50830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE URETER BY BOWEL","code_information":[{"code":"50840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"APPENDICO-VESICOSTOMY","code_information":[{"code":"50845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPLANT URETER TO SKIN","code_information":[{"code":"50860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ARTHROSCOPY","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"minimum":7761,"maximum":26089,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15791,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14928,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7761,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21243,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19917,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24613.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16407,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19561,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14423,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25908.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16199,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12248,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14393.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15401.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14825.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15113.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15257.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15113.38,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETER","code_information":[{"code":"50900","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSURE URETER/SKIN FISTULA","code_information":[{"code":"50920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSURE URETER/BOWEL FISTULA","code_information":[{"code":"50930","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE OF URETER","code_information":[{"code":"50940","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPY URETEROLITHOTOMY","code_information":[{"code":"50945","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO NEW URETER/BLADDER","code_information":[{"code":"50947","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO NEW URETER/BLADDER","code_information":[{"code":"50948","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC URETER","code_information":[{"code":"50949","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"ENDOSCOPY OF URETER","code_information":[{"code":"50951","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"ENDOSCOPY OF URETER","code_information":[{"code":"50953","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  BIOPSY","code_information":[{"code":"50955","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50957","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50961","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY","code_information":[{"code":"50970","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  CATHETER","code_information":[{"code":"50972","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  BIOPSY","code_information":[{"code":"50974","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50976","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"URETER ENDOSCOPY  TREATMENT","code_information":[{"code":"50980","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"SHOULDER ELBOW OR FOREARM PROCEDURES EXCEPT MAJOR JOINT PROCEDURES WITH MCC","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"minimum":12689,"maximum":42446,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25691,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24288,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15457,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25698,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24093,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36712.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31217,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37219,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28724,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38644.42,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42446,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12689,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21469.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22971.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22113.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22542.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22757.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22542.58,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5101","type":"APR-DRG"}],"standard_charges":[{"minimum":9322,"maximum":9322,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9322,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9322,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9322,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5102","type":"APR-DRG"}],"standard_charges":[{"minimum":9396,"maximum":9396,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9396,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9396,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9396,"methodology":"case rate"}]}]},{"description":"INCISE  TREAT BLADDER","code_information":[{"code":"51020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5103","type":"APR-DRG"}],"standard_charges":[{"minimum":17939,"maximum":17939,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17939,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17939,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17939,"methodology":"case rate"}]}]},{"description":"INCISE  TREAT BLADDER","code_information":[{"code":"51030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5086.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND OTHER RADICAL GYNECOLOGICAL PROCEDURES","code_information":[{"code":"5104","type":"APR-DRG"}],"standard_charges":[{"minimum":36906,"maximum":36906,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36906,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36906,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36906,"methodology":"case rate"}]}]},{"description":"INCISE  DRAIN BLADDER","code_information":[{"code":"51040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"INCISE BLADDER/DRAIN URETER","code_information":[{"code":"51045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BLADDER STONE","code_information":[{"code":"51050","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETER STONE","code_information":[{"code":"51060","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVE URETER CALCULUS","code_information":[{"code":"51065","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF BLADDER ABSCESS","code_information":[{"code":"51080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"SHOULDER ELBOW OR FOREARM PROCEDURES EXCEPT MAJOR JOINT PROCEDURES WITH CC","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"minimum":9319,"maximum":29126,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17629,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16666,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11327,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19350,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18142,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26859.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21391,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25503,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21051,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28273.32,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18084,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18084,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9319,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15707.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16806.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16178.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16492.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16649.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16492.77,"methodology":"case rate"}]}]},{"description":"DRAIN BLADDER BY NEEDLE","code_information":[{"code":"51100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"DRAIN BLADDER BY TROCAR/CATH","code_information":[{"code":"51101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1525.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1555.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":909.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":973.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":936.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":955.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1000.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":964.17,"methodology":"case rate"}]}]},{"description":"HC INSERT SUPRAPUBIC CATH","code_information":[{"code":"51102","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3497.58,"maximum":3497.58,"gross_charge":4318,"discounted_cash":1278.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3497.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3497.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3497.58,"methodology":"fee schedule"}]}]},{"description":"HC INSERT SUPRAPUBIC CATH","code_information":[{"code":"51102","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"gross_charge":4318,"discounted_cash":1278.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3497.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3497.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3497.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3022.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":863.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5111","type":"APR-DRG"}],"standard_charges":[{"minimum":9581,"maximum":9581,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9581,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9581,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9581,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5112","type":"APR-DRG"}],"standard_charges":[{"minimum":10935,"maximum":10935,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10935,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10935,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10935,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5113","type":"APR-DRG"}],"standard_charges":[{"minimum":14147,"maximum":14147,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14147,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14147,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14147,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY","code_information":[{"code":"5114","type":"APR-DRG"}],"standard_charges":[{"minimum":33316,"maximum":33316,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33316,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33316,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33316,"methodology":"case rate"}]}]},{"description":"SHOULDER ELBOW OR FOREARM PROCEDURES EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"minimum":6140,"maximum":24186.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14452,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13663,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9169,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17198,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16124,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22977.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17365,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20703,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17038,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24186.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23878,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14826,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14826,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6140,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13437.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14377.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13840.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14109.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14243.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14109.01,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5121","type":"APR-DRG"}],"standard_charges":[{"minimum":8881,"maximum":8881,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8881,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8881,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8881,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5122","type":"APR-DRG"}],"standard_charges":[{"minimum":9424,"maximum":9424,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9424,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9424,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9424,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5123","type":"APR-DRG"}],"standard_charges":[{"minimum":14893,"maximum":14893,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14893,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14893,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14893,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY","code_information":[{"code":"5124","type":"APR-DRG"}],"standard_charges":[{"minimum":29584,"maximum":29584,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29584,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29584,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29584,"methodology":"case rate"}]}]},{"description":"HAND OR WRIST PROCEDURES EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"minimum":7872,"maximum":23005.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13534,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12795,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9209,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19059,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17869,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21854.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17230,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20542,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17115,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23005.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22360,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13883,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13883,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7872,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12780.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13675.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13164.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13419.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13547.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13419.65,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5131","type":"APR-DRG"}],"standard_charges":[{"minimum":5851,"maximum":5851,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5851,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5851,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5851,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5132","type":"APR-DRG"}],"standard_charges":[{"minimum":8321,"maximum":8321,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8321,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8321,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8321,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5133","type":"APR-DRG"}],"standard_charges":[{"minimum":12241,"maximum":12241,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12241,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12241,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12241,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA","code_information":[{"code":"5134","type":"APR-DRG"}],"standard_charges":[{"minimum":22241,"maximum":22241,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22241,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22241,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22241,"methodology":"case rate"}]}]},{"description":"HAND OR WRIST PROCEDURES EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"minimum":5917,"maximum":17385.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9165,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8665,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5917,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15403,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14442,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16516.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11162,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13308,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10996,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17385.36,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15142,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9402,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9402,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6468,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9658.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10334.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9948.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10141.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10141.46,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5141","type":"APR-DRG"}],"standard_charges":[{"minimum":6641,"maximum":6641,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6641,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6641,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6641,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5142","type":"APR-DRG"}],"standard_charges":[{"minimum":11588,"maximum":11588,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11588,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11588,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11588,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5143","type":"APR-DRG"}],"standard_charges":[{"minimum":16992,"maximum":16992,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16992,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16992,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16992,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"5144","type":"APR-DRG"}],"standard_charges":[{"minimum":28399,"maximum":28399,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28399,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28399,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28399,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"minimum":17962,"maximum":78601,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27798,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26279,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17962,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78601,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":73694,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39286.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33700,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40179,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33379,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41353.71,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45925,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28515,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28515,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21645,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22974.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24582.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23663.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24123,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24352.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24123,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BLADDER CYST","code_information":[{"code":"51500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BLADDER LESION","code_information":[{"code":"51520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF BLADDER LESION","code_information":[{"code":"51525","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BLADDER LESION","code_information":[{"code":"51530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF URETER LESION","code_information":[{"code":"51535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF BLADDER","code_information":[{"code":"51550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF BLADDER","code_information":[{"code":"51555","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE BLADDER  URETER(S)","code_information":[{"code":"51565","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BLADDER","code_information":[{"code":"51570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BLADDER  NODES","code_information":[{"code":"51575","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BLADDER/REVISE TRACT","code_information":[{"code":"51580","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BLADDER  NODES","code_information":[{"code":"51585","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BLADDER/REVISE TRACT","code_information":[{"code":"51590","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BLADDER/REVISE TRACT","code_information":[{"code":"51595","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BLADDER/CREATE POUCH","code_information":[{"code":"51596","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PELVIC STRUCTURES","code_information":[{"code":"51597","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"minimum":11594,"maximum":36059,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18083,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17095,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11594,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36059,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33808,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27414.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21983,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26210,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21547,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28857.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29876,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18550,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18550,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16031.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17154.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16512.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16833.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16993.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16833.42,"methodology":"case rate"}]}]},{"description":"HC INJECTION CYSTOGRAPHY","code_information":[{"code":"51600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":247.86,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION CYSTOGRAPHY","code_information":[{"code":"51600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":45.9,"maximum":1753,"gross_charge":306,"discounted_cash":90.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":146.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":171.36,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"}]}]},{"description":"PREPARATION FOR BLADDER XRAY","code_information":[{"code":"51605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INJECTION URETHROGRAM RETRO","code_information":[{"code":"51610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":972.81,"maximum":972.81,"gross_charge":1201,"discounted_cash":355.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972.81,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION URETHROGRAM RETRO","code_information":[{"code":"51610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1753,"gross_charge":1201,"discounted_cash":355.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":576.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":672.56,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":840.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.2,"methodology":"fee schedule"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"minimum":8490,"maximum":26881,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13418,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12685,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8490,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26881,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25203,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21713.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16321,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19458,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15778,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22855.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22168,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13764,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13764,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11931,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12697.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13586.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13078.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13332.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13459.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13332.63,"methodology":"case rate"}]}]},{"description":"IRRIGATION OF BLADDER","code_information":[{"code":"51700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"HC INSERT BLADDER CATH","code_information":[{"code":"51701","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":359.64,"maximum":359.64,"gross_charge":444,"discounted_cash":131.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.64,"methodology":"fee schedule"}]}]},{"description":"HC INSERT BLADDER CATH","code_information":[{"code":"51701","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":444,"discounted_cash":131.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC STRAIGHT CATHETERIZATION","code_information":[{"code":"51701","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":359.64,"maximum":359.64,"gross_charge":444,"discounted_cash":131.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.64,"methodology":"fee schedule"}]}]},{"description":"HC STRAIGHT CATHETERIZATION","code_information":[{"code":"51701","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":444,"discounted_cash":131.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC INSERT BLADDER CATH SIMPL","code_information":[{"code":"51702","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":204.12,"maximum":204.12,"gross_charge":252,"discounted_cash":74.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.12,"methodology":"fee schedule"}]}]},{"description":"HC INSERT BLADDER CATH SIMPL","code_information":[{"code":"51702","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":252,"discounted_cash":74.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"INSERT TEMP BLADDER CATH COMP","code_information":[{"code":"51703","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":493.29,"maximum":493.29,"gross_charge":609,"discounted_cash":180.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"}]}]},{"description":"INSERT TEMP BLADDER CATH COMP","code_information":[{"code":"51703","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":609,"discounted_cash":180.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":426.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"CHANGE CYSTOTOMY TUBE","code_information":[{"code":"51705","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":631.8,"maximum":631.8,"gross_charge":780,"discounted_cash":230.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.8,"methodology":"fee schedule"}]}]},{"description":"CHANGE CYSTOTOMY TUBE","code_information":[{"code":"51705","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":780,"discounted_cash":230.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":546,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"HC CHANGE CYSTOTOMY TUBE SIMPL","code_information":[{"code":"51705","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":631.8,"maximum":631.8,"gross_charge":780,"discounted_cash":230.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.8,"methodology":"fee schedule"}]}]},{"description":"HC CHANGE CYSTOTOMY TUBE SIMPL","code_information":[{"code":"51705","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":780,"discounted_cash":230.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":546,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5171","type":"APR-DRG"}],"standard_charges":[{"minimum":5175,"maximum":5175,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5175,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5175,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5175,"methodology":"case rate"}]}]},{"description":"HC 51710-CHANGE/CYSTO TUBE COMP","code_information":[{"code":"51710","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2008.8,"maximum":2008.8,"gross_charge":2480,"discounted_cash":734.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2008.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2008.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2008.8,"methodology":"fee schedule"}]}]},{"description":"HC 51710-CHANGE/CYSTO TUBE COMP","code_information":[{"code":"51710","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2008.8,"gross_charge":2480,"discounted_cash":734.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2008.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2008.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2008.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":496,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":372,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":496,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HC INJ URETHRAL IMPLANT","code_information":[{"code":"51715","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":6348.78,"maximum":6348.78,"gross_charge":7838,"discounted_cash":2320.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6348.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6348.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6348.78,"methodology":"fee schedule"}]}]},{"description":"HC INJ URETHRAL IMPLANT","code_information":[{"code":"51715","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"gross_charge":7838,"discounted_cash":2320.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6348.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6348.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6348.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1567.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5172","type":"APR-DRG"}],"standard_charges":[{"minimum":7009,"maximum":7009,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7009,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7009,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7009,"methodology":"case rate"}]}]},{"description":"HC BLADDER INSTALLATION CHEMO","code_information":[{"code":"51720","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":929.88,"maximum":929.88,"gross_charge":1148,"discounted_cash":339.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":929.88,"methodology":"fee schedule"}]}]},{"description":"HC BLADDER INSTALLATION CHEMO","code_information":[{"code":"51720","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1148,"discounted_cash":339.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":929.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":803.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"SIMPLE CYSTOMETROGRAM","code_information":[{"code":"51725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1753,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"COMPLEX CYSTOMETROGRAM","code_information":[{"code":"51726","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"HC CYSTOMETROGRAM W/UP","code_information":[{"code":"51727","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":743.58,"maximum":743.58,"gross_charge":918,"discounted_cash":271.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.58,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOMETROGRAM W/UP","code_information":[{"code":"51727","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":918,"discounted_cash":271.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":642.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"CYSTOMETROGRAM W/VP","code_information":[{"code":"51728","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HC CYSTOMETROGRAM W/VP&UP","code_information":[{"code":"51729","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":743.58,"maximum":743.58,"gross_charge":918,"discounted_cash":271.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.58,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOMETROGRAM W/VP&UP","code_information":[{"code":"51729","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":918,"discounted_cash":271.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":642.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5173","type":"APR-DRG"}],"standard_charges":[{"minimum":8671,"maximum":8671,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8671,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8671,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8671,"methodology":"case rate"}]}]},{"description":"URINE FLOW MEASUREMENT","code_information":[{"code":"51736","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES","code_information":[{"code":"5174","type":"APR-DRG"}],"standard_charges":[{"minimum":18782,"maximum":18782,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18782,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18782,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18782,"methodology":"case rate"}]}]},{"description":"HC UROFLOWMETRY COMPLEX","code_information":[{"code":"51741","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":267.3,"maximum":267.3,"gross_charge":330,"discounted_cash":97.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"}]}]},{"description":"HC UROFLOWMETRY COMPLEX","code_information":[{"code":"51741","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":330,"discounted_cash":97.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC EMG URETHR SPHINCT NO NEEDL","code_information":[{"code":"51784","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":400.14,"maximum":400.14,"gross_charge":494,"discounted_cash":146.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.14,"methodology":"fee schedule"}]}]},{"description":"HC EMG URETHR SPHINCT NO NEEDL","code_information":[{"code":"51784","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":494,"discounted_cash":146.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":345.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"ANAL/URINARY MUSCLE STUDY","code_information":[{"code":"51785","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"URINARY REFLEX STUDY","code_information":[{"code":"51792","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC INTRABDOMINAL PRESSURE TEST","code_information":[{"code":"51797","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC INTRABDOMINAL PRESSURE TEST","code_information":[{"code":"51797","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":378.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"}]}]},{"description":"HC US POST V RESIUDAL URINE","code_information":[{"code":"51798","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":204.12,"maximum":204.12,"gross_charge":252,"discounted_cash":74.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.12,"methodology":"fee schedule"}]}]},{"description":"HC US POST V RESIUDAL URINE","code_information":[{"code":"51798","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":252,"discounted_cash":74.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"minimum":14027,"maximum":53226,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32217,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30457,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20747,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51268,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48068,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44686.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40293,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48039,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38556,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":47038.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53226,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33048,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33048,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14027,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26132.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27961.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26916.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27438.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27700.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27438.95,"methodology":"case rate"}]}]},{"description":"REVISION OF BLADDER/URETHRA","code_information":[{"code":"51800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5181","type":"APR-DRG"}],"standard_charges":[{"minimum":6266,"maximum":6266,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6266,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6266,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6266,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5182","type":"APR-DRG"}],"standard_charges":[{"minimum":9124,"maximum":9124,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9124,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9124,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9124,"methodology":"case rate"}]}]},{"description":"REVISION OF URINARY TRACT","code_information":[{"code":"51820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5183","type":"APR-DRG"}],"standard_charges":[{"minimum":16193,"maximum":16193,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16193,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16193,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16193,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM AND RELATED PROCEDURES","code_information":[{"code":"5184","type":"APR-DRG"}],"standard_charges":[{"minimum":27249,"maximum":27249,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27249,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27249,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27249,"methodology":"case rate"}]}]},{"description":"ATTACH BLADDER/URETHRA","code_information":[{"code":"51840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ATTACH BLADDER/URETHRA","code_information":[{"code":"51841","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLADDER NECK","code_information":[{"code":"51845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR OF BLADDER WOUND","code_information":[{"code":"51860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"REPAIR OF BLADDER WOUND","code_information":[{"code":"51865","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF BLADDER OPENING","code_information":[{"code":"51880","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"minimum":11184,"maximum":29285,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17725,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16757,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11184,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27566,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25845,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26977.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21610,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25765,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20784,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28397.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29285,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18183,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18183,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11898,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15776.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16880.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16249.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16564.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16722.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16564.95,"methodology":"case rate"}]}]},{"description":"REPAIR BLADDER/VAGINA LESION","code_information":[{"code":"51900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5191","type":"APR-DRG"}],"standard_charges":[{"minimum":6796,"maximum":6796,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6796,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6796,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6796,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5192","type":"APR-DRG"}],"standard_charges":[{"minimum":10342,"maximum":10342,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10342,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10342,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10342,"methodology":"case rate"}]}]},{"description":"CLOSE BLADDER-UTERUS FISTULA","code_information":[{"code":"51920","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HYSTERECTOMY/BLADDER REPAIR","code_information":[{"code":"51925","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5193","type":"APR-DRG"}],"standard_charges":[{"minimum":14669,"maximum":14669,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14669,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14669,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14669,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA","code_information":[{"code":"5194","type":"APR-DRG"}],"standard_charges":[{"minimum":26627,"maximum":26627,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26627,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26627,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26627,"methodology":"case rate"}]}]},{"description":"CORRECTION OF BLADDER DEFECT","code_information":[{"code":"51940","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF BLADDER  BOWEL","code_information":[{"code":"51960","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CONSTRUCT BLADDER OPENING","code_information":[{"code":"51980","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO URETHRAL SUSPENSION","code_information":[{"code":"51990","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO SLING OPERATION","code_information":[{"code":"51992","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC BLA","code_information":[{"code":"51999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"minimum":6476,"maximum":22167.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12883,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12179,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8133,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19076,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17885,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21059.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15995,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19070,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15114,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22167.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21285,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13216,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13216,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6476,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12315.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13177.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12684.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12931.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13054.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12931.29,"methodology":"case rate"}]}]},{"description":"HC CYSTOSCOPY","code_information":[{"code":"52000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1423.98,"maximum":1423.98,"gross_charge":1758,"discounted_cash":520.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1423.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1423.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1423.98,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOSCOPY","code_information":[{"code":"52000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":1758,"discounted_cash":520.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1423.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1423.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1423.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY REMOVAL OF CLOTS","code_information":[{"code":"52001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC CYSTOSCOPY W/RETRO PYELOGRAM","code_information":[{"code":"52005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3889.62,"maximum":3889.62,"gross_charge":4802,"discounted_cash":1421.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3889.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3889.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3889.62,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOSCOPY W/RETRO PYELOGRAM","code_information":[{"code":"52005","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"gross_charge":4802,"discounted_cash":1421.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3889.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3889.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3889.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":912.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND BIOPSY","code_information":[{"code":"52007","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY  DUCT CATHETER","code_information":[{"code":"52010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":17011,"maximum":51278,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26200,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24769,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17011,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51278,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48077,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37333.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32635,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38908,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31613,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39298.9,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43286,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26876,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26876,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21832.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23361.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22487.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22924.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23142.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22924.36,"methodology":"case rate"}]}]},{"description":"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":12000,"maximum":36643,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18950,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17915,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12000,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36643,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34356,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28473.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23487,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28002,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22301,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29971.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31308,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19439,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19439,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16651.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17816.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17150.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17483.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17650.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17483.65,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY W/BIOPSY(S)","code_information":[{"code":"52204","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52214","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52224","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC CYSTOSCOPY W/BLADDER TUM REM","code_information":[{"code":"52234","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3781.08,"maximum":3781.08,"gross_charge":4668,"discounted_cash":1381.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3781.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3781.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3781.08,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOSCOPY W/BLADDER TUM REM","code_information":[{"code":"52234","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"gross_charge":4668,"discounted_cash":1381.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3781.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3781.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3781.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":886.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":700.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND RADIOTRACER","code_information":[{"code":"52250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52265","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY  REVISE URETHRA","code_information":[{"code":"52270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY  REVISE URETHRA","code_information":[{"code":"52275","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52276","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52277","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC CYSTO DIL URETHRAL STRICTURE","code_information":[{"code":"52281","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3884.76,"maximum":3884.76,"gross_charge":4796,"discounted_cash":1419.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3884.76,"methodology":"fee schedule"}]}]},{"description":"HC CYSTO DIL URETHRAL STRICTURE","code_information":[{"code":"52281","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"gross_charge":4796,"discounted_cash":1419.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":911.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC CYSTO W/DIL URETHRAL STRIC","code_information":[{"code":"52281","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3884.76,"maximum":3884.76,"gross_charge":4796,"discounted_cash":1419.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3884.76,"methodology":"fee schedule"}]}]},{"description":"HC CYSTO W/DIL URETHRAL STRIC","code_information":[{"code":"52281","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"gross_charge":4796,"discounted_cash":1419.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3884.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":911.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":719.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY IMPLANT STENT","code_information":[{"code":"52282","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52283","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52285","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"HC CYSTOURETHROSCOPY","code_information":[{"code":"52287","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4057.29,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOURETHROSCOPY","code_information":[{"code":"52287","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"gross_charge":5009,"discounted_cash":1482.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3506.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52290","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52301","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52305","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52315","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVE BLADDER STONE","code_information":[{"code":"52317","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVE BLADDER STONE","code_information":[{"code":"52318","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY STONE REMOVAL","code_information":[{"code":"52325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY INJECT MATERIAL","code_information":[{"code":"52327","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOSCOPY AND TREATMENT","code_information":[{"code":"52330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC CYSTO W/INSERT URETERAL STENT","code_information":[{"code":"52332","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":6211.08,"maximum":6211.08,"gross_charge":7668,"discounted_cash":2269.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6211.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6211.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6211.08,"methodology":"fee schedule"}]}]},{"description":"HC CYSTO W/INSERT URETERAL STENT","code_information":[{"code":"52332","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"gross_charge":7668,"discounted_cash":2269.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6211.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6211.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6211.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1456.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1533.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CREATE PASSAGE TO KIDNEY","code_information":[{"code":"52334","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTO W/URETER STRICTURE TX","code_information":[{"code":"52341","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTO W/UP STRICTURE TX","code_information":[{"code":"52342","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTO W/RENAL STRICTURE TX","code_information":[{"code":"52343","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTO/URETERO STRICTURE TX","code_information":[{"code":"52344","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTO/URETERO W/UP STRICTURE","code_information":[{"code":"52345","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOURETERO W/RENAL STRICT","code_information":[{"code":"52346","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOURETERO  OR PYELOSCOPE","code_information":[{"code":"52351","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOURETERO W/STONE REMOVE","code_information":[{"code":"52352","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"HC CYSTO W/ LITHOTRIPSY","code_information":[{"code":"52353","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3933.36,"maximum":3933.36,"gross_charge":4856,"discounted_cash":1437.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3933.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3933.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3933.36,"methodology":"fee schedule"}]}]},{"description":"HC CYSTO W/ LITHOTRIPSY","code_information":[{"code":"52353","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":12869,"gross_charge":4856,"discounted_cash":1437.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3933.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3933.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3933.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8025,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12869,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOURETERO W/BIOPSY","code_information":[{"code":"52354","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOURETERO W/EXCISE TUMOR","code_information":[{"code":"52355","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"HC CYSTO LITHO/LASER STENT INS","code_information":[{"code":"52356","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8691.3,"maximum":8691.3,"gross_charge":10730,"discounted_cash":3176.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8691.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8691.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8691.3,"methodology":"fee schedule"}]}]},{"description":"HC CYSTO LITHO/LASER STENT INS","code_information":[{"code":"52356","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":11129.71,"gross_charge":10730,"discounted_cash":3176.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8691.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8691.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8691.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7511,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2038.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2146,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1609.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2146,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"CYSTOURETERO W/CONGEN REPR","code_information":[{"code":"52400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOURETHRO CUT EJACUL DUCT","code_information":[{"code":"52402","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"CYSTOURETHRO W/IMPLANT","code_information":[{"code":"52441","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CYSTOURETHRO W/ADDL IMPLANT","code_information":[{"code":"52442","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF PROSTATE","code_information":[{"code":"52450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISION OF BLADDER NECK","code_information":[{"code":"52500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY (TURP)","code_information":[{"code":"52601","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REMOVE PROSTATE REGROWTH","code_information":[{"code":"52630","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RELIEVE BLADDER CONTRACTURE","code_information":[{"code":"52640","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"LASER SURGERY OF PROSTATE","code_information":[{"code":"52647","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"LASER SURGERY OF PROSTATE","code_information":[{"code":"52648","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"PROSTATE LASER ENUCLEATION","code_information":[{"code":"52649","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PROSTATE ABSCESS","code_information":[{"code":"52700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5301","type":"APR-DRG"}],"standard_charges":[{"minimum":4315,"maximum":4315,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4315,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4315,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4315,"methodology":"case rate"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53010","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5302","type":"APR-DRG"}],"standard_charges":[{"minimum":6583,"maximum":6583,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6583,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6583,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6583,"methodology":"case rate"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"INCISION OF URETHRA","code_information":[{"code":"53025","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5303","type":"APR-DRG"}],"standard_charges":[{"minimum":7790,"maximum":7790,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM MALIGNANCY","code_information":[{"code":"5304","type":"APR-DRG"}],"standard_charges":[{"minimum":14065,"maximum":14065,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14065,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14065,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14065,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF URETHRA ABSCESS","code_information":[{"code":"53040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF URETHRA ABSCESS","code_information":[{"code":"53060","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF URINARY LEAKAGE","code_information":[{"code":"53080","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF URINARY LEAKAGE","code_information":[{"code":"53085","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5311","type":"APR-DRG"}],"standard_charges":[{"minimum":3589,"maximum":3589,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3589,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3589,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3589,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5312","type":"APR-DRG"}],"standard_charges":[{"minimum":5020,"maximum":5020,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5020,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5020,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5020,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5313","type":"APR-DRG"}],"standard_charges":[{"minimum":6091,"maximum":6091,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6091,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6091,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6091,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM INFECTIONS","code_information":[{"code":"5314","type":"APR-DRG"}],"standard_charges":[{"minimum":12027,"maximum":12027,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12027,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12027,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12027,"methodology":"case rate"}]}]},{"description":"BIOPSY OF URETHRA","code_information":[{"code":"53200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5321","type":"APR-DRG"}],"standard_charges":[{"minimum":3340,"maximum":3340,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3340,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3340,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3340,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETHRA","code_information":[{"code":"53210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETHRA","code_information":[{"code":"53215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5322","type":"APR-DRG"}],"standard_charges":[{"minimum":4326,"maximum":4326,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4326,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4326,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4326,"methodology":"case rate"}]}]},{"description":"TREATMENT OF URETHRA LESION","code_information":[{"code":"53220","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5323","type":"APR-DRG"}],"standard_charges":[{"minimum":5242,"maximum":5242,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5242,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5242,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5242,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETHRA LESION","code_information":[{"code":"53230","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETHRA LESION","code_information":[{"code":"53235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS","code_information":[{"code":"5324","type":"APR-DRG"}],"standard_charges":[{"minimum":9913,"maximum":9913,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9913,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9913,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9913,"methodology":"case rate"}]}]},{"description":"SURGERY FOR URETHRA POUCH","code_information":[{"code":"53240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETHRA GLAND","code_information":[{"code":"53250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"TREATMENT OF URETHRA LESION","code_information":[{"code":"53260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"TREATMENT OF URETHRA LESION","code_information":[{"code":"53265","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVAL OF URETHRA GLAND","code_information":[{"code":"53270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRA DEFECT","code_information":[{"code":"53275","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"FRACTURES OF FEMUR WITH MCC","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"minimum":5405,"maximum":43136,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13707,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12959,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9269,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43136,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40443,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22066.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15417,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18381,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17224,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23228.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22646,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14061,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14061,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5405,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12904.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13807.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13291.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13549.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13678.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13549.82,"methodology":"case rate"}]}]},{"description":"FRACTURES OF FEMUR WITHOUT MCC","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"minimum":2849,"maximum":20577,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7317,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6917,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4602,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20577,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19293,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14257.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8603,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10257,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8552,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15007.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7506,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7506,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2849,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8337.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8921.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8587.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8754.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8838.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8754.63,"methodology":"case rate"}]}]},{"description":"REVISE URETHRA STAGE 1","code_information":[{"code":"53400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REVISE URETHRA STAGE 2","code_information":[{"code":"53405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"53410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"53415","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RECONSTRUCT URETHRA STAGE 1","code_information":[{"code":"53420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT URETHRA STAGE 2","code_information":[{"code":"53425","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"53430","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT URETHRA/BLADDER","code_information":[{"code":"53431","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"MALE SLING PROCEDURE","code_information":[{"code":"53440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28444.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28444.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28444.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18729.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19862.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11615.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12428.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11964.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12196.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12777.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12312.68,"methodology":"case rate"}]}]},{"description":"REMOVE/REVISE MALE SLING","code_information":[{"code":"53442","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"INSERT TANDEM CUFF","code_information":[{"code":"53444","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"INSERT URO/VES NCK SPHINCTER","code_information":[{"code":"53445","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"REMOVE URO SPHINCTER","code_information":[{"code":"53446","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REMOVE/REPLACE UR SPHINCTER","code_information":[{"code":"53447","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"REMOV/REPLC UR SPHINCTR COMP","code_information":[{"code":"53448","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR URO SPHINCTER","code_information":[{"code":"53449","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"REVISION OF URETHRA","code_information":[{"code":"53450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISION OF URETHRA","code_information":[{"code":"53460","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"FRACTURES OF HIP AND PELVIS WITH MCC","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"minimum":5070,"maximum":33630,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11954,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11301,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7367,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33630,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31531,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19924.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13938,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16618,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13691,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20973.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12263,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12263,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5070,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11651.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12467.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12001.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12234.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12351.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12234.51,"methodology":"case rate"}]}]},{"description":"URETHRLYS TRANSVAG W/ SCOPE","code_information":[{"code":"53500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53502","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRA INJURY","code_information":[{"code":"53515","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRA DEFECT","code_information":[{"code":"53520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"FRACTURES OF HIP AND PELVIS WITHOUT MCC","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":4326,"maximum":20768,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7289,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6891,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4472,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20768,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19472,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14223.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8400,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10014,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8310,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14972.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12043,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7477,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7477,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4326,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8317.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8900.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8567.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8733.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8816.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8733.73,"methodology":"case rate"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"DILATE URETHRA STRICTURE","code_information":[{"code":"53621","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"DILATION OF URETHRA","code_information":[{"code":"53660","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"DILATION OF URETHRA","code_information":[{"code":"53661","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"DILATION OF URETHRA","code_information":[{"code":"53665","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"SPRAINS STRAINS AND DISLOCATIONS OF HIP PELVIS AND THIGH WITH CC/MCC","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"minimum":4072,"maximum":16222.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8261,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7810,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5494,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12422,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11647,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15410.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10738,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12802,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10210,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16222.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13648,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8474,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8474,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4072,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9012.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9643.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9282.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9462.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9553.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9462.89,"methodology":"case rate"}]}]},{"description":"SPRAINS STRAINS AND DISLOCATIONS OF HIP PELVIS AND THIGH WITHOUT CC/MCC","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"minimum":3060,"maximum":13360.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6036,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5706,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4029,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7322,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6865,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12692.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7525,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8972,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7487,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13360.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9972,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6192,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6192,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3060,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7422.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7941.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7644.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7793.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7867.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7793.44,"methodology":"case rate"}]}]},{"description":"PROSTATIC MICROWAVE THERMOTX","code_information":[{"code":"53850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"PROSTATIC RF THERMOTX","code_information":[{"code":"53852","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"TRURL DSTRJ PRST8 TISS RF WV","code_information":[{"code":"53854","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"INSERT PROST URETHRAL STENT","code_information":[{"code":"53855","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL RF TREATMENT","code_information":[{"code":"53860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"UROLOGY SURGERY PROCEDURE","code_information":[{"code":"53899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS WITH MCC","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"minimum":10687,"maximum":30035,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18179,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17186,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11274,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23918,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22425,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27531.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21574,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25721,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20951,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28980.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30035,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18649,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10687,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16100.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17227.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16583.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16905.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17066.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16905.58,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5391","type":"APR-DRG"}],"standard_charges":[{"minimum":5217,"maximum":5217,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5217,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5217,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5217,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5392","type":"APR-DRG"}],"standard_charges":[{"minimum":5963,"maximum":5963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5393","type":"APR-DRG"}],"standard_charges":[{"minimum":8585,"maximum":8585,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8585,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8585,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8585,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION","code_information":[{"code":"5394","type":"APR-DRG"}],"standard_charges":[{"minimum":13520,"maximum":13520,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13520,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13520,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13520,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS WITH CC","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"minimum":7376,"maximum":20559.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11633,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10997,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7376,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16403,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15379,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19531.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14555,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17354,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13706,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20559.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19219,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11933,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11933,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7713,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11421.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12221.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11764.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11993.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12107.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11993.03,"methodology":"case rate"}]}]},{"description":"SLITTING OF PREPUCE","code_information":[{"code":"54000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"SLITTING OF PREPUCE","code_information":[{"code":"54001","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5401","type":"APR-DRG"}],"standard_charges":[{"minimum":5433,"maximum":5433,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5433,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5433,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5433,"methodology":"case rate"}]}]},{"description":"DRAIN PENIS LESION","code_information":[{"code":"54015","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5402","type":"APR-DRG"}],"standard_charges":[{"minimum":6849,"maximum":6849,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5403","type":"APR-DRG"}],"standard_charges":[{"minimum":8784,"maximum":8784,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8784,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8784,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8784,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION","code_information":[{"code":"5404","type":"APR-DRG"}],"standard_charges":[{"minimum":15664,"maximum":15664,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15664,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15664,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15664,"methodology":"case rate"}]}]},{"description":"DESTRUCTION PENIS LESION(S)","code_information":[{"code":"54050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"DESTRUCTION PENIS LESION(S)","code_information":[{"code":"54055","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"CRYOSURGERY PENIS LESION(S)","code_information":[{"code":"54056","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"LASER SURG PENIS LESION(S)","code_information":[{"code":"54057","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"EXCISION OF PENIS LESION(S)","code_information":[{"code":"54060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DESTRUCTION PENIS LESION(S)","code_information":[{"code":"54065","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"OSTEOMYELITIS WITHOUT CC/MCC","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"minimum":4320,"maximum":15712.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7864,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7435,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4874,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10728,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10058,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14926.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8842,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10542,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9058,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15712.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8067,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8067,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4320,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8728.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9340,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8990.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9165.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9252.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9165.42,"methodology":"case rate"}]}]},{"description":"BIOPSY OF PENIS","code_information":[{"code":"54100","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"BIOPSY OF PENIS","code_information":[{"code":"54105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5411","type":"APR-DRG"}],"standard_charges":[{"minimum":6101,"maximum":6101,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"TREAT PENIS LESION GRAFT","code_information":[{"code":"54111","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"TREAT PENIS LESION GRAFT","code_information":[{"code":"54112","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5412","type":"APR-DRG"}],"standard_charges":[{"minimum":6101,"maximum":6101,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF PENIS","code_information":[{"code":"54120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF PENIS","code_information":[{"code":"54125","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5413","type":"APR-DRG"}],"standard_charges":[{"minimum":6101,"maximum":6101,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6101,"methodology":"case rate"}]}]},{"description":"REMOVE PENIS  NODES","code_information":[{"code":"54130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PENIS  NODES","code_information":[{"code":"54135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C","code_information":[{"code":"5414","type":"APR-DRG"}],"standard_charges":[{"minimum":7958,"maximum":7958,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7958,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7958,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7958,"methodology":"case rate"}]}]},{"description":"CIRCUMCISION W/REGIONL BLOCK","code_information":[{"code":"54150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CIRCUMCISION NEONATE","code_information":[{"code":"54160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2486,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1461.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":996.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1020.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":596.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":638.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":614.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":626.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":656.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":632.54,"methodology":"case rate"}]}]},{"description":"CIRCUM 28 DAYS OR OLDER","code_information":[{"code":"54161","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"LYSIS PENIL CIRCUMIC LESION","code_information":[{"code":"54162","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REPAIR OF CIRCUMCISION","code_information":[{"code":"54163","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"FRENULOTOMY OF PENIS","code_information":[{"code":"54164","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"minimum":8736,"maximum":36386,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16765,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15850,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10361,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36386,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34114,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25803.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19759,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23557,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19255,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27162.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27699,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17198,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17198,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8736,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15090.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16146.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15542.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15844.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15995.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15844.56,"methodology":"case rate"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5421","type":"APR-DRG"}],"standard_charges":[{"minimum":5215,"maximum":5215,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5215,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5215,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5215,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5422","type":"APR-DRG"}],"standard_charges":[{"minimum":6041,"maximum":6041,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6041,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6041,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6041,"methodology":"case rate"}]}]},{"description":"TREATMENT OF PENIS LESION","code_information":[{"code":"54220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5423","type":"APR-DRG"}],"standard_charges":[{"minimum":7410,"maximum":7410,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7410,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7410,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7410,"methodology":"case rate"}]}]},{"description":"PREPARE PENIS STUDY","code_information":[{"code":"54230","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DYNAMIC CAVERNOSOMETRY","code_information":[{"code":"54231","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"PENILE INJECTION","code_information":[{"code":"54235","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"5424","type":"APR-DRG"}],"standard_charges":[{"minimum":11664,"maximum":11664,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11664,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11664,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11664,"methodology":"case rate"}]}]},{"description":"HC IMPOTENCY EVAL","code_information":[{"code":"54240","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":2189.43,"maximum":2189.43,"gross_charge":2703,"discounted_cash":800.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2189.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2189.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2189.43,"methodology":"fee schedule"}]}]},{"description":"HC IMPOTENCY EVAL","code_information":[{"code":"54240","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2703,"discounted_cash":800.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2189.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2189.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2189.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1892.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"PENIS STUDY","code_information":[{"code":"54250","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"minimum":6197,"maximum":18580,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9536,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9016,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6197,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18580,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17420,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16969.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11771,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14034,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11516,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17862.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15755,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9783,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9783,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8520,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9923.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10618.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10221.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10420.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10519.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10420.04,"methodology":"case rate"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54304","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54308","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5431","type":"APR-DRG"}],"standard_charges":[{"minimum":4578,"maximum":4578,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4578,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4578,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4578,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54312","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54316","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54318","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5432","type":"APR-DRG"}],"standard_charges":[{"minimum":5147,"maximum":5147,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5147,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5147,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5147,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54322","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54324","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF URETHRA","code_information":[{"code":"54326","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISE PENIS/URETHRA","code_information":[{"code":"54328","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5433","type":"APR-DRG"}],"standard_charges":[{"minimum":7073,"maximum":7073,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7073,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7073,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7073,"methodology":"case rate"}]}]},{"description":"REVISE PENIS/URETHRA","code_information":[{"code":"54332","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISE PENIS/URETHRA","code_information":[{"code":"54336","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5434","type":"APR-DRG"}],"standard_charges":[{"minimum":8245,"maximum":8245,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8245,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8245,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8245,"methodology":"case rate"}]}]},{"description":"SECONDARY URETHRAL SURGERY","code_information":[{"code":"54340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"SECONDARY URETHRAL SURGERY","code_information":[{"code":"54344","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"SECONDARY URETHRAL SURGERY","code_information":[{"code":"54348","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"RECONSTRUCT URETHRA/PENIS","code_information":[{"code":"54352","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"PENIS PLASTIC SURGERY","code_information":[{"code":"54360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPAIR PENIS","code_information":[{"code":"54380","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REPAIR PENIS","code_information":[{"code":"54385","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REPAIR PENIS AND BLADDER","code_information":[{"code":"54390","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"minimum":3749,"maximum":14637,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6793,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6422,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4360,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14637,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13723,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13617.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8410,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10027,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8103,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14333.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11223,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6968,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6968,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3749,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7963.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8520.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8202.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8361.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8441.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8361.39,"methodology":"case rate"}]}]},{"description":"INSERT SEMI-RIGID PROSTHESIS","code_information":[{"code":"54400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28444.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28444.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28444.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18729.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19862.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11615.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12428.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11964.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12196.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12777.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12312.68,"methodology":"case rate"}]}]},{"description":"INSERT SELF-CONTD PROSTHESIS","code_information":[{"code":"54401","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"INSERT MULTI-COMP PENIS PROS","code_information":[{"code":"54405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"REMOVE MUTI-COMP PENIS PROS","code_information":[{"code":"54406","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPAIR MULTI-COMP PENIS PROS","code_information":[{"code":"54408","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REMOVE/REPLACE PENIS PROSTH","code_information":[{"code":"54410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"REMOV/REPLC PENIS PROS COMP","code_information":[{"code":"54411","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"REMOVE SELF-CONTD PENIS PROS","code_information":[{"code":"54415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMV/REPL PENIS CONTAIN PROS","code_information":[{"code":"54416","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":44067.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":44067.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29431.26,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30772.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17995.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19255.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18535.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18895.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19795.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19075.48,"methodology":"case rate"}]}]},{"description":"REMV/REPLC PENIS PROS COMPL","code_information":[{"code":"54417","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":28444.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28444.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28444.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18729.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19862.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11615.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12428.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11964.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12196.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12777.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12312.68,"methodology":"case rate"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF PENIS","code_information":[{"code":"54435","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPAIR CORPOREAL TEAR","code_information":[{"code":"54437","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REPLANTATION OF PENIS","code_information":[{"code":"54438","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF PENIS","code_information":[{"code":"54440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"PREPUTIAL STRETCHING","code_information":[{"code":"54450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITH MCC","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"minimum":13494,"maximum":37527,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22714,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21474,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14165,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28895,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27091,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33073.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27115,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32328,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26323,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34814.67,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37527,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23301,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23301,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13494,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19341.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20695.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19921.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20308.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20501.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20308.56,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TESTIS","code_information":[{"code":"54500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TESTIS","code_information":[{"code":"54505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"EXCISE LESION TESTIS","code_information":[{"code":"54512","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TESTIS","code_information":[{"code":"54520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"ORCHIECTOMY PARTIAL","code_information":[{"code":"54522","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TESTIS","code_information":[{"code":"54530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"EXTENSIVE TESTIS SURGERY","code_information":[{"code":"54535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"EXPLORATION FOR TESTIS","code_information":[{"code":"54550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"EXPLORATION FOR TESTIS","code_information":[{"code":"54560","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITH CC","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"minimum":6814,"maximum":18982.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10407,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9838,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6814,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15286,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14332,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18033.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13031,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15537,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12662,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18982.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17193,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10675,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10675,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7063,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10545.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11283.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10862.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11072.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11178.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11072.98,"methodology":"case rate"}]}]},{"description":"REDUCE TESTIS TORSION","code_information":[{"code":"54600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"SUSPENSION OF TESTIS","code_information":[{"code":"54620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"ORCHIOPEXY INGUN/SCROT APPR","code_information":[{"code":"54640","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"ORCHIOPEXY (FOWLER-STEPHENS)","code_information":[{"code":"54650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REVISION OF TESTIS","code_information":[{"code":"54660","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"REPAIR TESTIS INJURY","code_information":[{"code":"54670","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"RELOCATION OF TESTIS(ES)","code_information":[{"code":"54680","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY ORCHIECTOMY","code_information":[{"code":"54690","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY ORCHIOPEXY","code_information":[{"code":"54692","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPE PROC TESTIS","code_information":[{"code":"54699","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"minimum":4677,"maximum":14461,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6708,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6341,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4677,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14461,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13558,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13512.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9888,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11789,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8692,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14223.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11082,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6881,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6881,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7902.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8455.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8139.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8297.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8376.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8297.3,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF SCROTUM","code_information":[{"code":"54700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5471","type":"APR-DRG"}],"standard_charges":[{"minimum":5435,"maximum":5435,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5435,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5435,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5435,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5472","type":"APR-DRG"}],"standard_charges":[{"minimum":6607,"maximum":6607,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6607,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6607,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6607,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5473","type":"APR-DRG"}],"standard_charges":[{"minimum":9478,"maximum":9478,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9478,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9478,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9478,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITH O.R. PROCEDURE","code_information":[{"code":"5474","type":"APR-DRG"}],"standard_charges":[{"minimum":16882,"maximum":16882,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16882,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16882,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16882,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITH MCC","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"minimum":7965,"maximum":29919,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18109,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17120,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11077,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23317,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21862,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27446.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20968,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24999,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20586,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28890.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18577,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18577,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7965,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16050.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17173.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16531.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16852.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17013.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16852.98,"methodology":"case rate"}]}]},{"description":"BIOPSY OF EPIDIDYMIS","code_information":[{"code":"54800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5481","type":"APR-DRG"}],"standard_charges":[{"minimum":4118,"maximum":4118,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4118,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4118,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4118,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5482","type":"APR-DRG"}],"standard_charges":[{"minimum":7389,"maximum":7389,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7389,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7389,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7389,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5483","type":"APR-DRG"}],"standard_charges":[{"minimum":10783,"maximum":10783,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10783,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10783,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10783,"methodology":"case rate"}]}]},{"description":"REMOVE EPIDIDYMIS LESION","code_information":[{"code":"54830","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"5484","type":"APR-DRG"}],"standard_charges":[{"minimum":24282,"maximum":24282,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24282,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24282,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24282,"methodology":"case rate"}]}]},{"description":"REMOVE EPIDIDYMIS LESION","code_information":[{"code":"54840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EPIDIDYMIS","code_information":[{"code":"54860","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EPIDIDYMIS","code_information":[{"code":"54861","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"EXPLORE EPIDIDYMIS","code_information":[{"code":"54865","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITH CC","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"minimum":6853,"maximum":19530.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10833,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10241,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6853,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13987,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13114,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18553.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13097,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15615,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12735,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19530.35,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17897,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11112,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11112,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7965,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10850.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11609.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11175.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11392.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11501.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11392.7,"methodology":"case rate"}]}]},{"description":"FUSION OF SPERMATIC DUCTS","code_information":[{"code":"54900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"FUSION OF SPERMATIC DUCTS","code_information":[{"code":"54901","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITHOUT CC/MCC","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"minimum":4495,"maximum":15564.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7749,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7326,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5360,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11505,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10786,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14785.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13509,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9961,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15564.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12803,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7949,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7949,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4495,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8646.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9252.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8906.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9079.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9165.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9079.08,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF HYDROCELE","code_information":[{"code":"55000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HYDROCELE","code_information":[{"code":"55040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HYDROCELES","code_information":[{"code":"55041","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"REPAIR OF HYDROCELE","code_information":[{"code":"55060","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"MEDICAL BACK PROBLEMS WITH MCC","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"minimum":6590,"maximum":25966,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15339,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14501,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9669,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25966,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24345,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24060.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18088,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21565,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17969,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25327.01,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15735,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15735,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6590,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14070.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15055.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14492.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14774.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14914.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14774.09,"methodology":"case rate"}]}]},{"description":"INCIS & DRANG OF SCOTAL ABCESS","code_information":[{"code":"55100","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4410.45,"maximum":4410.45,"gross_charge":5445,"discounted_cash":1611.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4410.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4410.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4410.45,"methodology":"fee schedule"}]}]},{"description":"INCIS & DRANG OF SCOTAL ABCESS","code_information":[{"code":"55100","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":4410.45,"gross_charge":5445,"discounted_cash":1611.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4410.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4410.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4410.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1089,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1089,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"EXPLORE SCROTUM","code_information":[{"code":"55110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SCROTUM LESION","code_information":[{"code":"55120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SCROTUM","code_information":[{"code":"55150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISION OF SCROTUM","code_information":[{"code":"55175","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISION OF SCROTUM","code_information":[{"code":"55180","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"MEDICAL BACK PROBLEMS WITHOUT MCC","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":5358,"maximum":16740.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8664,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8190,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5490,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16419,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15394,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15903.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10382,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12378,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10202,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16740.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14313,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8887,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8887,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5358,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9300.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9951.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9579.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9765.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9858.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9765.07,"methodology":"case rate"}]}]},{"description":"INCISION OF SPERM DUCT","code_information":[{"code":"55200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SPERM DUCT(S)","code_information":[{"code":"55250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"BONE DISEASES AND ARTHROPATHIES WITH MCC","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"minimum":5057,"maximum":40154,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11740,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11098,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7678,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40154,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37647,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19662.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14332,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17087,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14269,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20697.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19395,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12043,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12043,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5057,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11498.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12303.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11843.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12073.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12188.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12073.29,"methodology":"case rate"}]}]},{"description":"PREPARE SPERM DUCT X-RAY","code_information":[{"code":"55300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"minimum":4669,"maximum":29658,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7502,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7092,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4669,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29658,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27807,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14483.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8866,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10570,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8677,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15246.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12395,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7696,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7696,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4735,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8470.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9062.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8724.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8893.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8978.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8893.59,"methodology":"case rate"}]}]},{"description":"REPAIR OF SPERM DUCT","code_information":[{"code":"55400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"minimum":6792,"maximum":21166.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12105,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11443,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7948,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16774,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15727,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20108.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14389,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17155,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14771,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21166.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19998,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12417,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12417,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6792,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11759.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12582.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12111.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12347.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12464.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12347.15,"methodology":"case rate"}]}]},{"description":"REMOVAL OF HYDROCELE","code_information":[{"code":"55500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SPERM CORD LESION","code_information":[{"code":"55520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISE SPERMATIC CORD VEINS","code_information":[{"code":"55530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"REVISE SPERMATIC CORD VEINS","code_information":[{"code":"55535","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":13660.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13660.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11038.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9539.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5578.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5969.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5745.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5857.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6136.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5913.31,"methodology":"case rate"}]}]},{"description":"REVISE HERNIA  SPERM VEINS","code_information":[{"code":"55540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7726.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7726.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5047.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5395.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3155.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3375.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3249.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3312.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3470.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3344.43,"methodology":"case rate"}]}]},{"description":"LAPARO LIGATE SPERMATIC VEIN","code_information":[{"code":"55550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO PROC SPERMATIC CORD","code_information":[{"code":"55559","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"minimum":4496,"maximum":15036.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7340,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6939,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4684,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7615,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7139,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14285,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8734,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10413,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8704,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15036.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7529,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7529,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4496,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8353.8,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8938.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8604.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8771.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8855.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8771.49,"methodology":"case rate"}]}]},{"description":"INCISE SPERM DUCT POUCH","code_information":[{"code":"55600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"INCISE SPERM DUCT POUCH","code_information":[{"code":"55605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SPERM DUCT POUCH","code_information":[{"code":"55650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SPERM POUCH LESION","code_information":[{"code":"55680","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"TENDONITIS MYOSITIS AND BURSITIS WITH MCC","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"minimum":5894,"maximum":23515.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13930,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13169,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8845,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18001,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16877,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22339.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15477,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18453,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16437,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23515.04,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23015,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14290,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14290,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5894,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13063.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13978.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13455.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13717.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13847.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13717.11,"methodology":"case rate"}]}]},{"description":"BIOPSY PROSTATE NEEDLE","code_information":[{"code":"55700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5714.55,"maximum":5714.55,"gross_charge":7055,"discounted_cash":2088.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5714.55,"methodology":"fee schedule"}]}]},{"description":"BIOPSY PROSTATE NEEDLE","code_information":[{"code":"55700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5714.55,"gross_charge":7055,"discounted_cash":2088.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5714.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1340.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1058.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1411,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"HC BIOPSY PROSTATE NEEDLE","code_information":[{"code":"55700","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":509.49,"maximum":509.49,"gross_charge":629,"discounted_cash":186.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":509.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.49,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY PROSTATE NEEDLE","code_information":[{"code":"55700","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":4484.85,"gross_charge":629,"discounted_cash":186.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":509.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"BIOPSY OF PROSTATE","code_information":[{"code":"55705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"PROSTATE SATURATION SAMPLING","code_information":[{"code":"55706","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PROSTATE ABSCESS","code_information":[{"code":"55720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PROSTATE ABSCESS","code_information":[{"code":"55725","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"TENDONITIS MYOSITIS AND BURSITIS WITHOUT MCC","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":4631,"maximum":15583.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7765,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7341,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4990,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10454,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9801,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14804.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9393,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11199,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9274,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15583.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12828,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7965,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7965,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4631,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8657.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9263.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8917.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9090.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9177.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9090.55,"methodology":"case rate"}]}]},{"description":"REMOVAL OF PROSTATE","code_information":[{"code":"55801","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55812","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55815","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PROSTATE","code_information":[{"code":"55821","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PROSTATE","code_information":[{"code":"55831","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55842","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55845","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SURGICAL EXPOSURE PROSTATE","code_information":[{"code":"55860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11129.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55862","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE PROSTATE SURGERY","code_information":[{"code":"55865","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO RADICAL PROSTATECTOMY","code_information":[{"code":"55866","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"ELECTROEJACULATION","code_information":[{"code":"55870","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"CRYOABLATE PROSTATE","code_information":[{"code":"55873","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"HC BULKING/SPACER MATERIAL IMPL","code_information":[{"code":"55874","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":12527.46,"maximum":12527.46,"gross_charge":15466,"discounted_cash":4577.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12527.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12527.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12527.46,"methodology":"fee schedule"}]}]},{"description":"HC BULKING/SPACER MATERIAL IMPL","code_information":[{"code":"55874","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":12527.46,"gross_charge":15466,"discounted_cash":4577.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12527.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12527.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12527.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2938.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3093.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2319.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3093.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"TRANSPERI PLACING INTERSTITIAL","code_information":[{"code":"55875","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":13961.97,"maximum":13961.97,"gross_charge":17237,"discounted_cash":5102.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13961.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13961.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13961.97,"methodology":"fee schedule"}]}]},{"description":"TRANSPERI PLACING INTERSTITIAL","code_information":[{"code":"55875","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":13961.97,"gross_charge":17237,"discounted_cash":5102.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13961.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13961.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13961.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11129.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7549.55,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7771.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3275.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3447.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2585.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3447.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4544.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4863.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4681.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4772.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4999.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4817.66,"methodology":"case rate"}]}]},{"description":"HC PLACE RT DEV/MARKER IN PROST","code_information":[{"code":"55876","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2860.92,"maximum":2860.92,"gross_charge":3532,"discounted_cash":1045.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2860.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2860.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2860.92,"methodology":"fee schedule"}]}]},{"description":"HC PLACE RT DEV/MARKER IN PROST","code_information":[{"code":"55876","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3532,"discounted_cash":1045.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2860.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2860.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2860.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2091.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2472.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1223.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1308.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1259.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1284.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1345.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1296.68,"methodology":"case rate"}]}]},{"description":"ABLTJ MAL PRST8 TISS HIFU","code_information":[{"code":"55880","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":20245.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20245.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13441.04,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14137.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8267.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8846.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8515.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8680.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9094.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8763.36,"methodology":"case rate"}]}]},{"description":"GENITAL SURGERY PROCEDURE","code_information":[{"code":"55899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":532.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":360.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":371.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":217.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":232.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":230.49,"methodology":"case rate"}]}]},{"description":"AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"minimum":10513,"maximum":39323,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16686,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15775,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10513,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39323,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36868,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25707.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19294,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23003,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19538,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27060.34,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27568,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17117,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17117,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17210,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15033.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16085.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15484.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15785.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15935.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15785.2,"methodology":"case rate"}]}]},{"description":"PLACE NEEDLES PELVIC FOR RT","code_information":[{"code":"55920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"SEX TRANSFORMATION M TO F","code_information":[{"code":"55970","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"SEX TRANSFORMATION F TO M","code_information":[{"code":"55980","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7550.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7550.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5086.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5272.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3083.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3299.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3176.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3237.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3391.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3268.53,"methodology":"case rate"}]}]},{"description":"AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"minimum":6432,"maximum":35123,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9677,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6432,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35123,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32931,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17824.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11842,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14119,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11953,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18762.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16911,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10500,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10500,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12044,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10423.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11153.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10736.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10944.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11049.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10944.82,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5601","type":"APR-DRG"}],"standard_charges":[{"minimum":4723,"maximum":4723,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4723,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4723,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4723,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5602","type":"APR-DRG"}],"standard_charges":[{"minimum":5286,"maximum":5286,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5286,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5286,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5603","type":"APR-DRG"}],"standard_charges":[{"minimum":6602,"maximum":6602,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6602,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6602,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6602,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY","code_information":[{"code":"5604","type":"APR-DRG"}],"standard_charges":[{"minimum":7909,"maximum":7909,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7909,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7909,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7909,"methodology":"case rate"}]}]},{"description":"AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"minimum":4433,"maximum":27742,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7349,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6948,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4433,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27742,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26010,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14297.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8541,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10183,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8237,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15049.57,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12142,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7539,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7539,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8906,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8360.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8946.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8611.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8778.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8862.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8778.92,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5611","type":"APR-DRG"}],"standard_charges":[{"minimum":2780,"maximum":2780,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2780,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2780,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2780,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5612","type":"APR-DRG"}],"standard_charges":[{"minimum":3601,"maximum":3601,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3601,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3601,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3601,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5613","type":"APR-DRG"}],"standard_charges":[{"minimum":4927,"maximum":4927,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4927,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4927,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4927,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE","code_information":[{"code":"5614","type":"APR-DRG"}],"standard_charges":[{"minimum":11539,"maximum":11539,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11539,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11539,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11539,"methodology":"case rate"}]}]},{"description":"FRACTURE SPRAIN STRAIN AND DISLOCATION EXCEPT FEMUR HIP PELVIS AND THIGH WITH MCC","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"minimum":5751,"maximum":26382,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13155,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12437,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8640,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26382,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24735,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21392.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15811,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18851,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16056,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22518.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21735,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13495,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13495,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5751,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12510.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13385.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12885.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13135.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13260.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13135.67,"methodology":"case rate"}]}]},{"description":"FRACTURE SPRAIN STRAIN AND DISLOCATION EXCEPT FEMUR HIP PELVIS AND THIGH WITHOUT MCC","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":5088,"maximum":15930.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8034,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7596,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5088,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14131,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13249,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15134.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9309,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11098,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9456,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15930.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13274,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8242,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8242,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5089,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8850.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9469.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9115.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9292.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9381.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9292.9,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":6739,"maximum":32485,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14106,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13335,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8874,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32485,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30457,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22553.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16790,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20017,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16491,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23740.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23304,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14470,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14470,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6739,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13189.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14112.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13584.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13848.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13980.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13848.64,"methodology":"case rate"}]}]},{"description":"I  D OF VULVA/PERINEUM","code_information":[{"code":"56405","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5641","type":"APR-DRG"}],"standard_charges":[{"minimum":3390,"maximum":3390,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3390,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3390,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3390,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5642","type":"APR-DRG"}],"standard_charges":[{"minimum":3939,"maximum":3939,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3939,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3939,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3939,"methodology":"case rate"}]}]},{"description":"INCISION ON VULVA PERINEUM INTROITUS","code_information":[{"code":"56420","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":522.45,"maximum":522.45,"gross_charge":645,"discounted_cash":190.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":522.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.45,"methodology":"fee schedule"}]}]},{"description":"INCISION ON VULVA PERINEUM INTROITUS","code_information":[{"code":"56420","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":645,"discounted_cash":190.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":522.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":451.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5643","type":"APR-DRG"}],"standard_charges":[{"minimum":4832,"maximum":4832,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4832,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4832,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4832,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"5644","type":"APR-DRG"}],"standard_charges":[{"minimum":11090,"maximum":11090,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11090,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11090,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11090,"methodology":"case rate"}]}]},{"description":"SURGERY FOR VULVA LESION","code_information":[{"code":"56440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"LYSIS OF LABIAL LESION(S)","code_information":[{"code":"56441","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"HYMENOTOMY","code_information":[{"code":"56442","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":5678,"maximum":18778,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9166,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8665,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5678,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18778,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17606,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16517.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10673,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12725,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10552,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17386.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15144,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9403,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9403,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6739,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9659.17,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10335.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9948.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10142.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10142.13,"methodology":"case rate"}]}]},{"description":"DESTROY VULVA LESIONS SIM","code_information":[{"code":"56501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"DESTROY VULVA LESION/S COMPL","code_information":[{"code":"56515","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4004.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"minimum":3450,"maximum":16247,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6725,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6357,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4264,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16247,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15233,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13533.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8028,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9571,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7924,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14245.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11110,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6898,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6898,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3450,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7914.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8468.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8151.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8310.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8389.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8310.12,"methodology":"case rate"}]}]},{"description":"BIOPSY OF VULVA/PERINEUM","code_information":[{"code":"56605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1906.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"BIOPSY OF VULVA/PERINEUM","code_information":[{"code":"56606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5661","type":"APR-DRG"}],"standard_charges":[{"minimum":3455,"maximum":3455,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3455,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3455,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3455,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5662","type":"APR-DRG"}],"standard_charges":[{"minimum":4173,"maximum":4173,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4173,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4173,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4173,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF VULVA","code_information":[{"code":"56620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"COMPLETE REMOVAL OF VULVA","code_information":[{"code":"56625","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5663","type":"APR-DRG"}],"standard_charges":[{"minimum":5804,"maximum":5804,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5804,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5804,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5804,"methodology":"case rate"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56631","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56633","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56634","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56637","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTEPARTUM WITHOUT O.R. PROCEDURE","code_information":[{"code":"5664","type":"APR-DRG"}],"standard_charges":[{"minimum":10997,"maximum":10997,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10997,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10997,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10997,"methodology":"case rate"}]}]},{"description":"EXTENSIVE VULVA SURGERY","code_information":[{"code":"56640","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL REMOVAL OF HYMEN","code_information":[{"code":"56700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINA GLAND LESION","code_information":[{"code":"56740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REPAIR OF VAGINA","code_information":[{"code":"56800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REPAIR CLITORIS","code_information":[{"code":"56805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REPAIR OF PERINEUM","code_information":[{"code":"56810","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"EXAM OF VULVA W/SCOPE","code_information":[{"code":"56820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"EXAM/BIOPSY OF VULVA W/SCOPE","code_information":[{"code":"56821","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"SKIN DEBRIDEMENT WITH MCC","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"minimum":9743,"maximum":44705,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27059,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":25581,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16602,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42112,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39483,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38383.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31531,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37593,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30853,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":40403.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44705,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27757,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27757,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9743,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22446.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24017.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23119.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23568.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23793,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23568.54,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF VAGINA","code_information":[{"code":"57000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PELVIC ABSCESS","code_information":[{"code":"57010","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF PELVIC FLUID","code_information":[{"code":"57020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"I  D VAGINAL HEMATOMA PP","code_information":[{"code":"57022","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"I  D VAG HEMATOMA NON-OB","code_information":[{"code":"57023","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"DESTROY VAG LESIONS SIMPLE","code_information":[{"code":"57061","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DESTROY VAG LESIONS COMPLEX","code_information":[{"code":"57065","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"SKIN DEBRIDEMENT WITH CC","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"minimum":7240,"maximum":25823,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15050,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14228,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9612,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25823,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24211,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23708.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17820,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21246,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17863,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24955.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24865,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15439,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15439,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7240,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13864.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14834.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14280.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14557.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14696.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14557.57,"methodology":"case rate"}]}]},{"description":"BIOPSY OF VAGINA","code_information":[{"code":"57100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"BIOPSY OF VAGINA","code_information":[{"code":"57105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINA WALL PARTIAL","code_information":[{"code":"57106","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINA TISSUE PART","code_information":[{"code":"57107","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"VAGINECTOMY PARTIAL W/NODES","code_information":[{"code":"57109","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINA WALL COMPLETE","code_information":[{"code":"57110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VAGINA TISSUE COMPL","code_information":[{"code":"57111","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAGINECTOMY W/NODES COMPL","code_information":[{"code":"57112","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOSURE OF VAGINA","code_information":[{"code":"57120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINA LESION","code_information":[{"code":"57130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINA LESION","code_information":[{"code":"57135","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"TREAT VAGINA INFECTION","code_information":[{"code":"57150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC INSERT OF TANDEM&OVIODS","code_information":[{"code":"57155","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3939.03,"maximum":3939.03,"gross_charge":4863,"discounted_cash":1439.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3939.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3939.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3939.03,"methodology":"fee schedule"}]}]},{"description":"HC INSERT OF TANDEM&OVIODS","code_information":[{"code":"57155","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"gross_charge":4863,"discounted_cash":1439.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3939.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3939.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3939.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":923.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"HC INSERTION/VAGINAL RAD","code_information":[{"code":"57156","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":609.93,"maximum":609.93,"gross_charge":753,"discounted_cash":222.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":609.93,"methodology":"fee schedule"}]}]},{"description":"HC INSERTION/VAGINAL RAD","code_information":[{"code":"57156","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":753,"discounted_cash":222.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":527.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"INSERT PESSARY/OTHER DEVICE","code_information":[{"code":"57160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"FITTING OF DIAPHRAGM/CAP","code_information":[{"code":"57170","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"TREAT VAGINAL BLEEDING","code_information":[{"code":"57180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"SKIN DEBRIDEMENT WITHOUT CC/MCC","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"minimum":5399,"maximum":18805.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10269,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9708,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6474,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16525,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15493,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17865.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13010,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15511,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12032,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18805.32,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16966,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10534,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10534,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5399,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10447.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11178.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10760.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10969.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11074.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10969.77,"methodology":"case rate"}]}]},{"description":"REPAIR OF VAGINA","code_information":[{"code":"57200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REPAIR VAGINA/PERINEUM","code_information":[{"code":"57210","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REVISION OF URETHRA","code_information":[{"code":"57220","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR OF URETHRAL LESION","code_information":[{"code":"57230","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"ANTERIOR COLPORRHAPHY","code_information":[{"code":"57240","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR RECTUM  VAGINA","code_information":[{"code":"57250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"CMBN ANT PST COLPRHY","code_information":[{"code":"57260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"CMBN AP COLPRHY W/NTRCL RPR","code_information":[{"code":"57265","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"INSERT MESH/PELVIC FLR ADDON","code_information":[{"code":"57267","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF BOWEL BULGE","code_information":[{"code":"57268","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR OF BOWEL POUCH","code_information":[{"code":"57270","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SUSPENSION OF VAGINA","code_information":[{"code":"57280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COLPOPEXY EXTRAPERITONEAL","code_information":[{"code":"57282","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"COLPOPEXY INTRAPERITONEAL","code_information":[{"code":"57283","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"REPAIR PARAVAG DEFECT OPEN","code_information":[{"code":"57284","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR PARAVAG DEFECT VAG","code_information":[{"code":"57285","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"REVISE/REMOVE SLING REPAIR","code_information":[{"code":"57287","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REPAIR BLADDER DEFECT","code_information":[{"code":"57288","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR BLADDER  VAGINA","code_information":[{"code":"57289","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"CONSTRUCTION OF VAGINA","code_information":[{"code":"57291","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"CONSTRUCT VAGINA WITH GRAFT","code_information":[{"code":"57292","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REVISE VAG GRAFT VIA VAGINA","code_information":[{"code":"57295","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REVISE VAG GRAFT OPEN ABD","code_information":[{"code":"57296","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"minimum":16472,"maximum":91456,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55356,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":52332,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35327,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76283,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71521,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":72964.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63454,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75653,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65651,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":76804.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91456,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":56785,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":56785,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16472,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42669.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45655.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43949.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44802.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45229.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44802.56,"methodology":"case rate"}]}]},{"description":"REPAIR RECTUM-VAGINA FISTULA","code_information":[{"code":"57300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REPAIR RECTUM-VAGINA FISTULA","code_information":[{"code":"57305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FISTULA REPAIR  COLOSTOMY","code_information":[{"code":"57307","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FISTULA REPAIR TRANSPERINE","code_information":[{"code":"57308","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR URETHROVAGINAL LESION","code_information":[{"code":"57310","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"REPAIR URETHROVAGINAL LESION","code_information":[{"code":"57311","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR BLADDER-VAGINA LESION","code_information":[{"code":"57320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REPAIR BLADDER-VAGINA LESION","code_information":[{"code":"57330","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"REPAIR VAGINA","code_information":[{"code":"57335","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"minimum":12973,"maximum":51457,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31146,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29445,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19350,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25914,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24296,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43377.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38962,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46452,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35958,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45661.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51457,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31950,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31950,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12973,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25367.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27142.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26128.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26635.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26889.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26635.6,"methodology":"case rate"}]}]},{"description":"DILATION OF VAGINA","code_information":[{"code":"57400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"PELVIC EXAMINATION","code_information":[{"code":"57410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE VAGINAL FOREIGN BODY","code_information":[{"code":"57415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"EXAM OF VAGINA W/SCOPE","code_information":[{"code":"57420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"EXAM/BIOPSY OF VAG W/SCOPE","code_information":[{"code":"57421","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"REPAIR PARAVAG DEFECT LAP","code_information":[{"code":"57423","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY SURG COLPOPEXY","code_information":[{"code":"57425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"REVISE PROSTH VAG GRAFT LAP","code_information":[{"code":"57426","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"EXAM OF CERVIX W/SCOPE","code_information":[{"code":"57452","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"BX/CURETT OF CERVIX W/SCOPE","code_information":[{"code":"57454","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"BIOPSY OF CERVIX W/SCOPE","code_information":[{"code":"57455","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"ENDOCERV CURETTAGE W/SCOPE","code_information":[{"code":"57456","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"BX OF CERVIX W/SCOPE LEEP","code_information":[{"code":"57460","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"CONZ OF CERVIX W/SCOPE LEEP","code_information":[{"code":"57461","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"CAM CERVIX UTERI DRG COLP","code_information":[{"code":"57465","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"minimum":8521,"maximum":29653,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17948,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16968,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11624,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21523,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20179,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27249.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22154,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26413,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21602,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28683.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29653,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18412,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18412,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8521,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15935.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17050.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16413.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16732.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16891.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16732.24,"methodology":"case rate"}]}]},{"description":"BIOPSY OF CERVIX","code_information":[{"code":"57500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"ENDOCERVICAL CURETTAGE","code_information":[{"code":"57505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"CAUTERIZATION OF CERVIX","code_information":[{"code":"57510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"CRYOCAUTERY OF CERVIX","code_information":[{"code":"57511","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"LASER SURGERY OF CERVIX","code_information":[{"code":"57513","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"CONIZATION OF CERVIX","code_information":[{"code":"57520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"CONIZATION OF CERVIX","code_information":[{"code":"57522","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVAL OF CERVIX","code_information":[{"code":"57530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REMOVAL OF CERVIX RADICAL","code_information":[{"code":"57531","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF RESIDUAL CERVIX","code_information":[{"code":"57540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE CERVIX/REPAIR PELVIS","code_information":[{"code":"57545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF RESIDUAL CERVIX","code_information":[{"code":"57550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REMOVE CERVIX/REPAIR VAGINA","code_information":[{"code":"57555","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REMOVE CERVIX REPAIR BOWEL","code_information":[{"code":"57556","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"DC OF CERVICAL STUMP","code_information":[{"code":"57558","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"minimum":30315,"maximum":80126,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48498,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":45849,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32288,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41456,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38868,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64583.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61060,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72799,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60002,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":67982.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49750,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30315,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37768.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40411.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38901.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39656.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40034.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39656.61,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"minimum":13509,"maximum":39545,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23936,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22628,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15050,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31461,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29497,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34566.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28306,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33747,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27969,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36386.12,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39545,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24554,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24554,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13509,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20214.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21629.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20820.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21225.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21427.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21225.24,"methodology":"case rate"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"57700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"57720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"minimum":8909,"maximum":25141.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15195,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14365,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9150,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15606,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14632,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23884.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18510,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22069,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17004,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25141.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25104,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15587,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15587,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8909,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13967.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14945.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14386.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14666.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14805.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14666.16,"methodology":"case rate"}]}]},{"description":"DILATION OF CERVICAL CANAL","code_information":[{"code":"57800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"minimum":18213,"maximum":48406,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29299,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27698,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18988,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43553,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40834,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41120.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34067,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40616,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35287,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":43284.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48406,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30055,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18213,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24047.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25730.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24768.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25249.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25489.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25249.45,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"minimum":8194,"maximum":26331,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15937,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15067,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9923,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18532,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17375,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24792.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18767,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22374,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18441,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26097.12,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26331,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16349,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16349,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8194,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14498.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15513.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14933.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15223.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15368.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15223.32,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5801","type":"APR-DRG"}],"standard_charges":[{"minimum":2237,"maximum":2237,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2237,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2237,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2237,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5802","type":"APR-DRG"}],"standard_charges":[{"minimum":2860,"maximum":2860,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2860,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2860,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2860,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5803","type":"APR-DRG"}],"standard_charges":[{"minimum":4692,"maximum":4692,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4692,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4692,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4692,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD NOT BORN HERE","code_information":[{"code":"5804","type":"APR-DRG"}],"standard_charges":[{"minimum":7693,"maximum":7693,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7693,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7693,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7693,"methodology":"case rate"}]}]},{"description":"OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"minimum":5844,"maximum":22237.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12937,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12230,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7651,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16059,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15057,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21125.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15257,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18190,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14218,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22237.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21374,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13271,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13271,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5844,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12354.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13218.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12724.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12971.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13095.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12971.76,"methodology":"case rate"}]}]},{"description":"HC CYSTOPLASTY ON BLADDER","code_information":[{"code":"58100","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":633.42,"maximum":633.42,"gross_charge":782,"discounted_cash":231.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":633.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":633.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":633.42,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOPLASTY ON BLADDER","code_information":[{"code":"58100","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":782,"discounted_cash":231.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":633.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":633.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":633.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":547.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5811","type":"APR-DRG"}],"standard_charges":[{"minimum":779,"maximum":779,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":779,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":779,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":779,"methodology":"case rate"}]}]},{"description":"BX DONE W/COLPOSCOPY ADD-ON","code_information":[{"code":"58110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5812","type":"APR-DRG"}],"standard_charges":[{"minimum":1166,"maximum":1166,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166,"methodology":"case rate"}]}]},{"description":"DILATION AND CURETTAGE","code_information":[{"code":"58120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5813","type":"APR-DRG"}],"standard_charges":[{"minimum":1788,"maximum":1788,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1788,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1788,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1788,"methodology":"case rate"}]}]},{"description":"NEONATE TRANSFERRED < 5 DAYS OLD BORN HERE","code_information":[{"code":"5814","type":"APR-DRG"}],"standard_charges":[{"minimum":2993,"maximum":2993,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2993,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2993,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2993,"methodology":"case rate"}]}]},{"description":"MYOMECTOMY ABDOM METHOD","code_information":[{"code":"58140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYOMECTOMY VAG METHOD","code_information":[{"code":"58145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"MYOMECTOMY ABDOM COMPLEX","code_information":[{"code":"58146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TOTAL HYSTERECTOMY","code_information":[{"code":"58150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TOTAL HYSTERECTOMY","code_information":[{"code":"58152","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL HYSTERECTOMY","code_information":[{"code":"58180","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5257,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITH CC/MCC","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"minimum":9132,"maximum":26007,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15742,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14882,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9893,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19439,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18225,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24552.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20913,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24934,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18385,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25845.03,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26007,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16148,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16148,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9132,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14358.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15363.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14789.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15076.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15219.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15076.27,"methodology":"case rate"}]}]},{"description":"EXTENSIVE HYSTERECTOMY","code_information":[{"code":"58200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE HYSTERECTOMY","code_information":[{"code":"58210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PELVIS CONTENTS","code_information":[{"code":"58240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAGINAL HYSTERECTOMY","code_information":[{"code":"58260","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"VAG HYST INCLUDING T/O","code_information":[{"code":"58262","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"VAG HYST W/T/O  VAG REPAIR","code_information":[{"code":"58263","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"VAG HYST W/URINARY REPAIR","code_information":[{"code":"58267","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAG HYST W/ENTEROCELE REPAIR","code_information":[{"code":"58270","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"HYSTERECTOMY/REVISE VAGINA","code_information":[{"code":"58275","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HYSTERECTOMY/REVISE VAGINA","code_information":[{"code":"58280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE HYSTERECTOMY","code_information":[{"code":"58285","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAG HYST COMPLEX","code_information":[{"code":"58290","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"VAG HYST INCL T/O COMPLEX","code_information":[{"code":"58291","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"VAG HYST T/O  REPAIR COMPL","code_information":[{"code":"58292","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"VAG HYST W/URO REPAIR COMPL","code_information":[{"code":"58293","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VAG HYST W/ENTEROCELE COMPL","code_information":[{"code":"58294","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"minimum":8565,"maximum":24590.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14766,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13960,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8646,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18507,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17351,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23360.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16330,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19470,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16068,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24590.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24396,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15147,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15147,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8565,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13661.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14617.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14071.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14344.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14481.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14344.42,"methodology":"case rate"}]}]},{"description":"INSERT INTRAUTERINE DEVICE","code_information":[{"code":"58300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE INTRAUTERINE DEVICE","code_information":[{"code":"58301","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5831","type":"APR-DRG"}],"standard_charges":[{"minimum":114541,"maximum":114541,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114541,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114541,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114541,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5832","type":"APR-DRG"}],"standard_charges":[{"minimum":132543,"maximum":132543,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":132543,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":132543,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":132543,"methodology":"case rate"}]}]},{"description":"ARTIFICIAL INSEMINATION","code_information":[{"code":"58321","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"ARTIFICIAL INSEMINATION","code_information":[{"code":"58322","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"SPERM WASHING","code_information":[{"code":"58323","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5833","type":"APR-DRG"}],"standard_charges":[{"minimum":179743,"maximum":179743,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179743,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":179743,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179743,"methodology":"case rate"}]}]},{"description":"NEONATE WITH ECMO","code_information":[{"code":"5834","type":"APR-DRG"}],"standard_charges":[{"minimum":226943,"maximum":226943,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":226943,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":226943,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":226943,"methodology":"case rate"}]}]},{"description":"HC INJ SIS/HYSTEROGRAPHY","code_information":[{"code":"58340","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":334.53,"maximum":334.53,"gross_charge":413,"discounted_cash":122.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.53,"methodology":"fee schedule"}]}]},{"description":"HC INJ SIS/HYSTEROGRAPHY","code_information":[{"code":"58340","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":413,"discounted_cash":122.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":198.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":231.28,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"}]}]},{"description":"HYSTERO CATHETERIZATION","code_information":[{"code":"58340","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":192.78,"maximum":192.78,"gross_charge":238,"discounted_cash":70.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":192.78,"methodology":"fee schedule"}]}]},{"description":"HYSTERO CATHETERIZATION","code_information":[{"code":"58340","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":238,"discounted_cash":70.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"}]}]},{"description":"REOPEN FALLOPIAN TUBE","code_information":[{"code":"58345","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"INSERT HEYMAN UTERI CAPSULE","code_information":[{"code":"58346","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"REOPEN FALLOPIAN TUBE","code_information":[{"code":"58350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"ENDOMETR ABLATE THERMAL","code_information":[{"code":"58353","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"ENDOMETRIAL CRYOABLATION","code_information":[{"code":"58356","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"BREAST BIOPSY LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"minimum":10168,"maximum":30406,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18404,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17399,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11127,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25172,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23601,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27806.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23086,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27524,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20679,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29270.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30406,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18879,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18879,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16261.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17399.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16748.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17074.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17236.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17074.21,"methodology":"case rate"}]}]},{"description":"SUSPENSION OF UTERUS","code_information":[{"code":"58400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SUSPENSION OF UTERUS","code_information":[{"code":"58410","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BREAST BIOPSY LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"minimum":9119,"maximum":29481,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17844,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16869,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9567,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19613,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18389,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27122.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19900,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23726,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17780,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28549.7,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29481,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18305,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9119,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15860.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16971.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16336.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16653.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16812.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16653.99,"methodology":"case rate"}]}]},{"description":"REPAIR OF RUPTURED UTERUS","code_information":[{"code":"58520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF UTERUS","code_information":[{"code":"58540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LSH UTERUS 250 G OR LESS","code_information":[{"code":"58541","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LSH W/T/O UT 250 G OR LESS","code_information":[{"code":"58542","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LSH UTERUS ABOVE 250 G","code_information":[{"code":"58543","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LSH W/T/O UTERUS ABOVE 250 G","code_information":[{"code":"58544","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPIC MYOMECTOMY","code_information":[{"code":"58545","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO-MYOMECTOMY COMPLEX","code_information":[{"code":"58546","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAP RADICAL HYST","code_information":[{"code":"58548","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO-ASST VAG HYSTERECTOMY","code_information":[{"code":"58550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPARO-VAG HYST INCL T/O","code_information":[{"code":"58552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO-VAG HYST COMPLEX","code_information":[{"code":"58553","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO-VAG HYST W/T/O COMPL","code_information":[{"code":"58554","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY DX SEP PROC","code_information":[{"code":"58555","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY BIOPSY","code_information":[{"code":"58558","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY LYSIS","code_information":[{"code":"58559","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY RESECT SEPTUM","code_information":[{"code":"58560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY REMOVE MYOMA","code_information":[{"code":"58561","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY REMOVE FB","code_information":[{"code":"58562","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY ABLATION","code_information":[{"code":"58563","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPY STERILIZATION","code_information":[{"code":"58565","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"TLH UTERUS 250 G OR LESS","code_information":[{"code":"58570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"TLH W/T/O 250 G OR LESS","code_information":[{"code":"58571","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"TLH UTERUS OVER 250 G","code_information":[{"code":"58572","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"TLH W/T/O UTERUS OVER 250 G","code_information":[{"code":"58573","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPS TOT HYST RESJ MAL","code_information":[{"code":"58575","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO PROC UTERUS","code_information":[{"code":"58578","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"HYSTEROSCOPE PROCEDURE","code_information":[{"code":"58579","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"DIVISION OF FALLOPIAN TUBE","code_information":[{"code":"58600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DIVISION OF FALLOPIAN TUBE","code_information":[{"code":"58605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LIGATE OVIDUCT(S) ADD-ON","code_information":[{"code":"58611","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OCCLUDE FALLOPIAN TUBE(S)","code_information":[{"code":"58615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY LYSIS","code_information":[{"code":"58660","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY REMOVE ADNEXA","code_information":[{"code":"58661","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY EXCISE LESIONS","code_information":[{"code":"58662","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY TUBAL CAUTERY","code_information":[{"code":"58670","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY TUBAL BLOCK","code_information":[{"code":"58671","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY FIMBRIOPLASTY","code_information":[{"code":"58672","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY SALPINGOSTOMY","code_information":[{"code":"58673","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPS ABLTJ UTERINE FIBROIDS","code_information":[{"code":"58674","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":22793.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22793.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15018.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15916.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9308.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9959.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9587.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9773.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10238.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9866.53,"methodology":"case rate"}]}]},{"description":"LAPARO PROC OVIDUCT-OVARY","code_information":[{"code":"58679","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVAL OF FALLOPIAN TUBE","code_information":[{"code":"58700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF OVARY/TUBE(S)","code_information":[{"code":"58720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ADHESIOLYSIS TUBE OVARY","code_information":[{"code":"58740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OVIDUCT","code_information":[{"code":"58750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE OVARIAN TUBE(S)","code_information":[{"code":"58752","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FIMBRIOPLASTY","code_information":[{"code":"58760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CREATE NEW TUBAL OPENING","code_information":[{"code":"58770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF OVARIAN CYST(S)","code_information":[{"code":"58800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF OVARIAN CYST(S)","code_information":[{"code":"58805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5881","type":"APR-DRG"}],"standard_charges":[{"minimum":77299,"maximum":77299,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77299,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77299,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77299,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5882","type":"APR-DRG"}],"standard_charges":[{"minimum":117432,"maximum":117432,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":117432,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117432,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":117432,"methodology":"case rate"}]}]},{"description":"DRAIN OVARY ABSCESS OPEN","code_information":[{"code":"58820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DRAIN OVARY ABSCESS PERCUT","code_information":[{"code":"58822","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPOSITION OVARY(S)","code_information":[{"code":"58825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5883","type":"APR-DRG"}],"standard_charges":[{"minimum":119928,"maximum":119928,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":119928,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119928,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":119928,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 1500 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"5884","type":"APR-DRG"}],"standard_charges":[{"minimum":167708,"maximum":167708,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167708,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167708,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167708,"methodology":"case rate"}]}]},{"description":"BIOPSY OF OVARY(S)","code_information":[{"code":"58900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5891","type":"APR-DRG"}],"standard_charges":[{"minimum":36370,"maximum":36370,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36370,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36370,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36370,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5892","type":"APR-DRG"}],"standard_charges":[{"minimum":30192,"maximum":30192,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30192,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30192,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30192,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF OVARY(S)","code_information":[{"code":"58920","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":16189.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16189.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11025.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11305.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6611.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7074.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6809.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6941.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7272.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7007.94,"methodology":"case rate"}]}]},{"description":"REMOVAL OF OVARIAN CYST(S)","code_information":[{"code":"58925","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5893","type":"APR-DRG"}],"standard_charges":[{"minimum":24016,"maximum":24016,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24016,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24016,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24016,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT < 500 GRAMS OR BIRTH WEIGHT 500-999 GRAMS AND GESTATIONAL AGE <24 WEEKS OR BIRTH WEIGHT 500-749 GRAMS WITH MAJOR ANOMALY OR WITHOUT LIFE SUSTAINING INTERVENTION","code_information":[{"code":"5894","type":"APR-DRG"}],"standard_charges":[{"minimum":510,"maximum":510,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":510,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":510,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":510,"methodology":"case rate"}]}]},{"description":"REMOVAL OF OVARY(S)","code_information":[{"code":"58940","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF OVARY(S)","code_information":[{"code":"58943","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT OVARIAN MALIGNANCY","code_information":[{"code":"58950","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT OVARIAN MALIGNANCY","code_information":[{"code":"58951","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT OVARIAN MALIGNANCY","code_information":[{"code":"58952","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TAH RAD DISSECT FOR DEBULK","code_information":[{"code":"58953","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TAH RAD DEBULK/LYMPH REMOVE","code_information":[{"code":"58954","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BSO OMENTECTOMY W/TAH","code_information":[{"code":"58956","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT RECURRENT GYN MAL","code_information":[{"code":"58957","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT RECUR GYN MAL W/LYM","code_information":[{"code":"58958","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORATION OF ABDOMEN","code_information":[{"code":"58960","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RETRIEVAL OF OOCYTE","code_information":[{"code":"58970","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1906.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"TRANSFER OF EMBRYO","code_information":[{"code":"58974","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1906.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"TRANSFER OF EMBRYO","code_information":[{"code":"58976","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"GENITAL SURGERY PROCEDURE","code_information":[{"code":"58999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"AMNIOCENTESIS DIAGNOSTIC","code_information":[{"code":"59000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_percentage":65,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"AMNIOCENTESIS THERAPEUTIC","code_information":[{"code":"59001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_percentage":65,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"FETAL CORD PUNCTURE PRENATAL","code_information":[{"code":"59012","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"CHORION BIOPSY","code_information":[{"code":"59015","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1906.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1172.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1331.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":778.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":832.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":801.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":817.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":856.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":825.19,"methodology":"case rate"}]}]},{"description":"FETAL CONTRACT STRESS TEST","code_information":[{"code":"59020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"FETAL NON-STRESS TEST","code_information":[{"code":"59025","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_percentage":65,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"FETAL SCALP BLOOD SAMPLE","code_information":[{"code":"59030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"FETAL MONITOR W/REPORT","code_information":[{"code":"59050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FETAL MONITOR/INTERPRET ONLY","code_information":[{"code":"59051","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSABDOM AMNIOINFUS W/US","code_information":[{"code":"59070","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"UMBILICAL CORD OCCLUD W/US","code_information":[{"code":"59072","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"FETAL FLUID DRAINAGE W/US","code_information":[{"code":"59074","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"FETAL SHUNT PLACEMENT W/US","code_information":[{"code":"59076","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"REMOVE UTERUS LESION","code_information":[{"code":"59100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10807.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10807.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7257.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7546.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4413.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4722.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4545.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4634.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4854.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4678.18,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5911","type":"APR-DRG"}],"standard_charges":[{"minimum":993,"maximum":993,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":993,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":993,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":993,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5912","type":"APR-DRG"}],"standard_charges":[{"minimum":36548,"maximum":36548,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36548,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36548,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36548,"methodology":"case rate"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3442,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59121","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5913","type":"APR-DRG"}],"standard_charges":[{"minimum":68685,"maximum":68685,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68685,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68685,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68685,"methodology":"case rate"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59130","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59136","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 500-749 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5914","type":"APR-DRG"}],"standard_charges":[{"minimum":122890,"maximum":122890,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122890,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122890,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122890,"methodology":"case rate"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"TREAT ECTOPIC PREGNANCY","code_information":[{"code":"59151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"D  C AFTER DELIVERY","code_information":[{"code":"59160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS WITH MCC","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"minimum":8574,"maximum":30538,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18484,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17474,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11875,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17750,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16642,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27904.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19283,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22990,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22067,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29373,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30538,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18961,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18961,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8574,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16318.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17460.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16807.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17134.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17297.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17134.25,"methodology":"case rate"}]}]},{"description":"INSERT CERVICAL DILATOR","code_information":[{"code":"59200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"SKIN ULCERS WITH CC","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"minimum":6028,"maximum":19733.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10991,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10390,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6874,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11391,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10680,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18747.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12451,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14845,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12774,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19733.85,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18158,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11275,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11275,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6028,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10963.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11730.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11292.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11511.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11621.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11511.42,"methodology":"case rate"}]}]},{"description":"EPISIOTOMY OR VAGINAL REPAIR","code_information":[{"code":"59300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5931","type":"APR-DRG"}],"standard_charges":[{"minimum":1146,"maximum":1146,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1146,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5932","type":"APR-DRG"}],"standard_charges":[{"minimum":63795,"maximum":63795,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63795,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63795,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63795,"methodology":"case rate"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"59320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REVISION OF CERVIX","code_information":[{"code":"59325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5933","type":"APR-DRG"}],"standard_charges":[{"minimum":87883,"maximum":87883,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87883,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87883,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87883,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE","code_information":[{"code":"5934","type":"APR-DRG"}],"standard_charges":[{"minimum":101772,"maximum":101772,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101772,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":101772,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101772,"methodology":"case rate"}]}]},{"description":"REPAIR OF UTERUS","code_information":[{"code":"59350","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKIN ULCERS WITHOUT CC/MCC","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"minimum":2989,"maximum":15409.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7629,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7212,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4473,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10780,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10107,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14638.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8365,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9973,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8313,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15409.19,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12604,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7826,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7826,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2989,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8560.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9159.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8817.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8988.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9074.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8988.7,"methodology":"case rate"}]}]},{"description":"OBSTETRICAL CARE","code_information":[{"code":"59400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OBSTETRICAL CARE","code_information":[{"code":"59409","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"OBSTETRICAL CARE","code_information":[{"code":"59410","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTEPARTUM MANIPULATION","code_information":[{"code":"59412","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"DELIVER PLACENTA","code_information":[{"code":"59414","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"ANTEPARTUM CARE ONLY","code_information":[{"code":"59425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTEPARTUM CARE ONLY","code_information":[{"code":"59426","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARE AFTER DELIVERY","code_information":[{"code":"59430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SKIN DISORDERS WITH MCC","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"minimum":8842,"maximum":31411,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19013,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17974,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12357,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23962,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22466,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28550.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23146,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27596,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22964,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30052.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31411,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19503,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19503,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8842,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16696.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17864.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17196.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17530.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17697.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17530.87,"methodology":"case rate"}]}]},{"description":"CESAREAN DELIVERY","code_information":[{"code":"59510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CESAREAN DELIVERY ONLY","code_information":[{"code":"59514","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CESAREAN DELIVERY","code_information":[{"code":"59515","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE UTERUS AFTER CESAREAN","code_information":[{"code":"59525","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MAJOR SKIN DISORDERS WITHOUT MCC","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"minimum":5336,"maximum":18096.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9718,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9187,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5732,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8125,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7618,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17191.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11801,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14070,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10653,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18096.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9969,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9969,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5336,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10053.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10757.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10355.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10556.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10656.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10556.28,"methodology":"case rate"}]}]},{"description":"VBAC DELIVERY","code_information":[{"code":"59610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VBAC DELIVERY ONLY","code_information":[{"code":"59612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"VBAC CARE AFTER DELIVERY","code_information":[{"code":"59614","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ATTEMPTED VBAC DELIVERY","code_information":[{"code":"59618","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ATTEMPTED VBAC DELIVERY ONLY","code_information":[{"code":"59620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ATTEMPTED VBAC AFTER CARE","code_information":[{"code":"59622","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH MCC","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"minimum":7299,"maximum":26089,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15791,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14928,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9093,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18120,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16989,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24613.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18202,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21702,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16898,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25908.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16199,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16199,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7299,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14393.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15401.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14825.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15113.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15257.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15113.38,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH CC","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"minimum":5522,"maximum":18071.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9698,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9168,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6811,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11511,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10793,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17167.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11545,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13765,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12657,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18071.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16023,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9949,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9949,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10039.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10742.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10340.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10541.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10641.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10541.45,"methodology":"case rate"}]}]},{"description":"TREATMENT OF MISCARRIAGE","code_information":[{"code":"59812","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"CARE OF MISCARRIAGE","code_information":[{"code":"59820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"TREATMENT OF MISCARRIAGE","code_information":[{"code":"59821","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"TREAT UTERUS INFECTION","code_information":[{"code":"59830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION","code_information":[{"code":"59840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"ABORTION","code_information":[{"code":"59841","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"ABORTION","code_information":[{"code":"59850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION","code_information":[{"code":"59851","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION","code_information":[{"code":"59852","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION","code_information":[{"code":"59855","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION","code_information":[{"code":"59856","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION","code_information":[{"code":"59857","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ABORTION (MPR)","code_information":[{"code":"59866","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":665.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":468.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":465.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":291,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":280.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":285.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":299.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":288.28,"methodology":"case rate"}]}]},{"description":"EVACUATE MOLE OF UTERUS","code_information":[{"code":"59870","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"REMOVE CERCLAGE SUTURE","code_information":[{"code":"59871","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6961.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6961.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4561.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4860.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2842.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3041.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2927.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2984.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3126.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3013.19,"methodology":"case rate"}]}]},{"description":"FETAL INVAS PX W/US","code_information":[{"code":"59897","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"LAPARO PROC OB CARE/DELIVER","code_information":[{"code":"59898","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"MATERNITY CARE PROCEDURE","code_information":[{"code":"59899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":440.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":290.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":307.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":179.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":192.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":185.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":188.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":197.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":190.64,"methodology":"case rate"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITHOUT CC/MCC","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"minimum":3822,"maximum":15480.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7685,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7265,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3822,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9630,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9029,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14706.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8081,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9634,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7103,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15480.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12696,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7883,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7883,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8600.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9202.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8858.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9030.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9116.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9030.52,"methodology":"case rate"}]}]},{"description":"NON-MALIGNANT BREAST DISORDERS WITH CC/MCC","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"minimum":5465,"maximum":16656.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8599,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8129,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5826,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13028,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12215,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15824.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11253,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13417,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10827,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16656.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14207,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8821,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8821,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5465,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9253.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9901.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9531.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9716.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9809.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9716.51,"methodology":"case rate"}]}]},{"description":"DRAIN THYROID/TONGUE CYST","code_information":[{"code":"60000","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"minimum":3599,"maximum":12527.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5389,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5095,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3599,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8328,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7808,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11901.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7608,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9071,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6688,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12527.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8903,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5528,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5528,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4086,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6959.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7446.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7168.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7307.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7377.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7307.78,"methodology":"case rate"}]}]},{"description":"HC BIOPSY NEEDLE THYROID","code_information":[{"code":"60100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":766.26,"maximum":766.26,"gross_charge":946,"discounted_cash":280.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":766.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":766.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":766.26,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY NEEDLE THYROID","code_information":[{"code":"60100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":946,"discounted_cash":280.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":766.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":766.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":766.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":662.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"CELLULITIS WITH MCC","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":8115,"maximum":22584.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13207,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12485,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8451,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15109,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14165,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21454.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18573,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15705,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22584.19,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21819,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13547,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13547,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8115,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12546.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13425.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12923.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13174.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13299.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13174.11,"methodology":"case rate"}]}]},{"description":"REMOVE THYROID LESION","code_information":[{"code":"60200","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6021","type":"APR-DRG"}],"standard_charges":[{"minimum":10296,"maximum":10296,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10296,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10296,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10296,"methodology":"case rate"}]}]},{"description":"PARTIAL THYROID EXCISION","code_information":[{"code":"60210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"PARTIAL THYROID EXCISION","code_information":[{"code":"60212","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6022","type":"APR-DRG"}],"standard_charges":[{"minimum":59687,"maximum":59687,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59687,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59687,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59687,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF THYROID","code_information":[{"code":"60220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF THYROID","code_information":[{"code":"60225","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6023","type":"APR-DRG"}],"standard_charges":[{"minimum":64820,"maximum":64820,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64820,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64820,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64820,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6024","type":"APR-DRG"}],"standard_charges":[{"minimum":72024,"maximum":72024,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72024,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72024,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72024,"methodology":"case rate"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60240","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60252","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXTENSIVE THYROID SURGERY","code_information":[{"code":"60254","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPEAT THYROID SURGERY","code_information":[{"code":"60260","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60270","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF THYROID","code_information":[{"code":"60271","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE THYROID DUCT LESION","code_information":[{"code":"60280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"REMOVE THYROID DUCT LESION","code_information":[{"code":"60281","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"CELLULITIS WITHOUT MCC","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":5026,"maximum":15780.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7917,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7485,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5026,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7815,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7328,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14991.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9531,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11364,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9341,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15780.37,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13081,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8122,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8122,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5250,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8766.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9380.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9029.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9205.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9292.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9205.22,"methodology":"case rate"}]}]},{"description":"ASPIR/INJ THYROID CYST","code_information":[{"code":"60300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6031","type":"APR-DRG"}],"standard_charges":[{"minimum":1138,"maximum":1138,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1138,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1138,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1138,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6032","type":"APR-DRG"}],"standard_charges":[{"minimum":44711,"maximum":44711,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44711,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44711,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44711,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6033","type":"APR-DRG"}],"standard_charges":[{"minimum":47492,"maximum":47492,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47492,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47492,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47492,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6034","type":"APR-DRG"}],"standard_charges":[{"minimum":97592,"maximum":97592,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97592,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97592,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97592,"methodology":"case rate"}]}]},{"description":"TRAUMA TO THE SKIN SUBCUTANEOUS TISSUE AND BREAST WITH MCC","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"minimum":5777,"maximum":24298,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13355,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12625,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8557,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24298,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22781,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21636.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16313,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19449,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15902,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22774.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22064,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13700,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13700,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5777,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12652.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13538.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13032.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13285.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13411.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13285.41,"methodology":"case rate"}]}]},{"description":"TRAUMA TO THE SKIN SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"minimum":4144,"maximum":16276.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8303,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7850,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5163,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8189,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7678,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15462.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9841,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11732,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9595,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16276.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13718,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8517,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8517,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4144,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9042.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9675.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9313.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9494.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9585.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9494.59,"methodology":"case rate"}]}]},{"description":"EXPLORE PARATHYROID GLANDS","code_information":[{"code":"60500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RE-EXPLORE PARATHYROIDS","code_information":[{"code":"60502","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORE PARATHYROID GLANDS","code_information":[{"code":"60505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AUTOTRANSPLANT PARATHYROID","code_information":[{"code":"60512","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF THYMUS GLAND","code_information":[{"code":"60520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVAL OF THYMUS GLAND","code_information":[{"code":"60521","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF THYMUS GLAND","code_information":[{"code":"60522","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORE ADRENAL GLAND","code_information":[{"code":"60540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLORE ADRENAL GLAND","code_information":[{"code":"60545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MINOR SKIN DISORDERS WITH MCC","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"minimum":5434,"maximum":24215.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14475,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13684,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9009,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11577,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10854,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23004.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16591,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19780,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16743,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24215.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23915,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14849,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5434,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13453.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14394.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13856.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14125.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14260.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14125.88,"methodology":"case rate"}]}]},{"description":"REMOVE CAROTID BODY LESION","code_information":[{"code":"60600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE CAROTID BODY LESION","code_information":[{"code":"60605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPAROSCOPY ADRENALECTOMY","code_information":[{"code":"60650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAPARO PROC ENDOCRINE","code_information":[{"code":"60659","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"ENDOCRINE SURGERY PROCEDURE","code_information":[{"code":"60699","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12773.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12773.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8418.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8919.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5216.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5581.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5372.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5476.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5737.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5529.12,"methodology":"case rate"}]}]},{"description":"MINOR SKIN DISORDERS WITHOUT MCC","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"minimum":4118,"maximum":15588.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7768,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7344,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5076,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7593,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7119,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14809,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9168,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10931,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9434,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15588.42,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12834,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7969,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7969,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4118,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8660.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9266.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8920.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9093.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9179.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9093.25,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6071","type":"APR-DRG"}],"standard_charges":[{"minimum":16666,"maximum":16666,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16666,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16666,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16666,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6072","type":"APR-DRG"}],"standard_charges":[{"minimum":41070,"maximum":41070,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41070,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41070,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41070,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6073","type":"APR-DRG"}],"standard_charges":[{"minimum":46587,"maximum":46587,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46587,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46587,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46587,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION OR MAJOR ANOMALY","code_information":[{"code":"6074","type":"APR-DRG"}],"standard_charges":[{"minimum":50960,"maximum":50960,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50960,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50960,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50960,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"608","type":"MS-DRG"}],"standard_charges":[{"minimum":20558,"maximum":20558,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20558,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6081","type":"APR-DRG"}],"standard_charges":[{"minimum":22289,"maximum":22289,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22289,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22289,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22289,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6082","type":"APR-DRG"}],"standard_charges":[{"minimum":33013,"maximum":33013,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33013,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33013,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33013,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6083","type":"APR-DRG"}],"standard_charges":[{"minimum":40307,"maximum":40307,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40307,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40307,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40307,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION","code_information":[{"code":"6084","type":"APR-DRG"}],"standard_charges":[{"minimum":42323,"maximum":42323,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42323,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42323,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42323,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"609","type":"MS-DRG"}],"standard_charges":[{"minimum":6259,"maximum":6259,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6259,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6091","type":"APR-DRG"}],"standard_charges":[{"minimum":26188,"maximum":26188,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26188,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26188,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26188,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6092","type":"APR-DRG"}],"standard_charges":[{"minimum":27567,"maximum":27567,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27567,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27567,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27567,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6093","type":"APR-DRG"}],"standard_charges":[{"minimum":50106,"maximum":50106,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50106,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50106,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50106,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-2499 GRAMS WITH MAJOR PROCEDURE","code_information":[{"code":"6094","type":"APR-DRG"}],"standard_charges":[{"minimum":116491,"maximum":116491,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":116491,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116491,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":116491,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"610","type":"MS-DRG"}],"standard_charges":[{"minimum":1365,"maximum":1365,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1365,"methodology":"case rate"}]}]},{"description":"REMOVE CRANIAL CAVITY FLUID","code_information":[{"code":"61000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"REMOVE CRANIAL CAVITY FLUID","code_information":[{"code":"61001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"REMOVE BRAIN CAVITY FLUID","code_information":[{"code":"61020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"VENTRICLR PUNC THRU PREV BURR HOLE","code_information":[{"code":"61026","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1895.4,"maximum":1895.4,"gross_charge":2340,"discounted_cash":692.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1895.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1895.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1895.4,"methodology":"fee schedule"}]}]},{"description":"VENTRICLR PUNC THRU PREV BURR HOLE","code_information":[{"code":"61026","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1895.4,"gross_charge":2340,"discounted_cash":692.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1895.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1895.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1895.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":468,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":351,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":468,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"REMOVE BRAIN CANAL FLUID","code_information":[{"code":"61050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INJECTION INTO BRAIN CANAL","code_information":[{"code":"61055","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"PUNCTR SHUNT OR RSVR/ASP OR INJ","code_information":[{"code":"61070","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1939.95,"maximum":1939.95,"gross_charge":2395,"discounted_cash":708.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1939.95,"methodology":"fee schedule"}]}]},{"description":"PUNCTR SHUNT OR RSVR/ASP OR INJ","code_information":[{"code":"61070","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1939.95,"gross_charge":2395,"discounted_cash":708.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1939.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":479,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":359.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":479,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"611","type":"MS-DRG"}],"standard_charges":[{"minimum":1555,"maximum":1555,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1555,"methodology":"case rate"}]}]},{"description":"TWIST DRILL HOLE","code_information":[{"code":"61105","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRILL SKULL FOR IMPLT CATH/DEV","code_information":[{"code":"61107","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":925.83,"maximum":925.83,"gross_charge":1143,"discounted_cash":338.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":925.83,"methodology":"fee schedule"}]}]},{"description":"DRILL SKULL FOR IMPLT CATH/DEV","code_information":[{"code":"61107","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1143,"discounted_cash":338.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":800.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.6,"methodology":"fee schedule"}]}]},{"description":"DRILL SKULL FOR DRAINAGE","code_information":[{"code":"61108","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6111","type":"APR-DRG"}],"standard_charges":[{"minimum":9802,"maximum":9802,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9802,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9802,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9802,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6112","type":"APR-DRG"}],"standard_charges":[{"minimum":15948,"maximum":15948,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15948,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15948,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15948,"methodology":"case rate"}]}]},{"description":"BURR HOLE FOR PUNCTURE","code_information":[{"code":"61120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6113","type":"APR-DRG"}],"standard_charges":[{"minimum":27725,"maximum":27725,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27725,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27725,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27725,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6114","type":"APR-DRG"}],"standard_charges":[{"minimum":50796,"maximum":50796,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50796,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50796,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50796,"methodology":"case rate"}]}]},{"description":"PIERCE SKULL FOR BIOPSY","code_information":[{"code":"61140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PIERCE SKULL FOR DRAINAGE","code_information":[{"code":"61150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PIERCE SKULL FOR DRAINAGE","code_information":[{"code":"61151","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PIERCE SKULL  REMOVE CLOT","code_information":[{"code":"61154","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PIERCE SKULL FOR DRAINAGE","code_information":[{"code":"61156","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"612","type":"MS-DRG"}],"standard_charges":[{"minimum":118601,"maximum":118601,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118601,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6121","type":"APR-DRG"}],"standard_charges":[{"minimum":18461,"maximum":18461,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18461,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18461,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18461,"methodology":"case rate"}]}]},{"description":"IMPLT VENTRILAR CATH/BUR HOLES","code_information":[{"code":"61210","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1048.95,"maximum":1048.95,"gross_charge":1295,"discounted_cash":383.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1048.95,"methodology":"fee schedule"}]}]},{"description":"IMPLT VENTRILAR CATH/BUR HOLES","code_information":[{"code":"61210","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1295,"discounted_cash":383.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1048.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":906.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":259,"methodology":"fee schedule"}]}]},{"description":"INSERT BRAIN-FLUID DEVICE","code_information":[{"code":"61215","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6122","type":"APR-DRG"}],"standard_charges":[{"minimum":27367,"maximum":27367,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27367,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27367,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27367,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6123","type":"APR-DRG"}],"standard_charges":[{"minimum":34797,"maximum":34797,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34797,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34797,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34797,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6124","type":"APR-DRG"}],"standard_charges":[{"minimum":38305,"maximum":38305,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38305,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38305,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38305,"methodology":"case rate"}]}]},{"description":"PIERCE SKULL  EXPLORE","code_information":[{"code":"61250","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PIERCE SKULL  EXPLORE","code_information":[{"code":"61253","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"613","type":"MS-DRG"}],"standard_charges":[{"minimum":31674,"maximum":31674,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31674,"methodology":"case rate"}]}]},{"description":"OPEN SKULL FOR EXPLORATION","code_information":[{"code":"61304","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN SKULL FOR EXPLORATION","code_information":[{"code":"61305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6131","type":"APR-DRG"}],"standard_charges":[{"minimum":10638,"maximum":10638,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10638,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10638,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10638,"methodology":"case rate"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61312","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61313","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61314","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61315","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLT CRAN BONE FLAP TO ABDO","code_information":[{"code":"61316","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6132","type":"APR-DRG"}],"standard_charges":[{"minimum":19307,"maximum":19307,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19307,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19307,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19307,"methodology":"case rate"}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OPEN SKULL FOR DRAINAGE","code_information":[{"code":"61321","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DECOMPRESSIVE CRANIOTOMY","code_information":[{"code":"61322","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DECOMPRESSIVE LOBECTOMY","code_information":[{"code":"61323","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6133","type":"APR-DRG"}],"standard_charges":[{"minimum":31076,"maximum":31076,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31076,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31076,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31076,"methodology":"case rate"}]}]},{"description":"DECOMPRESS EYE SOCKET","code_information":[{"code":"61330","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EXPLORE ORBIT/REMOVE LESION","code_information":[{"code":"61333","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6134","type":"APR-DRG"}],"standard_charges":[{"minimum":47657,"maximum":47657,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47657,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47657,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47657,"methodology":"case rate"}]}]},{"description":"SUBTEMPORAL DECOMPRESSION","code_information":[{"code":"61340","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL (PRESS RELIEF)","code_information":[{"code":"61343","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELIEVE CRANIAL PRESSURE","code_information":[{"code":"61345","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"minimum":12797,"maximum":36789,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20486,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19367,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12797,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36789,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34492,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30350.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25400,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30283,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23781,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31948.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33846,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21015,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21015,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15486,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17748.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18991.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18281.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18636.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18813.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18636.41,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6141","type":"APR-DRG"}],"standard_charges":[{"minimum":10113,"maximum":10113,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10113,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10113,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10113,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6142","type":"APR-DRG"}],"standard_charges":[{"minimum":19696,"maximum":19696,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19696,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19696,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19696,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6143","type":"APR-DRG"}],"standard_charges":[{"minimum":22166,"maximum":22166,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22166,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22166,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22166,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH OR WITHOUT OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6144","type":"APR-DRG"}],"standard_charges":[{"minimum":38297,"maximum":38297,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38297,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38297,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38297,"methodology":"case rate"}]}]},{"description":"INCISE SKULL FOR SURGERY","code_information":[{"code":"61450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL FOR BRAIN WOUND","code_information":[{"code":"61458","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL FOR SURGERY","code_information":[{"code":"61460","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"minimum":7618,"maximum":27623,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12881,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12178,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8358,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27623,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25898,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21057.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15952,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19019,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15532,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22165.6,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21282,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13214,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13214,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7618,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12314.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13176.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12683.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12929.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13053.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12929.94,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SKULL LESION","code_information":[{"code":"61500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE INFECTED SKULL BONE","code_information":[{"code":"61501","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61510","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BRAIN LINING LESION","code_information":[{"code":"61512","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN ABSCESS","code_information":[{"code":"61514","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61516","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLT BRAIN CHEMOTX ADD-ON","code_information":[{"code":"61517","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61518","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BRAIN LINING LESION","code_information":[{"code":"61519","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61520","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61521","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN ABSCESS","code_information":[{"code":"61522","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61524","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61526","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT BRAIN ELECTRODES","code_information":[{"code":"61531","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT BRAIN ELECTRODES","code_information":[{"code":"61533","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61534","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BRAIN ELECTRODES","code_information":[{"code":"61535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN LESION","code_information":[{"code":"61536","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61537","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61538","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61539","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF BRAIN TISSUE","code_information":[{"code":"61541","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61543","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE  TREAT BRAIN LESION","code_information":[{"code":"61544","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF BRAIN TUMOR","code_information":[{"code":"61545","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PITUITARY GLAND","code_information":[{"code":"61546","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF PITUITARY GLAND","code_information":[{"code":"61548","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE OF SKULL SEAMS","code_information":[{"code":"61550","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE OF SKULL SEAMS","code_information":[{"code":"61552","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL/SUTURES","code_information":[{"code":"61556","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL/SUTURES","code_information":[{"code":"61557","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF SKULL/SUTURES","code_information":[{"code":"61558","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF SKULL/SUTURES","code_information":[{"code":"61559","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF SKULL TUMOR","code_information":[{"code":"61563","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISION OF SKULL TUMOR","code_information":[{"code":"61564","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVAL OF BRAIN TISSUE","code_information":[{"code":"61566","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF BRAIN TISSUE","code_information":[{"code":"61567","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE FOREIGN BODY BRAIN","code_information":[{"code":"61570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL FOR BRAIN WOUND","code_information":[{"code":"61571","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKULL BASE/BRAINSTEM SURGERY","code_information":[{"code":"61575","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SKULL BASE/BRAINSTEM SURGERY","code_information":[{"code":"61576","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61580","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61581","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61582","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CRANIOFACIAL APPROACH SKULL","code_information":[{"code":"61583","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORBITOCRANIAL APPROACH/SKULL","code_information":[{"code":"61584","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORBITOCRANIAL APPROACH/SKULL","code_information":[{"code":"61585","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT NASOPHARYNX SKULL","code_information":[{"code":"61586","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INFRATEMPORAL APPROACH/SKULL","code_information":[{"code":"61590","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INFRATEMPORAL APPROACH/SKULL","code_information":[{"code":"61591","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORBITOCRANIAL APPROACH/SKULL","code_information":[{"code":"61592","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSTEMPORAL APPROACH/SKULL","code_information":[{"code":"61595","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSCOCHLEAR APPROACH/SKULL","code_information":[{"code":"61596","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSCONDYLAR APPROACH/SKULL","code_information":[{"code":"61597","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSPETROSAL APPROACH/SKULL","code_information":[{"code":"61598","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"minimum":19283,"maximum":57399,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34742,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32845,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22485,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52642,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49356,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47773.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40690,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48513,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41785,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":50287.49,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35639,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35639,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19283,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27937.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29893.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28775.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29334.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29613.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29334.37,"methodology":"case rate"}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61601","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61605","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61606","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61607","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE CRANIAL LESION","code_information":[{"code":"61608","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRANSECT ARTERY SINUS","code_information":[{"code":"61611","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE ANEURYSM SINUS","code_information":[{"code":"61613","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE LESION SKULL","code_information":[{"code":"61615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESECT/EXCISE LESION SKULL","code_information":[{"code":"61616","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DURA","code_information":[{"code":"61618","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR DURA","code_information":[{"code":"61619","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXT/INTCRANAL TEMP PTA ART OCC","code_information":[{"code":"61623","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":30251.88,"maximum":30251.88,"gross_charge":37348,"discounted_cash":11055.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30251.88,"methodology":"fee schedule"}]}]},{"description":"EXT/INTCRANAL TEMP PTA ART OCC","code_information":[{"code":"61623","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":30251.88,"gross_charge":37348,"discounted_cash":11055.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30251.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26143.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7096.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7469.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5602.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7469.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC CATH OCCLUSION/EMBO NEURO","code_information":[{"code":"61624","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":13119.57,"maximum":13119.57,"gross_charge":16197,"discounted_cash":4794.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13119.57,"methodology":"fee schedule"}]}]},{"description":"HC CATH OCCLUSION/EMBO NEURO","code_information":[{"code":"61624","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13119.57,"gross_charge":16197,"discounted_cash":4794.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11337.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3077.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2429.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.4,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL EMBOLIZATION","code_information":[{"code":"61624","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":13119.57,"maximum":13119.57,"gross_charge":16197,"discounted_cash":4794.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13119.57,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL EMBOLIZATION","code_information":[{"code":"61624","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":13119.57,"gross_charge":16197,"discounted_cash":4794.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13119.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11337.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3077.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2429.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3239.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH OCCLUSION/EMBO HEAD","code_information":[{"code":"61626","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4198.23,"maximum":4198.23,"gross_charge":5183,"discounted_cash":1534.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4198.23,"methodology":"fee schedule"}]}]},{"description":"HC CATH OCCLUSION/EMBO HEAD","code_information":[{"code":"61626","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":5183,"discounted_cash":1534.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3628.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"NON-CNS EXTCRANL EMBOLIZATION","code_information":[{"code":"61626","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4198.23,"maximum":4198.23,"gross_charge":5183,"discounted_cash":1534.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4198.23,"methodology":"fee schedule"}]}]},{"description":"NON-CNS EXTCRANL EMBOLIZATION","code_information":[{"code":"61626","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":5183,"discounted_cash":1534.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4198.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3628.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":777.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1036.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"INTRACRANIAL PTA","code_information":[{"code":"61630","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8242.56,"maximum":8242.56,"gross_charge":10176,"discounted_cash":3012.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8242.56,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL PTA","code_information":[{"code":"61630","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8242.56,"gross_charge":10176,"discounted_cash":3012.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1933.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2035.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1526.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2035.2,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL STENT","code_information":[{"code":"61635","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9380.61,"maximum":9380.61,"gross_charge":11581,"discounted_cash":3427.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9380.61,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL STENT","code_information":[{"code":"61635","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":9380.61,"gross_charge":11581,"discounted_cash":3427.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9380.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8106.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2200.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2316.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1737.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2316.2,"methodology":"fee schedule"}]}]},{"description":"PTA INTRACRANIAL (VASOSPASM)","code_information":[{"code":"61640","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":8242.56,"maximum":8242.56,"gross_charge":10176,"discounted_cash":3012.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8242.56,"methodology":"fee schedule"}]}]},{"description":"PTA INTRACRANIAL (VASOSPASM)","code_information":[{"code":"61640","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":8242.56,"gross_charge":10176,"discounted_cash":3012.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8242.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7123.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1933.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2035.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1526.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2035.2,"methodology":"fee schedule"}]}]},{"description":"DILAT IC VSPSM EA VSL SM TER","code_information":[{"code":"61641","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DILAT IC VSPSM EA DIFF TER","code_information":[{"code":"61642","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ARTERIAL THROMBECT-MECHANICAL","code_information":[{"code":"61645","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5844.96,"maximum":5844.96,"gross_charge":7216,"discounted_cash":2135.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5844.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5844.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5844.96,"methodology":"fee schedule"}]}]},{"description":"ARTERIAL THROMBECT-MECHANICAL","code_information":[{"code":"61645","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":5844.96,"gross_charge":7216,"discounted_cash":2135.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5844.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5844.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5844.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1371.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1082.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1443.2,"methodology":"fee schedule"}]}]},{"description":"INTRCRAN NON-THROMBLYTIC INFUSION","code_information":[{"code":"61650","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1695.33,"maximum":1695.33,"gross_charge":2093,"discounted_cash":619.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1695.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1695.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1695.33,"methodology":"fee schedule"}]}]},{"description":"INTRCRAN NON-THROMBLYTIC INFUSION","code_information":[{"code":"61650","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2093,"discounted_cash":619.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1695.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1695.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1695.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.6,"methodology":"fee schedule"}]}]},{"description":"ADDL INTRCRAN NON-THROM INFUS","code_information":[{"code":"61651","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":818.1,"maximum":818.1,"gross_charge":1010,"discounted_cash":298.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":818.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":818.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":818.1,"methodology":"fee schedule"}]}]},{"description":"ADDL INTRCRAN NON-THROM INFUS","code_information":[{"code":"61651","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1010,"discounted_cash":298.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":818.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":818.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":818.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":202,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":202,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61680","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61682","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61684","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61686","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61690","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INTRACRANIAL VESSEL SURGERY","code_information":[{"code":"61692","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BRAIN ANEURYSM REPR COMPLX","code_information":[{"code":"61697","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BRAIN ANEURYSM REPR COMPLX","code_information":[{"code":"61698","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH CC","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":11149,"maximum":36945,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17363,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16415,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11275,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36945,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34638,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26534.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21013,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25052,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20952,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27931.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28686,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17811,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17811,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11149,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15517.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16603.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15982.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16293.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16448.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16293.12,"methodology":"case rate"}]}]},{"description":"BRAIN ANEURYSM REPR SIMPLE","code_information":[{"code":"61700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INNER SKULL VESSEL SURGERY","code_information":[{"code":"61702","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLAMP NECK ARTERY","code_information":[{"code":"61703","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE CIRCULATION TO HEAD","code_information":[{"code":"61705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE CIRCULATION TO HEAD","code_information":[{"code":"61708","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE CIRCULATION TO HEAD","code_information":[{"code":"61710","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF SKULL ARTERIES","code_information":[{"code":"61711","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL/BRAIN SURGERY","code_information":[{"code":"61720","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"INCISE SKULL/BRAIN SURGERY","code_information":[{"code":"61735","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MRI BRAIN ABLATION","code_information":[{"code":"61736","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2729.7,"maximum":2729.7,"gross_charge":3370,"discounted_cash":997.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2729.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2729.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2729.7,"methodology":"fee schedule"}]}]},{"description":"MRI BRAIN ABLATION","code_information":[{"code":"61736","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":505.5,"maximum":5079,"gross_charge":3370,"discounted_cash":997.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2729.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2729.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2729.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":640.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":674,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":674,"methodology":"fee schedule"}]}]},{"description":"MRI BRAIN ABLATION ADDL LESION","code_information":[{"code":"61737","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3248.1,"maximum":3248.1,"gross_charge":4010,"discounted_cash":1186.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3248.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3248.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3248.1,"methodology":"fee schedule"}]}]},{"description":"MRI BRAIN ABLATION ADDL LESION","code_information":[{"code":"61737","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":601.5,"maximum":5079,"gross_charge":4010,"discounted_cash":1186.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3248.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3248.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3248.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":802,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":802,"methodology":"fee schedule"}]}]},{"description":"INCISE SKULL/BRAIN BIOPSY","code_information":[{"code":"61750","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BRAIN BIOPSY W/CT/MR GUIDE","code_information":[{"code":"61751","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT BRAIN ELECTRODES","code_information":[{"code":"61760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL FOR TREATMENT","code_information":[{"code":"61770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"SCAN PROC CRANIAL INTRA","code_information":[{"code":"61781","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SCAN PROC CRANIAL EXTRA","code_information":[{"code":"61782","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SCAN PROC SPINAL","code_information":[{"code":"61783","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREAT TRIGEMINAL NERVE","code_information":[{"code":"61790","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"TREAT TRIGEMINAL TRACT","code_information":[{"code":"61791","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"SRS CRANIAL LESION SIMPLE","code_information":[{"code":"61796","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SRS CRAN LES SIMPLE ADDL","code_information":[{"code":"61797","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SRS CRANIAL LESION COMPLEX","code_information":[{"code":"61798","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SRS CRAN LES COMPLEX ADDL","code_information":[{"code":"61799","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"minimum":6599,"maximum":29384,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11192,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10581,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6599,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29384,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27549,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18993.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12678,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15115,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12263,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19992.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18491,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11481,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11481,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7883,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11107.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11884.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11440.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11662.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11773.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11662.51,"methodology":"case rate"}]}]},{"description":"APPLY SRS HEADFRAME ADD-ON","code_information":[{"code":"61800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"61850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"61860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRODE","code_information":[{"code":"61863","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRDE ADDL","code_information":[{"code":"61864","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRODE","code_information":[{"code":"61867","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRDE ADDL","code_information":[{"code":"61868","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"61870","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE/REMOVE NEUROELECTRODE","code_information":[{"code":"61880","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7529.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4964.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5257.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3074.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3289.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3166.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3228.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3382.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3259.09,"methodology":"case rate"}]}]},{"description":"INSRT/REDO NEUROSTIM 1 ARRAY","code_information":[{"code":"61885","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":46948.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31917.1,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32784.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19172.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20514.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19747.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20130.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21089.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20322.47,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROSTIM ARRAYS","code_information":[{"code":"61886","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":66716.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66716.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":66716.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":45306.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46588.28,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27244.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29151.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28061.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28606.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29969.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28879.29,"methodology":"case rate"}]}]},{"description":"REVISE/REMOVE NEURORECEIVER","code_information":[{"code":"61888","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":27301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19874.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19064.72,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11148.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11929.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11483.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11706.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12263.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11817.9,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITH MCC","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"minimum":14786,"maximum":46241,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24508,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23170,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14786,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46241,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43355,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35266.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31256,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37265,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27477,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":37122.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23589,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40491,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25141,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25141,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16316,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20623.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22067.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21242.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21654.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21861.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21654.91,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITH CC","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"minimum":9216,"maximum":33455,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14355,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13571,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9216,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33455,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31366,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22858.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18220,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21722,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17127,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24061.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23589,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23717,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14726,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14726,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10492,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13367.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14303.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13768.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14036.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14169.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14036.16,"methodology":"case rate"}]}]},{"description":"TREAT SKULL FRACTURE","code_information":[{"code":"62000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"TREAT SKULL FRACTURE","code_information":[{"code":"62005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TREATMENT OF HEAD INJURY","code_information":[{"code":"62010","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"minimum":8441,"maximum":28619,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13140,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12422,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8620,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28619,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26832,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21373.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16808,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20039,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16020,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22498.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23589,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21709,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8441,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12499.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13374.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12874.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13124.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13249.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13124.21,"methodology":"case rate"}]}]},{"description":"REPAIR BRAIN FLUID LEAKAGE","code_information":[{"code":"62100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6211","type":"APR-DRG"}],"standard_charges":[{"minimum":2374,"maximum":2374,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2374,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2374,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2374,"methodology":"case rate"}]}]},{"description":"REDUCTION OF SKULL DEFECT","code_information":[{"code":"62115","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REDUCTION OF SKULL DEFECT","code_information":[{"code":"62117","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6212","type":"APR-DRG"}],"standard_charges":[{"minimum":13445,"maximum":13445,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13445,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13445,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13445,"methodology":"case rate"}]}]},{"description":"REPAIR SKULL CAVITY LESION","code_information":[{"code":"62120","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SKULL REPAIR","code_information":[{"code":"62121","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6213","type":"APR-DRG"}],"standard_charges":[{"minimum":17932,"maximum":17932,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17932,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17932,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17932,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6214","type":"APR-DRG"}],"standard_charges":[{"minimum":39850,"maximum":39850,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39850,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39850,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39850,"methodology":"case rate"}]}]},{"description":"REPAIR OF SKULL DEFECT","code_information":[{"code":"62140","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SKULL DEFECT","code_information":[{"code":"62141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SKULL PLATE/FLAP","code_information":[{"code":"62142","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE SKULL PLATE/FLAP","code_information":[{"code":"62143","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SKULL  BRAIN","code_information":[{"code":"62145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SKULL WITH GRAFT","code_information":[{"code":"62146","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SKULL WITH GRAFT","code_information":[{"code":"62147","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RETR BONE FLAP TO FIX SKULL","code_information":[{"code":"62148","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEUROENDOSCOPY ADD-ON","code_information":[{"code":"62160","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DISSECT BRAIN W/SCOPE","code_information":[{"code":"62161","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE COLLOID CYST W/SCOPE","code_information":[{"code":"62162","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ZNEUROENDOSCOPY W/FB REMOVAL","code_information":[{"code":"62163","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE BRAIN TUMOR W/SCOPE","code_information":[{"code":"62164","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE PITUIT TUMOR W/SCOPE","code_information":[{"code":"62165","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62190","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62192","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE/IRRIGATE CATHETER","code_information":[{"code":"62194","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"minimum":19668,"maximum":90859,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33637,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":31799,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21735,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":90859,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":85187,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46421.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39140,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46665,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40391,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":48865.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55573,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":34505,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34505,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19668,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27147.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29047.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27961.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28504.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28776.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28504.7,"methodology":"case rate"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BRAIN CAVITY SHUNT W/SCOPE","code_information":[{"code":"62201","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6221","type":"APR-DRG"}],"standard_charges":[{"minimum":9811,"maximum":9811,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9811,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6222","type":"APR-DRG"}],"standard_charges":[{"minimum":15264,"maximum":15264,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15264,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15264,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15264,"methodology":"case rate"}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESTABLISH BRAIN CAVITY SHUNT","code_information":[{"code":"62223","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE/IRRIGATE CATHETER","code_information":[{"code":"62225","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6223","type":"APR-DRG"}],"standard_charges":[{"minimum":19538,"maximum":19538,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19538,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19538,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19538,"methodology":"case rate"}]}]},{"description":"REPLACE/REVISE BRAIN SHUNT","code_information":[{"code":"62230","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6224","type":"APR-DRG"}],"standard_charges":[{"minimum":31454,"maximum":31454,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31454,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31454,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31454,"methodology":"case rate"}]}]},{"description":"CSF SHUNT REPROGRAM","code_information":[{"code":"62252","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":435.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":458.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":268.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":286.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":276.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":281.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":294.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":284.22,"methodology":"case rate"}]}]},{"description":"REMOVE BRAIN CAVITY SHUNT","code_information":[{"code":"62256","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPLACE BRAIN CAVITY SHUNT","code_information":[{"code":"62258","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EPIDURAL LYSIS MULT SESSIONS","code_information":[{"code":"62263","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"EPIDURAL LYSIS ON SINGLE DAY","code_information":[{"code":"62264","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC PERC VERT DISC ASPIRATION","code_information":[{"code":"62267","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1936.71,"maximum":1936.71,"gross_charge":2391,"discounted_cash":707.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1936.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1936.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1936.71,"methodology":"fee schedule"}]}]},{"description":"HC PERC VERT DISC ASPIRATION","code_information":[{"code":"62267","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2391,"discounted_cash":707.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1936.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1936.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1936.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1673.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DRAIN SPINAL CORD CYST","code_information":[{"code":"62268","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NEEDLE BIOPSY SPINAL CORD","code_information":[{"code":"62269","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"HC SPINAL LUMBAR PUNCTURE DIAG","code_information":[{"code":"62270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2030.67,"maximum":2030.67,"gross_charge":2507,"discounted_cash":742.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2030.67,"methodology":"fee schedule"}]}]},{"description":"HC SPINAL LUMBAR PUNCTURE DIAG","code_information":[{"code":"62270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2030.67,"gross_charge":2507,"discounted_cash":742.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC SPINAL PUNCTURE CSF DRAIN","code_information":[{"code":"62272","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1633.77,"maximum":1633.77,"gross_charge":2017,"discounted_cash":597.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1633.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1633.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1633.77,"methodology":"fee schedule"}]}]},{"description":"HC SPINAL PUNCTURE CSF DRAIN","code_information":[{"code":"62272","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"gross_charge":2017,"discounted_cash":597.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1633.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1633.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1633.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC BLOOD PATCH","code_information":[{"code":"62273","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2223.45,"maximum":2223.45,"gross_charge":2745,"discounted_cash":812.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2223.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2223.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2223.45,"methodology":"fee schedule"}]}]},{"description":"HC BLOOD PATCH","code_information":[{"code":"62273","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2223.45,"gross_charge":2745,"discounted_cash":812.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2223.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2223.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2223.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":549,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":549,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"TREAT SPINAL CORD LESION","code_information":[{"code":"62280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"TREAT SPINAL CORD LESION","code_information":[{"code":"62281","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"TREAT SPINAL CANAL LESION","code_information":[{"code":"62282","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ MYELOGRAPHY&CT SPINE","code_information":[{"code":"62284","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":710.37,"maximum":710.37,"gross_charge":877,"discounted_cash":259.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":710.37,"methodology":"fee schedule"}]}]},{"description":"HC INJ MYELOGRAPHY&CT SPINE","code_information":[{"code":"62284","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":877,"discounted_cash":259.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":420.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":491.12,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":613.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS DISKECTOMY","code_information":[{"code":"62287","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"HC INJECT FOR DISCOGRAPHY LUMBAR","code_information":[{"code":"62290","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2736.18,"maximum":2736.18,"gross_charge":3378,"discounted_cash":999.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2736.18,"methodology":"fee schedule"}]}]},{"description":"HC INJECT FOR DISCOGRAPHY LUMBAR","code_information":[{"code":"62290","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3378,"discounted_cash":999.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2736.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2364.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":675.6,"methodology":"fee schedule"}]}]},{"description":"INJ DISCOGRAM CERV/THOR EA LVL","code_information":[{"code":"62291","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"INJ DISCOGRAM CERV/THOR EA LVL","code_information":[{"code":"62291","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"}]}]},{"description":"NJX CHEMONUCLEOLYSIS LMBR","code_information":[{"code":"62292","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INJECTION INTO SPINAL ARTERY","code_information":[{"code":"62294","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITH CC","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":10575,"maximum":28496,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17194,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16255,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10575,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28496,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26717,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26327.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20371,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24287,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19653,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27713.67,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17638,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17638,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10745,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15396.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16474.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15858.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16166.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16320.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16166.31,"methodology":"case rate"}]}]},{"description":"HC MYELOGRAPHY CERVICAL","code_information":[{"code":"62302","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2178.9,"maximum":2178.9,"gross_charge":2690,"discounted_cash":796.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"}]}]},{"description":"HC MYELOGRAPHY CERVICAL","code_information":[{"code":"62302","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2690,"discounted_cash":796.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC MYELOGRAPHY THORACIC","code_information":[{"code":"62303","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2178.9,"maximum":2178.9,"gross_charge":2690,"discounted_cash":796.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"}]}]},{"description":"HC MYELOGRAPHY THORACIC","code_information":[{"code":"62303","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2690,"discounted_cash":796.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC 62304 LUMBAR/SACRAL MYELOGRAM","code_information":[{"code":"62304","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1825.74,"maximum":1825.74,"gross_charge":2254,"discounted_cash":667.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1825.74,"methodology":"fee schedule"}]}]},{"description":"HC 62304 LUMBAR/SACRAL MYELOGRAM","code_information":[{"code":"62304","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2254,"discounted_cash":667.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC MYELOGRAPHY LUBOSACRAL","code_information":[{"code":"62304","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2304.45,"maximum":2304.45,"gross_charge":2845,"discounted_cash":842.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2304.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2304.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2304.45,"methodology":"fee schedule"}]}]},{"description":"HC MYELOGRAPHY LUBOSACRAL","code_information":[{"code":"62304","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2845,"discounted_cash":842.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2304.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2304.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2304.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":569,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":569,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC MYELOGRAPHY 2 OR MORE REGIONS","code_information":[{"code":"62305","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2178.9,"maximum":2178.9,"gross_charge":2690,"discounted_cash":796.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"}]}]},{"description":"HC MYELOGRAPHY 2 OR MORE REGIONS","code_information":[{"code":"62305","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2690,"discounted_cash":796.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6231","type":"APR-DRG"}],"standard_charges":[{"minimum":7135,"maximum":7135,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7135,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7135,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7135,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6232","type":"APR-DRG"}],"standard_charges":[{"minimum":9196,"maximum":9196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9196,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9196,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9196,"methodology":"case rate"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62320","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"EPIDURL INTRLAMNAR CERVC/THORC","code_information":[{"code":"62321","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3357.45,"maximum":3357.45,"gross_charge":4145,"discounted_cash":1226.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3357.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3357.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3357.45,"methodology":"fee schedule"}]}]},{"description":"EPIDURL INTRLAMNAR CERVC/THORC","code_information":[{"code":"62321","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3357.45,"gross_charge":4145,"discounted_cash":1226.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3357.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3357.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3357.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":829,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":829,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC CERV/THORACIC EPIDUR W/FLURO","code_information":[{"code":"62321","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1074.87,"maximum":1074.87,"gross_charge":1327,"discounted_cash":392.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1074.87,"methodology":"fee schedule"}]}]},{"description":"HC CERV/THORACIC EPIDUR W/FLURO","code_information":[{"code":"62321","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1327,"discounted_cash":392.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62322","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ LUMBAR W IMAGING","code_information":[{"code":"62323","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1074.87,"maximum":1074.87,"gross_charge":1327,"discounted_cash":392.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1074.87,"methodology":"fee schedule"}]}]},{"description":"HC INJ LUMBAR W IMAGING","code_information":[{"code":"62323","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1327,"discounted_cash":392.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1074.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62324","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX INTERLAMINAR CRV/THRC","code_information":[{"code":"62325","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62326","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX INTERLAMINAR LMBR/SAC","code_information":[{"code":"62327","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"SPINAL PUNCTURE LUMBAR W/ IMAG","code_information":[{"code":"62328","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2030.67,"maximum":2030.67,"gross_charge":2507,"discounted_cash":742.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2030.67,"methodology":"fee schedule"}]}]},{"description":"SPINAL PUNCTURE LUMBAR W/ IMAG","code_information":[{"code":"62328","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2507,"discounted_cash":742.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2030.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":501.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"SPINE PUNCT.DRAIN CS W S&I","code_information":[{"code":"62329","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1989.36,"maximum":1989.36,"gross_charge":2456,"discounted_cash":726.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1989.36,"methodology":"fee schedule"}]}]},{"description":"SPINE PUNCT.DRAIN CS W S&I","code_information":[{"code":"62329","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2456,"discounted_cash":726.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6233","type":"APR-DRG"}],"standard_charges":[{"minimum":23804,"maximum":23804,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23804,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23804,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23804,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6234","type":"APR-DRG"}],"standard_charges":[{"minimum":28866,"maximum":28866,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28866,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28866,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28866,"methodology":"case rate"}]}]},{"description":"IMPLANT SPINAL CANAL CATH","code_information":[{"code":"62350","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"IMPLANT SPINAL CANAL CATH","code_information":[{"code":"62351","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINAL CANAL CATHETER","code_information":[{"code":"62355","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INSERT SPINE INFUSION DEVICE","code_information":[{"code":"62360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":38694.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38694.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38694.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26020.81,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27020.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15801.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16907.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16275.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16591.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17381.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16749.45,"methodology":"case rate"}]}]},{"description":"IMPLANT SPINE INFUSION PUMP","code_information":[{"code":"62361","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":38694.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38694.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38694.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26020.81,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27020.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15801.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16907.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16275.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16591.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17381.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16749.45,"methodology":"case rate"}]}]},{"description":"IMPLANT SPINE INFUSION PUMP","code_information":[{"code":"62362","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":38694.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38694.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38694.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26020.81,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27020.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15801.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16907.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16275.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16591.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17381.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16749.45,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE INFUSION DEVICE","code_information":[{"code":"62365","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"ANALYZE SPINE INFUS PUMP","code_information":[{"code":"62367","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":435.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":458.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":268.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":286.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":276.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":281.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":294.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":284.22,"methodology":"case rate"}]}]},{"description":"ANALYZE SP INF PUMP W/REPROG","code_information":[{"code":"62368","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":435.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":458.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":268.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":286.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":276.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":281.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":294.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":284.22,"methodology":"case rate"}]}]},{"description":"ANAL SP INF PMP W/REPRGFILL","code_information":[{"code":"62369","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":435.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":458.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":268.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":286.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":276.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":281.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":294.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":284.22,"methodology":"case rate"}]}]},{"description":"HC INTRATHECAL PUMP REFILL","code_information":[{"code":"62370","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":906.39,"maximum":906.39,"gross_charge":1119,"discounted_cash":331.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":906.39,"methodology":"fee schedule"}]}]},{"description":"HC INTRATHECAL PUMP REFILL","code_information":[{"code":"62370","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1119,"discounted_cash":331.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":435.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":458.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":783.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":268.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":286.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":276.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":281.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":294.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":284.22,"methodology":"case rate"}]}]},{"description":"NDSC DCMPRN 1 NTRSPC LUMBAR","code_information":[{"code":"62380","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"minimum":4311,"maximum":26876,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9017,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8524,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6332,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26876,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25198,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16334.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10690,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12745,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11767,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17194.56,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14897,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4311,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9552.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10221.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9839.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10030.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10125.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10030.16,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"minimum":11186,"maximum":54651,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25772,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24365,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16596,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54651,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51239,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36811.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31100,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37078,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30842,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38748.5,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42579,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26438,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26438,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11186,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21526.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23033.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22172.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22603.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22818.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22603.29,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6251","type":"APR-DRG"}],"standard_charges":[{"minimum":11926,"maximum":11926,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11926,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11926,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11926,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6252","type":"APR-DRG"}],"standard_charges":[{"minimum":13095,"maximum":13095,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13095,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13095,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13095,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6253","type":"APR-DRG"}],"standard_charges":[{"minimum":18953,"maximum":18953,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18953,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18953,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18953,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6254","type":"APR-DRG"}],"standard_charges":[{"minimum":26593,"maximum":26593,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26593,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26593,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26593,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"minimum":8476,"maximum":23047.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13567,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12826,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8476,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21048,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19734,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21895.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17502,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20867,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15751,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23047.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22415,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13917,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13917,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9455,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12804.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13700.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13188.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13444.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13572.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13444.6,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6261","type":"APR-DRG"}],"standard_charges":[{"minimum":2221,"maximum":2221,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2221,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2221,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2221,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6262","type":"APR-DRG"}],"standard_charges":[{"minimum":2268,"maximum":2268,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2268,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2268,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2268,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6263","type":"APR-DRG"}],"standard_charges":[{"minimum":5517,"maximum":5517,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5517,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5517,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5517,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT 2000-2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6264","type":"APR-DRG"}],"standard_charges":[{"minimum":17750,"maximum":17750,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17750,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17750,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17750,"methodology":"case rate"}]}]},{"description":"THYROID PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"minimum":6887,"maximum":20244.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11388,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10766,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7022,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12158,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11399,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19232.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13791,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16443,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13050,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20244.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18815,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11682,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11682,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6887,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11247.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12034.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11584.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11809.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11922.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11809.55,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"minimum":14365,"maximum":96731,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35468,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33531,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22808,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":96731,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90692,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48659.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39397,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46971,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42385,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":51220.64,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58598,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36383,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36383,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14365,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28455.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30447.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29309.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29878.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30163.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29878.71,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"minimum":12856,"maximum":33402,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20217,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19113,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12856,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30668,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28753,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30022.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24253,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28916,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23891,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31602.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33402,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20739,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20739,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14365,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17556.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18785.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18083.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18434.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18610.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18434.73,"methodology":"case rate"}]}]},{"description":"OTHER ENDOCRINE NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"minimum":7121,"maximum":21799.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12596,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11908,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7933,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20515,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19235,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20709.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15178,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18096,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14742,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21799.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20811,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12921,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7121,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12110.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12958.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12473.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12716.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12837.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12716.11,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 CRVL","code_information":[{"code":"63001","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 THRC","code_information":[{"code":"63003","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 LMBR","code_information":[{"code":"63005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6301","type":"APR-DRG"}],"standard_charges":[{"minimum":16432,"maximum":16432,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16432,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16432,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16432,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA 1/2 SCRL","code_information":[{"code":"63011","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE LAMINA/FACETS LUMBAR","code_information":[{"code":"63012","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA >2 CRVCL","code_information":[{"code":"63015","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA >2 THRC","code_information":[{"code":"63016","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA >2 LMBR","code_information":[{"code":"63017","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6302","type":"APR-DRG"}],"standard_charges":[{"minimum":24985,"maximum":24985,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24985,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24985,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24985,"methodology":"case rate"}]}]},{"description":"NECK SPINE DISK SURGERY","code_information":[{"code":"63020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6303","type":"APR-DRG"}],"standard_charges":[{"minimum":90356,"maximum":90356,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90356,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90356,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90356,"methodology":"case rate"}]}]},{"description":"LOW BACK DISK SURGERY","code_information":[{"code":"63030","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":4409,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"SPINAL DISK SURGERY ADD-ON","code_information":[{"code":"63035","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR CARDIOVASCULAR PROCEDURE","code_information":[{"code":"6304","type":"APR-DRG"}],"standard_charges":[{"minimum":171096,"maximum":171096,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171096,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171096,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171096,"methodology":"case rate"}]}]},{"description":"LAMINOTOMY SINGLE CERVICAL","code_information":[{"code":"63040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LAMINOTOMY SINGLE LUMBAR","code_information":[{"code":"63042","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5186,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"LAMINOTOMY ADDL CERVICAL","code_information":[{"code":"63043","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LAMINOTOMY ADDL LUMBAR","code_information":[{"code":"63044","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SPINE LAMINA 1 CRVL","code_information":[{"code":"63045","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA 1 THRC","code_information":[{"code":"63046","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE LAMINA 1 LMBR","code_information":[{"code":"63047","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REMOVE SPINAL LAMINA ADD-ON","code_information":[{"code":"63048","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CERVICAL LAMINOPLSTY 2/> SEG","code_information":[{"code":"63050","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"C-LAMINOPLASTY W/GRAFT/PLATE","code_information":[{"code":"63051","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DECOMPRESS SPINAL CORD THRC","code_information":[{"code":"63055","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DECOMPRESS SPINAL CORD LMBR","code_information":[{"code":"63056","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DECOMPRESS SPINE CORD ADD-ON","code_information":[{"code":"63057","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DECOMPRESS SPINAL CORD THRC","code_information":[{"code":"63064","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"DECOMPRESS SPINE CORD ADD-ON","code_information":[{"code":"63066","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NECK SPINE DISK SURGERY","code_information":[{"code":"63075","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"NECK SPINE DISK SURGERY","code_information":[{"code":"63076","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPINE DISK SURGERY THORAX","code_information":[{"code":"63077","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPINE DISK SURGERY THORAX","code_information":[{"code":"63078","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT BODY DCMPRN CRVL","code_information":[{"code":"63081","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63082","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT BODY DCMPRN THRC","code_information":[{"code":"63085","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63086","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOV VERTBR DCMPRN THRCLMBR","code_information":[{"code":"63087","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63088","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT BODY DCMPRN LMBR","code_information":[{"code":"63090","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63091","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"631","type":"MS-DRG"}],"standard_charges":[{"minimum":72994,"maximum":72994,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72994,"methodology":"case rate"}]}]},{"description":"REMOVE VERT BODY DCMPRN THRC","code_information":[{"code":"63101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT BODY DCMPRN LMBR","code_information":[{"code":"63102","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63103","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6311","type":"APR-DRG"}],"standard_charges":[{"minimum":9217,"maximum":9217,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9217,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9217,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9217,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6312","type":"APR-DRG"}],"standard_charges":[{"minimum":9217,"maximum":9217,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9217,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9217,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9217,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6313","type":"APR-DRG"}],"standard_charges":[{"minimum":22070,"maximum":22070,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22070,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22070,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22070,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER MAJOR PROCEDURE","code_information":[{"code":"6314","type":"APR-DRG"}],"standard_charges":[{"minimum":76850,"maximum":76850,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76850,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76850,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76850,"methodology":"case rate"}]}]},{"description":"INCISE SPINAL CORD TRACT(S)","code_information":[{"code":"63170","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAINAGE OF SPINAL CYST","code_information":[{"code":"63172","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRAINAGE OF SPINAL CYST","code_information":[{"code":"63173","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE SPINAL CORD LIGAMENTS","code_information":[{"code":"63180","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE SPINAL CORD LIGAMENTS","code_information":[{"code":"63182","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINE NRV HALF SEGMNT","code_information":[{"code":"63185","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINE NRV >2 SEGMNTS","code_information":[{"code":"63190","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINE ACCESSORY NERVE","code_information":[{"code":"63191","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINE  CORD CERVICAL","code_information":[{"code":"63194","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINE  CORD THORACIC","code_information":[{"code":"63195","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINECORD 2 TRX CRVL","code_information":[{"code":"63196","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINECORD 2 TRX THRC","code_information":[{"code":"63197","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINCORD 2 STGS CRVL","code_information":[{"code":"63198","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE SPINCORD 2 STGS THRC","code_information":[{"code":"63199","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"632","type":"MS-DRG"}],"standard_charges":[{"minimum":36443,"maximum":36443,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36443,"methodology":"case rate"}]}]},{"description":"RELEASE SPINAL CORD LUMBAR","code_information":[{"code":"63200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE SPINAL CORD VSLS CRVL","code_information":[{"code":"63250","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE SPINAL CORD VSLS THRC","code_information":[{"code":"63251","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE SPINE CORD VSL THRLMB","code_information":[{"code":"63252","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISE INTRASPINL LESION CRV","code_information":[{"code":"63265","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXCISE INTRSPINL LESION THRC","code_information":[{"code":"63266","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXCISE INTRSPINL LESION LMBR","code_information":[{"code":"63267","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXCISE INTRSPINL LESION SCRL","code_information":[{"code":"63268","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"EXCISE INTRSPINL LESION CRVL","code_information":[{"code":"63270","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISE INTRSPINL LESION THRC","code_information":[{"code":"63271","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISE INTRSPINL LESION LMBR","code_information":[{"code":"63272","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXCISE INTRSPINL LESION SCRL","code_information":[{"code":"63273","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC XDRL SPINE LESN CRVL","code_information":[{"code":"63275","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC XDRL SPINE LESN THRC","code_information":[{"code":"63276","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC XDRL SPINE LESN LMBR","code_information":[{"code":"63277","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC XDRL SPINE LESN SCRL","code_information":[{"code":"63278","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL SPINE LESN CRVL","code_information":[{"code":"63280","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL SPINE LESN THRC","code_information":[{"code":"63281","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL SPINE LESN LMBR","code_information":[{"code":"63282","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL SPINE LESN SCRL","code_information":[{"code":"63283","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL IMED LESN CERVL","code_information":[{"code":"63285","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL IMED LESN THRC","code_information":[{"code":"63286","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC IDRL IMED LESN THRLMB","code_information":[{"code":"63287","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BX/EXC XDRL/IDRL LSN ANY LVL","code_information":[{"code":"63290","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":10901,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR LAMINECTOMY DEFECT","code_information":[{"code":"63295","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"633","type":"MS-DRG"}],"standard_charges":[{"minimum":82662,"maximum":82662,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82662,"methodology":"case rate"}]}]},{"description":"REMOVE VERT XDRL BODY CRVCL","code_information":[{"code":"63300","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT XDRL BODY THRC","code_information":[{"code":"63301","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT XDRL BODY THRLMB","code_information":[{"code":"63302","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOV VERT XDRL BDY LMBR/SAC","code_information":[{"code":"63303","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT IDRL BODY CRVCL","code_information":[{"code":"63304","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERT IDRL BODY THRC","code_information":[{"code":"63305","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOV VERT IDRL BDY THRCLMBR","code_information":[{"code":"63306","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOV VERT IDRL BDY LMBR/SAC","code_information":[{"code":"63307","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE VERTEBRAL BODY ADD-ON","code_information":[{"code":"63308","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6331","type":"APR-DRG"}],"standard_charges":[{"minimum":2683,"maximum":2683,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2683,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2683,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2683,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6332","type":"APR-DRG"}],"standard_charges":[{"minimum":7459,"maximum":7459,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7459,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7459,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7459,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6333","type":"APR-DRG"}],"standard_charges":[{"minimum":30140,"maximum":30140,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30140,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30140,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30140,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH MAJOR ANOMALY","code_information":[{"code":"6334","type":"APR-DRG"}],"standard_charges":[{"minimum":76431,"maximum":76431,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76431,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76431,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76431,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"634","type":"MS-DRG"}],"standard_charges":[{"minimum":36649,"maximum":36649,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36649,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6341","type":"APR-DRG"}],"standard_charges":[{"minimum":5451,"maximum":5451,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5451,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5451,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5451,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6342","type":"APR-DRG"}],"standard_charges":[{"minimum":12008,"maximum":12008,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12008,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12008,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12008,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6343","type":"APR-DRG"}],"standard_charges":[{"minimum":24207,"maximum":24207,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24207,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24207,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24207,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJOR RESPIRATORY CONDITION","code_information":[{"code":"6344","type":"APR-DRG"}],"standard_charges":[{"minimum":74545,"maximum":74545,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74545,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74545,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74545,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"635","type":"MS-DRG"}],"standard_charges":[{"minimum":44962,"maximum":44962,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44962,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"636","type":"MS-DRG"}],"standard_charges":[{"minimum":60384,"maximum":60384,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60384,"methodology":"case rate"}]}]},{"description":"REMOVE SPINAL CORD LESION","code_information":[{"code":"63600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6361","type":"APR-DRG"}],"standard_charges":[{"minimum":5546,"maximum":5546,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5546,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5546,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5546,"methodology":"case rate"}]}]},{"description":"STIMULATION OF SPINAL CORD","code_information":[{"code":"63610","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6362","type":"APR-DRG"}],"standard_charges":[{"minimum":6660,"maximum":6660,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"}]}]},{"description":"SRS SPINAL LESION","code_information":[{"code":"63620","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5355,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SRS SPINAL LESION ADDL","code_information":[{"code":"63621","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6363","type":"APR-DRG"}],"standard_charges":[{"minimum":9496,"maximum":9496,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9496,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9496,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9496,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH CONGENITAL OR PERINATAL INFECTION","code_information":[{"code":"6364","type":"APR-DRG"}],"standard_charges":[{"minimum":17531,"maximum":17531,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17531,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17531,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17531,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"63650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14368.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9978.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10033.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5867.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6043.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6160.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6454.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6219.55,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"63655","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":46948.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31917.1,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32784.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19172.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20514.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19747.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20130.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21089.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20322.47,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE ELTRD PERQ ARAY","code_information":[{"code":"63661","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE SPINE ELTRD PLATE","code_information":[{"code":"63662","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7529.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4964.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5257.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3074.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3289.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3166.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3228.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3382.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3259.09,"methodology":"case rate"}]}]},{"description":"REVISE SPINE ELTRD PERQ ARAY","code_information":[{"code":"63663","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14368.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9978.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10033.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5867.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6043.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6160.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6454.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6219.55,"methodology":"case rate"}]}]},{"description":"REVISE SPINE ELTRD PLATE","code_information":[{"code":"63664","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":27301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19874.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19064.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11148.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11929.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11483.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11706.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12263.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11817.9,"methodology":"case rate"}]}]},{"description":"INSRT/REDO SPINE N GENERATOR","code_information":[{"code":"63685","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":66716.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66716.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":66716.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":45306.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46588.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27244.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29151.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28061.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28606.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29969.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28879.29,"methodology":"case rate"}]}]},{"description":"REVISE/REMOVE NEURORECEIVER","code_information":[{"code":"63688","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7529.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4964.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5257.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3074.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3289.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3166.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3228.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3382.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3259.09,"methodology":"case rate"}]}]},{"description":"DIABETES WITH MCC","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":8026,"maximum":22435.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13091,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12376,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8234,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14545,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13637,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21313.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15086,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17986,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15302,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22435.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21628,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13429,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13429,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8026,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12463.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13336.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12837.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13087.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13211.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13087.1,"methodology":"case rate"}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63702","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63704","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF SPINAL HERNIATION","code_information":[{"code":"63706","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SPINAL FLUID LEAKAGE","code_information":[{"code":"63707","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR SPINAL FLUID LEAKAGE","code_information":[{"code":"63709","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GRAFT REPAIR OF SPINE DEFECT","code_information":[{"code":"63710","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSTALL SPINAL SHUNT","code_information":[{"code":"63740","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INSTALL SPINAL SHUNT","code_information":[{"code":"63741","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REVISION OF SPINAL SHUNT","code_information":[{"code":"63744","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REMOVAL OF SPINAL SHUNT","code_information":[{"code":"63746","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"DIABETES WITH CC","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":4684,"maximum":16201.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8245,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7794,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5110,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9811,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9198,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15391.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9469,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11289,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9496,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16201.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13621,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8458,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8458,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4684,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9000.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9630.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9270.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9450.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9540.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9450.74,"methodology":"case rate"}]}]},{"description":"DIABETES WITHOUT CC/MCC","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":3262,"maximum":12840.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5632,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5325,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3537,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6786,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6362,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12198.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6494,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7743,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6572,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12840.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9306,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5778,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5778,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3262,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7133.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7633.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7347.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7490.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7561.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7490.58,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6391","type":"APR-DRG"}],"standard_charges":[{"minimum":4359,"maximum":4359,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4359,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4359,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4359,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6392","type":"APR-DRG"}],"standard_charges":[{"minimum":6972,"maximum":6972,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6972,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6972,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6972,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6393","type":"APR-DRG"}],"standard_charges":[{"minimum":20180,"maximum":20180,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS WITH OTHER SIGNIFICANT CONDITION","code_information":[{"code":"6394","type":"APR-DRG"}],"standard_charges":[{"minimum":20180,"maximum":20180,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20180,"methodology":"case rate"}]}]},{"description":"MISCELLANEOUS DISORDERS OF NUTRITION METABOLISM FLUIDS AND ELECTROLYTES WITH MCC","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":5763,"maximum":20951.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11937,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11285,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7472,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12280,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11513,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19903.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13677,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16306,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13886,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20951.46,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19722,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12245,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12245,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5763,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11639.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12454.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11988.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12221.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12338.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12221.69,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6401","type":"APR-DRG"}],"standard_charges":[{"minimum":1780,"maximum":1780,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1780,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6402","type":"APR-DRG"}],"standard_charges":[{"minimum":2167,"maximum":2167,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2167,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2167,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2167,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6403","type":"APR-DRG"}],"standard_charges":[{"minimum":3520,"maximum":3520,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520,"methodology":"case rate"}]}]},{"description":"NEONATE BIRTH WEIGHT > 2499 GRAMS NORMAL NEWBORN OR NEONATE WITH OTHER PROBLEM","code_information":[{"code":"6404","type":"APR-DRG"}],"standard_charges":[{"minimum":14647,"maximum":14647,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14647,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14647,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14647,"methodology":"case rate"}]}]},{"description":"MISCELLANEOUS DISORDERS OF NUTRITION METABOLISM FLUIDS AND ELECTROLYTES WITHOUT MCC","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":4414,"maximum":14630.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7024,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6640,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4439,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7596,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7122,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13899.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8325,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9926,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8250,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14630.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11605,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7205,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7205,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4414,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8128.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8697.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8372.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8534.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8616.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8534.74,"methodology":"case rate"}]}]},{"description":"INBORN AND OTHER DISORDERS OF METABOLISM","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"minimum":5462,"maximum":19946.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11156,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10547,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7404,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10002,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9377,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18949.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15168,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18084,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13760,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19946.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18432,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11444,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11444,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5462,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11081.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11857.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11413.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11635.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11746.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11635.53,"methodology":"case rate"}]}]},{"description":"ENDOCRINE DISORDERS WITH MCC","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"minimum":9346,"maximum":24759.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14897,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14084,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9346,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19928,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18684,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23521.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17767,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21182,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17369,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24759.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24613,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15282,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15282,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10127,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13755.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14718,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14167.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14442.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14580.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14442.9,"methodology":"case rate"}]}]},{"description":"ENDOCRINE DISORDERS WITH CC","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"minimum":5372,"maximum":17544.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9289,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8782,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6032,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14211,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13324,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16667.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11015,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13133,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11209,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17544.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15347,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9529,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9529,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5372,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9747.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10429.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10039.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10234.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10332.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10234.54,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD TRIGEMINAL NRV","code_information":[{"code":"64400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"median_amount":50,"10th_percentile":50,"90th_percentile":50,"count":"1 through 10","methodology":"percent of total billed charges"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC INJ ANESTH GREATER OCCIPITAL NERVE","code_information":[{"code":"64405","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":843.21,"maximum":843.21,"gross_charge":1041,"discounted_cash":308.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.21,"methodology":"fee schedule"}]}]},{"description":"HC INJ ANESTH GREATER OCCIPITAL NERVE","code_information":[{"code":"64405","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1041,"discounted_cash":308.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":728.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC INJECT ANESH AGENT OCC NERVE","code_information":[{"code":"64405","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":843.21,"maximum":843.21,"gross_charge":1041,"discounted_cash":308.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.21,"methodology":"fee schedule"}]}]},{"description":"HC INJECT ANESH AGENT OCC NERVE","code_information":[{"code":"64405","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1041,"discounted_cash":308.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":728.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD VAGUS NRV","code_information":[{"code":"64408","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"HC PRE SGL N BLOCKBRACHIAL W/GEN ANES","code_information":[{"code":"64415","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2640.6,"maximum":2640.6,"gross_charge":3260,"discounted_cash":964.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2640.6,"methodology":"fee schedule"}]}]},{"description":"HC PRE SGL N BLOCKBRACHIAL W/GEN ANES","code_information":[{"code":"64415","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2640.6,"gross_charge":3260,"discounted_cash":964.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":652,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":489,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":652,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD BRACH PLEX NFS","code_information":[{"code":"64416","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD AXILLARY NRV","code_information":[{"code":"64417","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD SPRSCAP NRV","code_information":[{"code":"64418","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD NTRCOST NRV 1","code_information":[{"code":"64420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD NTRCOST NRV EA","code_information":[{"code":"64421","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD II IH NERVES","code_information":[{"code":"64425","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD PUDENDAL NERVE","code_information":[{"code":"64430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD PARACRV NRV","code_information":[{"code":"64435","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD SCIATIC NERVE","code_information":[{"code":"64445","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD SCIATIC NRV NFS","code_information":[{"code":"64446","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC PRE SGL BLOCKFEMORAL W/GEN ANES","code_information":[{"code":"64447","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2053.35,"maximum":2053.35,"gross_charge":2535,"discounted_cash":750.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2053.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2053.35,"methodology":"fee schedule"}]}]},{"description":"HC PRE SGL BLOCKFEMORAL W/GEN ANES","code_information":[{"code":"64447","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2535,"discounted_cash":750.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2053.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2053.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2053.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1774.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":507,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":507,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA&/STRD FEM NRV NFS IMG","code_information":[{"code":"64448","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2640.6,"maximum":2640.6,"gross_charge":3260,"discounted_cash":964.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2640.6,"methodology":"fee schedule"}]}]},{"description":"NJX AA&/STRD FEM NRV NFS IMG","code_information":[{"code":"64448","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3260,"discounted_cash":964.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2640.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2282,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":652,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":489,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":652,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD LMBR PLEX NFS","code_information":[{"code":"64449","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD OTHER PN/BRANCH","code_information":[{"code":"64450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD NRV NRVTG SI JT","code_information":[{"code":"64451","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"NJX AA/STRD GNCLR NRV BRNCH","code_information":[{"code":"64454","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC INS ANES/STER PLNTR NERVE DIG","code_information":[{"code":"64455","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1355.13,"maximum":1355.13,"gross_charge":1673,"discounted_cash":495.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1355.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1355.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1355.13,"methodology":"fee schedule"}]}]},{"description":"HC INS ANES/STER PLNTR NERVE DIG","code_information":[{"code":"64455","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1673,"discounted_cash":495.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1355.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1355.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1355.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1171.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"PARAVERTEBRAL BLK SNGL INITIAL","code_information":[{"code":"64461","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1910.79,"maximum":1910.79,"gross_charge":2359,"discounted_cash":698.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1910.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1910.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1910.79,"methodology":"fee schedule"}]}]},{"description":"PARAVERTEBRAL BLK SNGL INITIAL","code_information":[{"code":"64461","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2359,"discounted_cash":698.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1910.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1910.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1910.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":471.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"PARAVERTEBRAL BLK SNGL ADDL","code_information":[{"code":"64462","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2865.78,"maximum":2865.78,"gross_charge":3538,"discounted_cash":1047.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2865.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2865.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2865.78,"methodology":"fee schedule"}]}]},{"description":"PARAVERTEBRAL BLK SNGL ADDL","code_information":[{"code":"64462","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":3538,"discounted_cash":1047.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2865.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2865.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2865.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.6,"methodology":"fee schedule"}]}]},{"description":"PVB THORACIC CONT INFUSION","code_information":[{"code":"64463","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC INJ(S) FORAMEN EPIDURAL","code_information":[{"code":"64479","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2584.71,"maximum":2584.71,"gross_charge":3191,"discounted_cash":944.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2584.71,"methodology":"fee schedule"}]}]},{"description":"HC INJ(S) FORAMEN EPIDURAL","code_information":[{"code":"64479","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2584.71,"gross_charge":3191,"discounted_cash":944.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC TRANSFORAMINAL CS/TS INJ","code_information":[{"code":"64479","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2584.71,"maximum":2584.71,"gross_charge":3191,"discounted_cash":944.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2584.71,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFORAMINAL CS/TS INJ","code_information":[{"code":"64479","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2584.71,"gross_charge":3191,"discounted_cash":944.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":606.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC TRANSFORAMINAL CS/TS INJ BIL","code_information":[{"code":"64479","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3849.12,"maximum":3849.12,"gross_charge":4752,"discounted_cash":1406.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3849.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3849.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3849.12,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFORAMINAL CS/TS INJ BIL","code_information":[{"code":"64479","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":3849.12,"gross_charge":4752,"discounted_cash":1406.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3849.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3849.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3849.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":950.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ(S) FORAMEN EPIDURAL ADL","code_information":[{"code":"64480","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1278.99,"maximum":1278.99,"gross_charge":1579,"discounted_cash":467.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1278.99,"methodology":"fee schedule"}]}]},{"description":"HC INJ(S) FORAMEN EPIDURAL ADL","code_information":[{"code":"64480","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":1579,"discounted_cash":467.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":757.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":884.24,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.8,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFORAMINAL CS/TS INJ SEC","code_information":[{"code":"64480","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1278.99,"maximum":1278.99,"gross_charge":1579,"discounted_cash":467.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1278.99,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFORAMINAL CS/TS INJ SEC","code_information":[{"code":"64480","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":1579,"discounted_cash":467.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1278.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.8,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFORM CS/TS INJ SEC BIL","code_information":[{"code":"64480","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1917.27,"maximum":1917.27,"gross_charge":2367,"discounted_cash":700.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1917.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1917.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1917.27,"methodology":"fee schedule"}]}]},{"description":"HC TRANSFORM CS/TS INJ SEC BIL","code_information":[{"code":"64480","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1917.27,"gross_charge":2367,"discounted_cash":700.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1917.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1917.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1917.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.4,"methodology":"fee schedule"}]}]},{"description":"HC INJ(S) FORAMEN LUMB/SAC","code_information":[{"code":"64483","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1737.45,"maximum":1737.45,"gross_charge":2145,"discounted_cash":634.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1737.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1737.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1737.45,"methodology":"fee schedule"}]}]},{"description":"HC INJ(S) FORAMEN LUMB/SAC","code_information":[{"code":"64483","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"gross_charge":2145,"discounted_cash":634.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1737.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1737.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1737.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":429,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":429,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ(S) FORAMEN LUMB/SAC ADL","code_information":[{"code":"64484","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1650.78,"maximum":1650.78,"gross_charge":2038,"discounted_cash":603.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1650.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1650.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1650.78,"methodology":"fee schedule"}]}]},{"description":"HC INJ(S) FORAMEN LUMB/SAC ADL","code_information":[{"code":"64484","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":2038,"discounted_cash":603.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1650.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1650.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1650.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":978.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1141.28,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.6,"methodology":"fee schedule"}]}]},{"description":"HC TAP BLOCK UNILATERAL (BLK RM)","code_information":[{"code":"64486","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1028.7,"maximum":1028.7,"gross_charge":1270,"discounted_cash":375.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1028.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1028.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1028.7,"methodology":"fee schedule"}]}]},{"description":"HC TAP BLOCK UNILATERAL (BLK RM)","code_information":[{"code":"64486","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1270,"discounted_cash":375.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1028.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1028.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1028.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":254,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":254,"methodology":"fee schedule"}]}]},{"description":"TAP BLOCK UNI BY INFUSION","code_information":[{"code":"64487","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC TAP BLOCK BILATERAL (BLK RM)","code_information":[{"code":"64488","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":210.6,"maximum":210.6,"gross_charge":260,"discounted_cash":76.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"}]}]},{"description":"HC TAP BLOCK BILATERAL (BLK RM)","code_information":[{"code":"64488","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":260,"discounted_cash":76.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"}]}]},{"description":"TAP BLOCK BI BY INFUSION","code_information":[{"code":"64489","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FACET JOINT CERVICAL/THORACIC","code_information":[{"code":"64490","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1130.76,"maximum":1130.76,"gross_charge":1396,"discounted_cash":413.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1130.76,"methodology":"fee schedule"}]}]},{"description":"FACET JOINT CERVICAL/THORACIC","code_information":[{"code":"64490","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1396,"discounted_cash":413.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":977.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ PARAVERT F JNT C/T 1LEV","code_information":[{"code":"64490","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1130.76,"maximum":1130.76,"gross_charge":1396,"discounted_cash":413.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1130.76,"methodology":"fee schedule"}]}]},{"description":"HC INJ PARAVERT F JNT C/T 1LEV","code_information":[{"code":"64490","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1396,"discounted_cash":413.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1130.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":977.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ PARAVERT F JNT C/T 2 LEV","code_information":[{"code":"64491","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":412.29,"maximum":412.29,"gross_charge":509,"discounted_cash":150.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.29,"methodology":"fee schedule"}]}]},{"description":"HC INJ PARAVERT F JNT C/T 2 LEV","code_information":[{"code":"64491","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":509,"discounted_cash":150.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":244.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":285.04,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.8,"methodology":"fee schedule"}]}]},{"description":"HC PARAINJCER/THORA SECOND LEV","code_information":[{"code":"64491","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1283.04,"maximum":1283.04,"gross_charge":1584,"discounted_cash":468.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1283.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1283.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1283.04,"methodology":"fee schedule"}]}]},{"description":"HC PARAINJCER/THORA SECOND LEV","code_information":[{"code":"64491","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1584,"discounted_cash":468.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1283.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1283.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1283.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1108.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"}]}]},{"description":"HC INJ DIAG/THERP 3RD+FACET","code_information":[{"code":"64492","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":596.16,"maximum":596.16,"gross_charge":736,"discounted_cash":217.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":596.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":596.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":596.16,"methodology":"fee schedule"}]}]},{"description":"HC INJ DIAG/THERP 3RD+FACET","code_information":[{"code":"64492","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":736,"discounted_cash":217.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":596.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":596.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":596.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":515.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.2,"methodology":"fee schedule"}]}]},{"description":"HC INJ FACET LUMBAR","code_information":[{"code":"64493","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1368.9,"maximum":1368.9,"gross_charge":1690,"discounted_cash":500.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1368.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1368.9,"methodology":"fee schedule"}]}]},{"description":"HC INJ FACET LUMBAR","code_information":[{"code":"64493","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1690,"discounted_cash":500.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1368.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1368.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1368.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1183,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":338,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":338,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"INJ FACET LUMBAR 64493","code_information":[{"code":"64493","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1334.88,"maximum":1334.88,"gross_charge":1648,"discounted_cash":487.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1334.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1334.88,"methodology":"fee schedule"}]}]},{"description":"INJ FACET LUMBAR 64493","code_information":[{"code":"64493","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1648,"discounted_cash":487.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1334.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1334.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1334.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1153.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJ FACET LUMBAR ADDL","code_information":[{"code":"64494","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1784.43,"maximum":1784.43,"gross_charge":2203,"discounted_cash":652.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1784.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1784.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1784.43,"methodology":"fee schedule"}]}]},{"description":"HC INJ FACET LUMBAR ADDL","code_information":[{"code":"64494","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2203,"discounted_cash":652.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1784.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1784.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1784.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1057.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1233.68,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1542.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.6,"methodology":"fee schedule"}]}]},{"description":"INJ FACET LUMBAR ADDL 64494","code_information":[{"code":"64494","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1732.59,"maximum":1732.59,"gross_charge":2139,"discounted_cash":633.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1732.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1732.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1732.59,"methodology":"fee schedule"}]}]},{"description":"INJ FACET LUMBAR ADDL 64494","code_information":[{"code":"64494","type":"CPT"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":2139,"discounted_cash":633.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1732.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1732.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1732.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1497.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.8,"methodology":"fee schedule"}]}]},{"description":"HC INJ DIAG/THER LUMB/SAC 3RD+FCT","code_information":[{"code":"64495","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":641.52,"maximum":641.52,"gross_charge":792,"discounted_cash":234.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":641.52,"methodology":"fee schedule"}]}]},{"description":"HC INJ DIAG/THER LUMB/SAC 3RD+FCT","code_information":[{"code":"64495","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":792,"discounted_cash":234.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"}]}]},{"description":"ENDOCRINE DISORDERS WITHOUT CC/MCC","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":4130,"maximum":14599.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7000,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6617,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4323,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11557,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10835,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13869.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8027,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9570,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8034,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14599.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11565,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7180,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7180,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4130,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8110.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8678.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8354.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8516.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8597.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8516.52,"methodology":"case rate"}]}]},{"description":"N BLOCK SPENOPALATINE GANGL","code_information":[{"code":"64505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"N BLOCK STELLATE GANGLION","code_information":[{"code":"64510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"N BLOCK INJ HYPOGAS PLXS","code_information":[{"code":"64517","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC 64520-INJEC SYMP.LUMBAR/THOR","code_information":[{"code":"64520","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2388.69,"maximum":2388.69,"gross_charge":2949,"discounted_cash":872.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2388.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2388.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2388.69,"methodology":"fee schedule"}]}]},{"description":"HC 64520-INJEC SYMP.LUMBAR/THOR","code_information":[{"code":"64520","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2388.69,"gross_charge":2949,"discounted_cash":872.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2388.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2388.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2388.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"HC INJCELIAC PLEXUS","code_information":[{"code":"64530","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1775.52,"maximum":1775.52,"gross_charge":2192,"discounted_cash":648.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1775.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1775.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1775.52,"methodology":"fee schedule"}]}]},{"description":"HC INJCELIAC PLEXUS","code_information":[{"code":"64530","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"gross_charge":2192,"discounted_cash":648.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1775.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1775.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1775.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64553","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":27301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19874.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19064.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11148.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11929.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11483.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11706.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12263.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11817.9,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64555","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14368.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9978.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10033.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5867.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6043.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6160.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6454.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6219.55,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64561","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14368.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9978.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10033.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5867.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6043.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6160.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6454.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6219.55,"methodology":"case rate"}]}]},{"description":"NEUROELTRD STIM POST TIBIAL","code_information":[{"code":"64566","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INC FOR VAGUS N ELECT IMPL","code_information":[{"code":"64568","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":66716.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66716.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":66716.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":45306.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46588.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27244.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29151.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28061.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28606.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29969.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28879.29,"methodology":"case rate"}]}]},{"description":"REVISE/REPL VAGUS N ELTRD","code_information":[{"code":"64569","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":27301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19874.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19064.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11148.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11929.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11483.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11706.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12263.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11817.9,"methodology":"case rate"}]}]},{"description":"REMOVE VAGUS N ELTRD","code_information":[{"code":"64570","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64575","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":27301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27301.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19874.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19064.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11148.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11929.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11483.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11706.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12263.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11817.9,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64580","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":46948.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31917.1,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32784.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19172.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20514.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19747.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20130.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21089.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20322.47,"methodology":"case rate"}]}]},{"description":"IMPLANT NEUROELECTRODES","code_information":[{"code":"64581","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14368.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14368.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9978.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10033.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5867.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6278.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6043.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6160.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6454.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6219.55,"methodology":"case rate"}]}]},{"description":"REVISE/REMOVE NEUROELECTRODE","code_information":[{"code":"64585","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7529.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4964.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5257.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3074.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3289.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3166.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3228.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3382.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3259.09,"methodology":"case rate"}]}]},{"description":"INSRT/REDO PN/GASTR STIMUL","code_information":[{"code":"64590","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":46948.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46948.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31917.1,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32784.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19172.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20514.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19747.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20130.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21089.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20322.47,"methodology":"case rate"}]}]},{"description":"REVISE/RMV PN/GASTR STIMUL","code_information":[{"code":"64595","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7529.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7529.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4964.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5257.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3074.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3289.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3166.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3228.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3382.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3259.09,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"646","type":"MS-DRG"}],"standard_charges":[{"minimum":45661,"maximum":45661,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45661,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64610","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"CHEMODENERV SALIV GLANDS","code_information":[{"code":"64611","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"DESTROY NERVE FACE MUSCLE","code_information":[{"code":"64612","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"CHEMODENERV MUSC MIGRAINE","code_information":[{"code":"64615","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"CHEMODENERV MUSC NECK DYSTON","code_information":[{"code":"64616","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"CHEMODENER MUSCLE LARYNX EMG","code_information":[{"code":"64617","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1949.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"DSTRJ NULYT AGT GNCLR NRV","code_information":[{"code":"64624","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"RF ABLTJ NRV NRVTG SI JT","code_information":[{"code":"64625","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4865,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64630","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"N BLOCK INJ COMMON DIGIT","code_information":[{"code":"64632","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"DESTROY CERV/THOR FACET JNT","code_information":[{"code":"64633","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"DESTROY C/TH FACET JNT ADDL","code_information":[{"code":"64634","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DESTROY LUMB/SAC FACET JNT","code_information":[{"code":"64635","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"DESTROY L/S FACET JNT ADDL","code_information":[{"code":"64636","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64640","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"CHEMODENERV 1 EXTREMITY 1-4","code_information":[{"code":"64642","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"CHEMODENERV 1 EXTREM 1-4 EA","code_information":[{"code":"64643","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMODENERV 1 EXTREM 5/> MUS","code_information":[{"code":"64644","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"CHEMODENERV 1 EXTREM 5/> EA","code_information":[{"code":"64645","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMODENERV TRUNK MUSC 1-5","code_information":[{"code":"64646","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"CHEMODENERV TRUNK MUSC 6/>","code_information":[{"code":"64647","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"CHEMODENERV ECCRINE GLANDS","code_information":[{"code":"64650","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"CHEMODENERV ECCRINE GLANDS","code_information":[{"code":"64653","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64680","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF NERVE","code_information":[{"code":"64681","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1949.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1329.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1361.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":795.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":851.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":819.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":835.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":875.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":843.71,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"647","type":"MS-DRG"}],"standard_charges":[{"minimum":22608,"maximum":22608,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22608,"methodology":"case rate"}]}]},{"description":"REVISE FINGER/TOE NERVE","code_information":[{"code":"64702","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISE HAND/FOOT NERVE","code_information":[{"code":"64704","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISE ARM/LEG NERVE","code_information":[{"code":"64708","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISION OF SCIATIC NERVE","code_information":[{"code":"64712","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISION OF ARM NERVE(S)","code_information":[{"code":"64713","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISE LOW BACK NERVE(S)","code_information":[{"code":"64714","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISION OF CRANIAL NERVE","code_information":[{"code":"64716","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISE ULNAR NERVE AT ELBOW","code_information":[{"code":"64718","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REVISE ULNAR NERVE AT WRIST","code_information":[{"code":"64719","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"HC NEUROPLASTYMED NERVECARPAL","code_information":[{"code":"64721","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5468.31,"maximum":5468.31,"gross_charge":6751,"discounted_cash":1998.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5468.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5468.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5468.31,"methodology":"fee schedule"}]}]},{"description":"HC NEUROPLASTYMED NERVECARPAL","code_information":[{"code":"64721","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5468.31,"gross_charge":6751,"discounted_cash":1998.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5468.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5468.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5468.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1282.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1012.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1350.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"RELIEVE PRESSURE ON NERVE(S)","code_information":[{"code":"64722","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"RELEASE FOOT/TOE NERVE","code_information":[{"code":"64726","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INTERNAL NERVE REVISION","code_information":[{"code":"64727","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF BROW NERVE","code_information":[{"code":"64732","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF CHEEK NERVE","code_information":[{"code":"64734","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF CHIN NERVE","code_information":[{"code":"64736","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF JAW NERVE","code_information":[{"code":"64738","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF TONGUE NERVE","code_information":[{"code":"64740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF FACIAL NERVE","code_information":[{"code":"64742","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISE NERVE BACK OF HEAD","code_information":[{"code":"64744","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISE DIAPHRAGM NERVE","code_information":[{"code":"64746","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF STOMACH NERVES","code_information":[{"code":"64755","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISION OF VAGUS NERVE","code_information":[{"code":"64760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INCISE HIP/THIGH NERVE","code_information":[{"code":"64763","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISE HIP/THIGH NERVE","code_information":[{"code":"64766","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"SEVER CRANIAL NERVE","code_information":[{"code":"64771","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"INCISION OF SPINAL NERVE","code_information":[{"code":"64772","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE SKIN NERVE LESION","code_information":[{"code":"64774","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE DIGIT NERVE LESION","code_information":[{"code":"64776","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"DIGIT NERVE SURGERY ADD-ON","code_information":[{"code":"64778","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE LIMB NERVE LESION","code_information":[{"code":"64782","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"LIMB NERVE SURGERY ADD-ON","code_information":[{"code":"64783","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE NERVE LESION","code_information":[{"code":"64784","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE SCIATIC NERVE LESION","code_information":[{"code":"64786","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"IMPLANT NERVE END","code_information":[{"code":"64787","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SKIN NERVE LESION","code_information":[{"code":"64788","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NERVE LESION","code_information":[{"code":"64790","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NERVE LESION","code_information":[{"code":"64792","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"BIOPSY OF NERVE","code_information":[{"code":"64795","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"648","type":"MS-DRG"}],"standard_charges":[{"minimum":15711,"maximum":15711,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15711,"methodology":"case rate"}]}]},{"description":"SYMPATHECTOMY CERVICAL","code_information":[{"code":"64802","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64804","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64809","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64818","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SYMPATHECTOMY DIGITAL ARTERY","code_information":[{"code":"64820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64821","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REMOVE SYMPATHETIC NERVES","code_information":[{"code":"64822","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"SYMPATHECTOMY SUPFC PALMAR","code_information":[{"code":"64823","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":7103.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7103.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4722.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4960.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2900.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3103.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2987.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3045.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3190.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3074.86,"methodology":"case rate"}]}]},{"description":"REPAIR OF DIGIT NERVE","code_information":[{"code":"64831","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REPAIR NERVE ADD-ON","code_information":[{"code":"64832","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF HAND OR FOOT NERVE","code_information":[{"code":"64834","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR OF HAND OR FOOT NERVE","code_information":[{"code":"64835","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR OF HAND OR FOOT NERVE","code_information":[{"code":"64836","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR NERVE ADD-ON","code_information":[{"code":"64837","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF LEG NERVE","code_information":[{"code":"64840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR/TRANSPOSE NERVE","code_information":[{"code":"64856","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR ARM/LEG NERVE","code_information":[{"code":"64857","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR SCIATIC NERVE","code_information":[{"code":"64858","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"NERVE SURGERY","code_information":[{"code":"64859","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF ARM NERVES","code_information":[{"code":"64861","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4275.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"REPAIR OF LOW BACK NERVES","code_information":[{"code":"64862","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR OF FACIAL NERVE","code_information":[{"code":"64864","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"REPAIR OF FACIAL NERVE","code_information":[{"code":"64865","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"FUSION OF FACIAL/OTHER NERVE","code_information":[{"code":"64866","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUSION OF FACIAL/OTHER NERVE","code_information":[{"code":"64868","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SUBSEQUENT REPAIR OF NERVE","code_information":[{"code":"64872","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR  REVISE NERVE ADD-ON","code_information":[{"code":"64874","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR NERVE/SHORTEN BONE","code_information":[{"code":"64876","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2818.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NERVE GRAFT HEAD/NECK </4 CM","code_information":[{"code":"64885","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT HEAD/NECK >4 CM","code_information":[{"code":"64886","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT HAND/FOOT </4 CM","code_information":[{"code":"64890","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT HAND/FOOT >4 CM","code_information":[{"code":"64891","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT ARM/LEG <4 CM","code_information":[{"code":"64892","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT ARM/LEG >4 CM","code_information":[{"code":"64893","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT HAND/FOOT </4 CM","code_information":[{"code":"64895","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT HAND/FOOT >4 CM","code_information":[{"code":"64896","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT ARM/LEG </4 CM","code_information":[{"code":"64897","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT ARM/LEG >4 CM","code_information":[{"code":"64898","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"649","type":"MS-DRG"}],"standard_charges":[{"minimum":13310,"maximum":13310,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13310,"methodology":"case rate"}]}]},{"description":"NERVE GRAFT ADD-ON","code_information":[{"code":"64901","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NERVE GRAFT ADD-ON","code_information":[{"code":"64902","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NERVE PEDICLE TRANSFER","code_information":[{"code":"64905","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE PEDICLE TRANSFER","code_information":[{"code":"64907","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NERVE REPAIR W/ALLOGRAFT","code_information":[{"code":"64910","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NEURORRAPHY W/VEIN AUTOGRAFT","code_information":[{"code":"64911","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NRV RPR W/NRV ALGRFT 1ST","code_information":[{"code":"64912","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":14020.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14020.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9719.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9790.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5725.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6126.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5897.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6011.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6298.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6069.02,"methodology":"case rate"}]}]},{"description":"NRV RPR W/NRV ALGRFT EA ADDL","code_information":[{"code":"64913","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CT INTERVERT DISC CORE BIOPSY","code_information":[{"code":"64999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":827.82,"maximum":827.82,"gross_charge":1022,"discounted_cash":302.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.82,"methodology":"fee schedule"}]}]},{"description":"CT INTERVERT DISC CORE BIOPSY","code_information":[{"code":"64999","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":1022,"discounted_cash":302.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":827.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":646.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":432.14,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":451.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":715.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":263.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":282.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":271.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":277.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":290.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":279.74,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"minimum":8654,"maximum":75545,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41415,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39153,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25552,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":75545,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70829,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":55927.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50196,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59846,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47485,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":58870.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68423,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42484,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42484,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8654,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32706.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34995.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33687.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34341.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34668.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34341.36,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6501","type":"APR-DRG"}],"standard_charges":[{"minimum":10882,"maximum":10882,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10882,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10882,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10882,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6502","type":"APR-DRG"}],"standard_charges":[{"minimum":10882,"maximum":10882,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10882,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10882,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10882,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6503","type":"APR-DRG"}],"standard_charges":[{"minimum":18182,"maximum":18182,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18182,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18182,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18182,"methodology":"case rate"}]}]},{"description":"SPLENECTOMY","code_information":[{"code":"6504","type":"APR-DRG"}],"standard_charges":[{"minimum":32606,"maximum":32606,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32606,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32606,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32606,"methodology":"case rate"}]}]},{"description":"REVISE EYE","code_information":[{"code":"65091","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE EYE WITH IMPLANT","code_information":[{"code":"65093","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"minimum":19648,"maximum":61827,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31214,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29509,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19648,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61827,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57967,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43461.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45700,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36514,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45748.89,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51570,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32020,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32020,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51089,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25416.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27195.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26178.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26686.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26941.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26686.86,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EYE","code_information":[{"code":"65101","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REMOVE EYE/INSERT IMPLANT","code_information":[{"code":"65103","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REMOVE EYE/ATTACH IMPLANT","code_information":[{"code":"65105","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6511","type":"APR-DRG"}],"standard_charges":[{"minimum":8211,"maximum":8211,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8211,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EYE","code_information":[{"code":"65110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REMOVE EYE/REVISE SOCKET","code_information":[{"code":"65112","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REMOVE EYE/REVISE SOCKET","code_information":[{"code":"65114","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6512","type":"APR-DRG"}],"standard_charges":[{"minimum":9355,"maximum":9355,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9355,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9355,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9355,"methodology":"case rate"}]}]},{"description":"REVISE OCULAR IMPLANT","code_information":[{"code":"65125","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6513","type":"APR-DRG"}],"standard_charges":[{"minimum":15637,"maximum":15637,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15637,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15637,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15637,"methodology":"case rate"}]}]},{"description":"INSERT OCULAR IMPLANT","code_information":[{"code":"65130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"INSERT OCULAR IMPLANT","code_information":[{"code":"65135","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"OTHER PROCEDURES OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6514","type":"APR-DRG"}],"standard_charges":[{"minimum":35929,"maximum":35929,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35929,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35929,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35929,"methodology":"case rate"}]}]},{"description":"ATTACH OCULAR IMPLANT","code_information":[{"code":"65140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE OCULAR IMPLANT","code_information":[{"code":"65150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REINSERT OCULAR IMPLANT","code_information":[{"code":"65155","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REMOVAL OF OCULAR IMPLANT","code_information":[{"code":"65175","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"KIDNEY TRANSPLANT","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"minimum":22839.37,"maximum":82081,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51312,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48108,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39055.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33347,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39758,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31720,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41110.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45614,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28321,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28321,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82081,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22839.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24438.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23524.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23981.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24209.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23981.34,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65205","type":"CPT"}],"standard_charges":[{"minimum":115.24,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65222","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65235","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65260","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVE FOREIGN BODY FROM EYE","code_information":[{"code":"65265","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65270","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65272","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65273","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65275","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65280","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65285","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE WOUND","code_information":[{"code":"65286","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPAIR OF EYE SOCKET WOUND","code_information":[{"code":"65290","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH MCC","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"minimum":28398,"maximum":82789,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50110,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":47373,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":30756,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76514,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71737,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":66553.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60062,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71609,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57157,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":70056.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82789,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":51403,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51403,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28398,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38920.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41644.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":40087.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40866.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":41255.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40866.04,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH CC","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"minimum":13009,"maximum":41911,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25368,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23982,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15553,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41268,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38692,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36316.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30725,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36631,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28903,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":38228.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41911,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26023,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26023,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13009,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21237.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22724.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21875,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22299.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22512.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22299.76,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EYE LESION","code_information":[{"code":"65400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2120.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"BIOPSY OF CORNEA","code_information":[{"code":"65410","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EYE LESION","code_information":[{"code":"65420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EYE LESION","code_information":[{"code":"65426","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"CORNEAL SMEAR","code_information":[{"code":"65430","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"CURETTE/TREAT CORNEA","code_information":[{"code":"65435","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"CURETTE/TREAT CORNEA","code_information":[{"code":"65436","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"TREATMENT OF CORNEAL LESION","code_information":[{"code":"65450","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"minimum":10721,"maximum":30850,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18673,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17653,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11975,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26890,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25211,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28135.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23333,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27819,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22254,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29615.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30850,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19155,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19155,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10721,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16453.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17604.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16946.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17275.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17440.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17275.9,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"minimum":16172,"maximum":71596,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29286,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27686,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17826,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":71596,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67126,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41105.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35727,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42595,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33127,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":43268.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48385,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30042,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30042,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16172,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24038.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25720.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24759.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25240.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25480.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25240.01,"methodology":"case rate"}]}]},{"description":"REVISION OF CORNEA","code_information":[{"code":"65600","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"minimum":10478,"maximum":34435,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16433,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15535,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10478,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34435,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32286,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25397.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20299,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24202,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19471,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26734.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27149,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16857,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16857,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14130,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14852.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15892.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15297.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15594.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15743.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15594.98,"methodology":"case rate"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65710","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65730","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"CORNEAL TRANSPLANT","code_information":[{"code":"65755","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"CORNEAL TRNSPL ENDOTHELIAL","code_information":[{"code":"65756","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"PREP CORNEAL ENDO ALLOGRAFT","code_information":[{"code":"65757","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF CORNEA","code_information":[{"code":"65760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISION OF CORNEA","code_information":[{"code":"65765","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORNEAL TISSUE TRANSPLANT","code_information":[{"code":"65767","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE CORNEA WITH IMPLANT","code_information":[{"code":"65770","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":31283.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31283.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":31283.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18087.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21845.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12775.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13669.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13158.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13413.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14052.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13541.72,"methodology":"case rate"}]}]},{"description":"RADIAL KERATOTOMY","code_information":[{"code":"65771","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CORRECTION OF ASTIGMATISM","code_information":[{"code":"65772","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"CORRECTION OF ASTIGMATISM","code_information":[{"code":"65775","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"COVER EYE W/MEMBRANE","code_information":[{"code":"65778","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"COVER EYE W/MEMBRANE SUTURE","code_information":[{"code":"65779","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"OCULAR RECONST TRANSPLANT","code_information":[{"code":"65780","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"OCULAR RECONST TRANSPLANT","code_information":[{"code":"65781","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"OCULAR RECONST TRANSPLANT","code_information":[{"code":"65782","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"IMPLTJ NTRSTRML CRNL RNG SEG","code_information":[{"code":"65785","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"minimum":8411,"maximum":29292,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13519,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12781,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8411,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29292,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27463,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21837.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17067,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20349,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15630,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22986.6,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22336,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13868,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13868,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10564,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12770.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13664.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13153.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13408.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13536.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13408.85,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF EYE","code_information":[{"code":"65800","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF EYE","code_information":[{"code":"65810","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF EYE","code_information":[{"code":"65815","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"RELIEVE INNER EYE PRESSURE","code_information":[{"code":"65820","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"INCISION OF EYE","code_information":[{"code":"65850","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"TRABECULOPLASTY LASER SURG","code_information":[{"code":"65855","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3324,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65860","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65865","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65870","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65875","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"INCISE INNER EYE ADHESIONS","code_information":[{"code":"65880","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"minimum":14708,"maximum":51144,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23230,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21961,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14708,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51144,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47951,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33704.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27854,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33209,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27334,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35478.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38380,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23830,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23830,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14937,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19710.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21089.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20301.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20695.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20892.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20695.74,"methodology":"case rate"}]}]},{"description":"REMOVE EYE LESION","code_information":[{"code":"65900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVE IMPLANT OF EYE","code_information":[{"code":"65920","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVE BLOOD CLOT FROM EYE","code_information":[{"code":"65930","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"minimum":7647,"maximum":22320,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12045,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11387,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7647,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22320,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20926,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20035.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15254,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18186,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14210,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21090.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19900,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12356,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12356,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8161,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11716.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12536.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12068.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12302.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12419.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12302.63,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6601","type":"APR-DRG"}],"standard_charges":[{"minimum":5533,"maximum":5533,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5533,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5533,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5533,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6602","type":"APR-DRG"}],"standard_charges":[{"minimum":9685,"maximum":9685,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9685,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9685,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9685,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF EYE","code_information":[{"code":"66020","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6603","type":"APR-DRG"}],"standard_charges":[{"minimum":12315,"maximum":12315,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12315,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12315,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12315,"methodology":"case rate"}]}]},{"description":"INJECTION TREATMENT OF EYE","code_information":[{"code":"66030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGIC OR IMMUNOLOGIC DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION","code_information":[{"code":"6604","type":"APR-DRG"}],"standard_charges":[{"minimum":20193,"maximum":20193,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20193,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20193,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20193,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"minimum":5956,"maximum":17466.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9228,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8724,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5956,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16547,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15514,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16592.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11651,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13891,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11069,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17466.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15246,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9466,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9466,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7240,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9703.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10382.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9994.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10188.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10285.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10188.67,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6611","type":"APR-DRG"}],"standard_charges":[{"minimum":5819,"maximum":5819,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5819,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5819,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5819,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6612","type":"APR-DRG"}],"standard_charges":[{"minimum":9806,"maximum":9806,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6613","type":"APR-DRG"}],"standard_charges":[{"minimum":9806,"maximum":9806,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9806,"methodology":"case rate"}]}]},{"description":"REMOVE EYE LESION","code_information":[{"code":"66130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"COAGULATION AND PLATELET DISORDERS","code_information":[{"code":"6614","type":"APR-DRG"}],"standard_charges":[{"minimum":19192,"maximum":19192,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19192,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19192,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19192,"methodology":"case rate"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66150","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66155","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66160","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"GLAUCOMA SURGERY","code_information":[{"code":"66170","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"INCISION OF EYE","code_information":[{"code":"66172","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"TRANSLUM DIL EYE CANAL","code_information":[{"code":"66174","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"TRNSLUM DIL EYE CANAL W/STNT","code_information":[{"code":"66175","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"AQUEOUS SHUNT EYE W/O GRAFT","code_information":[{"code":"66179","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"AQUEOUS SHUNT EYE W/GRAFT","code_information":[{"code":"66180","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"INSERT ANT DRAINAGE DEVICE","code_information":[{"code":"66183","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"REVISION OF AQUEOUS SHUNT","code_information":[{"code":"66184","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REVISE AQUEOUS SHUNT EYE","code_information":[{"code":"66185","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"MINOR BLADDER PROCEDURES WITH MCC","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"minimum":17025,"maximum":46329,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28042,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26510,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17025,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34106,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31977,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39584.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32845,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39160,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31639,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41668.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46329,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28766,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28766,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20373,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23149.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24769.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23843.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24306.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24537.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24306.47,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6621","type":"APR-DRG"}],"standard_charges":[{"minimum":6094,"maximum":6094,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6094,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6094,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6094,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6622","type":"APR-DRG"}],"standard_charges":[{"minimum":7924,"maximum":7924,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7924,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7924,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7924,"methodology":"case rate"}]}]},{"description":"REPAIR/GRAFT EYE LESION","code_information":[{"code":"66225","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6623","type":"APR-DRG"}],"standard_charges":[{"minimum":10741,"maximum":10741,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10741,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10741,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10741,"methodology":"case rate"}]}]},{"description":"SICKLE CELL ANEMIA CRISIS","code_information":[{"code":"6624","type":"APR-DRG"}],"standard_charges":[{"minimum":20236,"maximum":20236,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20236,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20236,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20236,"methodology":"case rate"}]}]},{"description":"FOLLOW-UP SURGERY OF EYE","code_information":[{"code":"66250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"MINOR BLADDER PROCEDURES WITH CC","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"minimum":7864,"maximum":23257.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13730,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12980,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22303,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20911,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22094.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16484,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19653,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15404,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23257.17,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22684,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14084,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14084,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7864,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12920.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13825.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13308.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13566.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13695.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13566.69,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6631","type":"APR-DRG"}],"standard_charges":[{"minimum":3961,"maximum":3961,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3961,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3961,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3961,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6632","type":"APR-DRG"}],"standard_charges":[{"minimum":5273,"maximum":5273,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5273,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5273,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5273,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6633","type":"APR-DRG"}],"standard_charges":[{"minimum":8572,"maximum":8572,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8572,"methodology":"case rate"}]}]},{"description":"OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS","code_information":[{"code":"6634","type":"APR-DRG"}],"standard_charges":[{"minimum":11478,"maximum":11478,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11478,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11478,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11478,"methodology":"case rate"}]}]},{"description":"MINOR BLADDER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"minimum":6031,"maximum":18081.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9706,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9176,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6031,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17563,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16466,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17177.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12178,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14520,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11208,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18081.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16036,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9957,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9957,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10045.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10748.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10346.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10547.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10647.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10547.52,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY WITH MCC","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"minimum":15460,"maximum":50993,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30865,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29179,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17550,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35810,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33574,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43034.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39438,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32615,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":45299.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50993,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":31661,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":31661,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15460,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25166.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26927.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25921.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26424.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26676.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26424.47,"methodology":"case rate"}]}]},{"description":"INCISION OF IRIS","code_information":[{"code":"66500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"INCISION OF IRIS","code_information":[{"code":"66505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY WITH CC","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"minimum":9757,"maximum":24643.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14808,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13999,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9757,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24591,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23056,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23411.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18612,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22190,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18132,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24643.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24464,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15190,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15190,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10066,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13690.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14649.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14101.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14375.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14512.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14375.45,"methodology":"case rate"}]}]},{"description":"REMOVE IRIS AND LESION","code_information":[{"code":"66600","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66605","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66625","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66630","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF IRIS","code_information":[{"code":"66635","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPAIR IRIS  CILIARY BODY","code_information":[{"code":"66680","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPAIR IRIS  CILIARY BODY","code_information":[{"code":"66682","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"PROSTATECTOMY WITHOUT CC/MCC","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"minimum":5914,"maximum":17480.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9239,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8734,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5963,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9881,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9264,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16606.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10635,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12680,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11082,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17480.16,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15264,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9477,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9477,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5914,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9711.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10390.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10002.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10196.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10293.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10196.76,"methodology":"case rate"}]}]},{"description":"DESTRUCTION CILIARY BODY","code_information":[{"code":"66700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"CILIARY TRANSSLERAL THERAPY","code_information":[{"code":"66710","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"ECP CILIARY BODY DESTRUCTION","code_information":[{"code":"66711","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"DESTRUCTION CILIARY BODY","code_information":[{"code":"66720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"DESTRUCTION CILIARY BODY","code_information":[{"code":"66740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISION OF IRIS","code_information":[{"code":"66761","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"REVISION OF IRIS","code_information":[{"code":"66762","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"REMOVAL OF INNER EYE LESION","code_information":[{"code":"66770","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITH MCC","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"minimum":14798,"maximum":43310,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26215,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24783,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16010,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39899,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37408,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37351.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30513,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36379,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29752,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39317.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43310,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26891,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26891,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14798,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21843,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23372.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22498.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22935.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23153.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22935.15,"methodology":"case rate"}]}]},{"description":"INCISION SECONDARY CATARACT","code_information":[{"code":"66820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"AFTER CATARACT LASER SURGERY","code_information":[{"code":"66821","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"REPOSITION INTRAOCULAR LENS","code_information":[{"code":"66825","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LENS LESION","code_information":[{"code":"66830","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LENS MATERIAL","code_information":[{"code":"66840","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LENS MATERIAL","code_information":[{"code":"66850","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVAL OF LENS MATERIAL","code_information":[{"code":"66852","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITH CC","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"minimum":6802,"maximum":23489.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13910,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13151,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8719,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21759,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20401,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22315.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17016,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20287,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16202,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23489.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22982,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14269,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14269,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6802,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13049.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13963.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13441.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13702.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13832.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13702.27,"methodology":"case rate"}]}]},{"description":"EXTRACTION OF LENS","code_information":[{"code":"66920","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"EXTRACTION OF LENS","code_information":[{"code":"66930","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"EXTRACTION OF LENS","code_information":[{"code":"66940","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"XCAPSL CTRC RMVL CPLX WO ECP","code_information":[{"code":"66982","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5429.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3703,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3910,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5186,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4852,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5429.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"CATARACT SURG W/IOL 1 STAGE","code_information":[{"code":"66983","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5429.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3703,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3910,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5186,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4852,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5429.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"XCAPSL CTRC RMVL W/O ECP","code_information":[{"code":"66984","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5429.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3703,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3910,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4815,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5186,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4852,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5429.67,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"INSERT LENS PROSTHESIS","code_information":[{"code":"66985","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3147,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3322,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4091,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":4409,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4127,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4616.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"EXCHANGE LENS PROSTHESIS","code_information":[{"code":"66986","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3147,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3322,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4091,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":4409,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4127,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4616.5,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"XCAPSL CTRC RMVL CPLX W/ECP","code_information":[{"code":"66987","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"XCAPSL CTRC RMVL W/ECP","code_information":[{"code":"66988","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"OPHTHALMIC ENDOSCOPE ADD-ON","code_information":[{"code":"66990","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EYE SURGERY PROCEDURE","code_information":[{"code":"66999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"minimum":4583,"maximum":16646.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8591,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8122,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5469,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12603,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11816,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15814.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10674,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12726,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10163,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16646.46,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14193,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8813,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4583,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9248.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9895.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9525.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9710.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9802.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9710.44,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF EYE FLUID","code_information":[{"code":"67005","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL OF EYE FLUID","code_information":[{"code":"67010","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"RELEASE OF EYE FLUID","code_information":[{"code":"67015","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPLACE EYE FLUID","code_information":[{"code":"67025","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"IMPLANT EYE DRUG SYSTEM","code_information":[{"code":"67027","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":33638.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33638.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33638.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23028.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23489.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13736.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14698.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14148.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14423.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15110.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14560.98,"methodology":"case rate"}]}]},{"description":"INJECTION EYE DRUG","code_information":[{"code":"67028","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"INCISE INNER EYE STRANDS","code_information":[{"code":"67030","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"LASER SURGERY EYE STRANDS","code_information":[{"code":"67031","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"REMOVAL OF INNER EYE FLUID","code_information":[{"code":"67036","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"LASER TREATMENT OF RETINA","code_information":[{"code":"67039","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"LASER TREATMENT OF RETINA","code_information":[{"code":"67040","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"VIT FOR MACULAR PUCKER","code_information":[{"code":"67041","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"VIT FOR MACULAR HOLE","code_information":[{"code":"67042","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"VIT FOR MEMBRANE DISSECT","code_information":[{"code":"67043","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"URETHRAL PROCEDURES WITH CC/MCC","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"minimum":8171,"maximum":25599,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15494,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14648,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9726,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19158,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17962,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24250.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19797,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23603,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18074,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25527.05,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25599,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15894,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15894,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8171,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14181.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15174.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14607.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14890.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15032.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14890.78,"methodology":"case rate"}]}]},{"description":"REPAIR DETACHED RETINA CRTX","code_information":[{"code":"67101","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPAIR DETACHED RETINA PC","code_information":[{"code":"67105","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"REPAIR DETACHED RETINA","code_information":[{"code":"67107","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"REPAIR DETACHED RETINA","code_information":[{"code":"67108","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"REPAIR DETACHED RETINA","code_information":[{"code":"67110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REPAIR RETINAL DETACH CPLX","code_information":[{"code":"67113","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":11296.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11296.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7625.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7888.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4612.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4935.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4751.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4843.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5074.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4889.77,"methodology":"case rate"}]}]},{"description":"RELEASE ENCIRCLING MATERIAL","code_information":[{"code":"67115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"REMOVE EYE IMPLANT MATERIAL","code_information":[{"code":"67120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REMOVE EYE IMPLANT MATERIAL","code_information":[{"code":"67121","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RETINA","code_information":[{"code":"67141","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RETINA","code_information":[{"code":"67145","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"URETHRAL PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"minimum":5326,"maximum":18250.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9838,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9300,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5326,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14643,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13729,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11260,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13424,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9898,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18250.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16253,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10091,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10091,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7120,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10139.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10646,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10747.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10646,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RETINAL LESION","code_information":[{"code":"67208","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RETINAL LESION","code_information":[{"code":"67210","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"TREATMENT OF RETINAL LESION","code_information":[{"code":"67218","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"TREATMENT OF CHOROID LESION","code_information":[{"code":"67220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"OCULAR PHOTODYNAMIC THER","code_information":[{"code":"67221","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"EYE PHOTODYNAMIC THER ADD-ON","code_information":[{"code":"67225","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DSTRJ EXTENSIVE RETINOPATHY","code_information":[{"code":"67227","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"TREATMENT X10SV RETINOPATHY","code_information":[{"code":"67228","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"TR RETINAL LES PRETERM INF","code_information":[{"code":"67229","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1201.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":848.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":505.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.9,"methodology":"case rate"}]}]},{"description":"REINFORCE EYE WALL","code_information":[{"code":"67250","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REINFORCE/GRAFT EYE WALL","code_information":[{"code":"67255","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8807.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8807.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5932.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6150.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3596.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3848.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3704.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3776.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3956.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3812.4,"methodology":"case rate"}]}]},{"description":"EYE SURGERY PROCEDURE","code_information":[{"code":"67299","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"minimum":15784,"maximum":62220,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37660,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":35603,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21010,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58416,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54769,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":51338.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37767,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45027,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39043,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":54040.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62220,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38632,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38632,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15784,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30022.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":32124.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30923.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31523.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31824.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31523.87,"methodology":"case rate"}]}]},{"description":"REVISE EYE MUSCLE","code_information":[{"code":"67311","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE TWO EYE MUSCLES","code_information":[{"code":"67312","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE EYE MUSCLE","code_information":[{"code":"67314","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE TWO EYE MUSCLES","code_information":[{"code":"67316","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE EYE MUSCLE(S)","code_information":[{"code":"67318","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE EYE MUSCLE(S) ADD-ON","code_information":[{"code":"67320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EYE SURGERY FOLLOW-UP ADD-ON","code_information":[{"code":"67331","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REREVISE EYE MUSCLES ADD-ON","code_information":[{"code":"67332","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE EYE MUSCLE W/SUTURE","code_information":[{"code":"67334","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EYE SUTURE DURING SURGERY","code_information":[{"code":"67335","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REVISE EYE MUSCLE ADD-ON","code_information":[{"code":"67340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3481.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE EYE TISSUE","code_information":[{"code":"67343","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"DESTROY NERVE OF EYE MUSCLE","code_information":[{"code":"67345","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"BIOPSY EYE MUSCLE","code_information":[{"code":"67346","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"UNLISTED PX EXTRAOCULAR MUSC","code_information":[{"code":"67399","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"minimum":13534,"maximum":34282,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20750,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19617,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13534,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28294,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26528,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30673.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25623,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30549,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25151,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32288.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34282,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21286,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21286,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15208,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17937.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19193.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18475.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18834.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19014.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18834.73,"methodology":"case rate"}]}]},{"description":"EXPLORE/BIOPSY EYE SOCKET","code_information":[{"code":"67400","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"EXPLORE/DRAIN EYE SOCKET","code_information":[{"code":"67405","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67412","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67413","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"EXPLR/DECOMPRESS EYE SOCKET","code_information":[{"code":"67414","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"ASPIRATION ORBITAL CONTENTS","code_information":[{"code":"67415","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67420","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"EXPLORE/TREAT EYE SOCKET","code_information":[{"code":"67430","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"EXPLORE/DRAIN EYE SOCKET","code_information":[{"code":"67440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"EXPLR/DECOMPRESS EYE SOCKET","code_information":[{"code":"67445","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"EXPLORE/BIOPSY EYE SOCKET","code_information":[{"code":"67450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"minimum":7770,"maximum":23695.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14070,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13302,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9013,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21459,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20120,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22510.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18228,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21733,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16750,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23695.42,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23246,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14434,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14434,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7770,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13164.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14085.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13559.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13822.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13953.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13822.33,"methodology":"case rate"}]}]},{"description":"INJECT/TREAT EYE SOCKET","code_information":[{"code":"67500","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"INJECT/TREAT EYE SOCKET","code_information":[{"code":"67505","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"INJECT/TREAT EYE SOCKET","code_information":[{"code":"67515","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"INSERT EYE SOCKET IMPLANT","code_information":[{"code":"67550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE EYE SOCKET IMPLANT","code_information":[{"code":"67560","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"DECOMPRESS OPTIC NERVE","code_information":[{"code":"67570","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"ORBIT SURGERY PROCEDURE","code_information":[{"code":"67599","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"676","type":"MS-DRG"}],"standard_charges":[{"minimum":25354,"maximum":25354,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25354,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"677","type":"MS-DRG"}],"standard_charges":[{"minimum":13892,"maximum":13892,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13892,"methodology":"case rate"}]}]},{"description":"DRAINAGE OF EYELID ABSCESS","code_information":[{"code":"67700","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"INCISION OF EYELID","code_information":[{"code":"67710","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"INCISION OF EYELID FOLD","code_information":[{"code":"67715","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"678","type":"MS-DRG"}],"standard_charges":[{"minimum":8643,"maximum":8643,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8643,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LESION","code_information":[{"code":"67800","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LESIONS","code_information":[{"code":"67801","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LESIONS","code_information":[{"code":"67805","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LESION(S)","code_information":[{"code":"67808","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"BIOPSY EYELID  LID MARGIN","code_information":[{"code":"67810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67820","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67825","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67830","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":2469.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"REVISE EYELASHES","code_information":[{"code":"67835","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LESION","code_information":[{"code":"67840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"TREAT EYELID LESION","code_information":[{"code":"67850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"CLOSURE OF EYELID BY SUTURE","code_information":[{"code":"67875","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67880","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67882","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"679","type":"MS-DRG"}],"standard_charges":[{"minimum":5790,"maximum":5790,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5790,"methodology":"case rate"}]}]},{"description":"REPAIR BROW DEFECT","code_information":[{"code":"67900","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67901","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67902","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67903","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67904","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67906","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67908","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE EYELID DEFECT","code_information":[{"code":"67909","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE EYELID DEFECT","code_information":[{"code":"67911","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"CORRECTION EYELID W/IMPLANT","code_information":[{"code":"67912","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67914","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67915","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67916","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67917","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67921","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67922","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67923","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID DEFECT","code_information":[{"code":"67924","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID WOUND","code_information":[{"code":"67930","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REPAIR EYELID WOUND","code_information":[{"code":"67935","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID FOREIGN BODY","code_information":[{"code":"67938","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67950","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67961","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67966","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67971","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67973","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67974","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"RECONSTRUCTION OF EYELID","code_information":[{"code":"67975","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISION OF EYELID","code_information":[{"code":"67999","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"680","type":"MS-DRG"}],"standard_charges":[{"minimum":3472,"maximum":3472,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3472,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6801","type":"APR-DRG"}],"standard_charges":[{"minimum":17629,"maximum":17629,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17629,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17629,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17629,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6802","type":"APR-DRG"}],"standard_charges":[{"minimum":17629,"maximum":17629,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17629,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17629,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17629,"methodology":"case rate"}]}]},{"description":"INCISE/DRAIN EYELID LINING","code_information":[{"code":"68020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6803","type":"APR-DRG"}],"standard_charges":[{"minimum":20906,"maximum":20906,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20906,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20906,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20906,"methodology":"case rate"}]}]},{"description":"MAJOR O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6804","type":"APR-DRG"}],"standard_charges":[{"minimum":43550,"maximum":43550,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43550,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43550,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43550,"methodology":"case rate"}]}]},{"description":"TREATMENT OF EYELID LESIONS","code_information":[{"code":"68040","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"681","type":"MS-DRG"}],"standard_charges":[{"minimum":58642,"maximum":58642,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58642,"methodology":"case rate"}]}]},{"description":"BIOPSY OF EYELID LINING","code_information":[{"code":"68100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6811","type":"APR-DRG"}],"standard_charges":[{"minimum":8101,"maximum":8101,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8101,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8101,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8101,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68110","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68115","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6812","type":"APR-DRG"}],"standard_charges":[{"minimum":9854,"maximum":9854,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9854,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9854,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9854,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6813","type":"APR-DRG"}],"standard_charges":[{"minimum":22286,"maximum":22286,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22286,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22286,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22286,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68130","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVE EYELID LINING LESION","code_information":[{"code":"68135","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"OTHER  O.R. PROCEDURES FOR LYMPHATIC HEMATOPOIETIC OR OTHER NEOPLASMS","code_information":[{"code":"6814","type":"APR-DRG"}],"standard_charges":[{"minimum":41033,"maximum":41033,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41033,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41033,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41033,"methodology":"case rate"}]}]},{"description":"RENAL FAILURE WITH MCC","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":7873,"maximum":23004,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13501,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12763,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8527,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23004,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21568,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21814.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16069,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19158,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15845,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22962.32,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22305,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13849,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13849,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7873,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12756.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13649.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13139.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13394.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13522.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13394.69,"methodology":"case rate"}]}]},{"description":"TREAT EYELID BY INJECTION","code_information":[{"code":"68200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"RENAL FAILURE WITH CC","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":5118,"maximum":15874.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7990,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7554,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5118,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13920,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13051,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15080.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9673,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11533,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9511,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15874.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13201,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8197,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8197,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5552,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8818.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9436.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9083.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9259.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9348.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9259.85,"methodology":"case rate"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68325","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68326","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68328","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE EYELID LINING","code_information":[{"code":"68330","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4993.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4993.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3400.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3486.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2039.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2181.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2100.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2141.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2242.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2161.4,"methodology":"case rate"}]}]},{"description":"REVISE/GRAFT EYELID LINING","code_information":[{"code":"68335","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"SEPARATE EYELID ADHESIONS","code_information":[{"code":"68340","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE EYELID LINING","code_information":[{"code":"68360","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"REVISE EYELID LINING","code_information":[{"code":"68362","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"HARVEST EYE TISSUE ALOGRAFT","code_information":[{"code":"68371","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"EYELID LINING SURGERY","code_information":[{"code":"68399","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"RENAL FAILURE WITHOUT CC/MCC","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":3442,"maximum":12618.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5460,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5162,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3457,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9675,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9071,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11988.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6537,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7794,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6425,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12618.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9021,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5601,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5601,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7010.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7501.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7220.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7361.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7431.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7361.07,"methodology":"case rate"}]}]},{"description":"INCISE/DRAIN TEAR GLAND","code_information":[{"code":"68400","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2120.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1477.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1480.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":865.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":926.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":891.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":909.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":952.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":917.86,"methodology":"case rate"}]}]},{"description":"INCISE/DRAIN TEAR SAC","code_information":[{"code":"68420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"INCISE TEAR DUCT OPENING","code_information":[{"code":"68440","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"minimum":3070,"maximum":3070,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3070,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TEAR GLAND","code_information":[{"code":"68500","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"PARTIAL REMOVAL TEAR GLAND","code_information":[{"code":"68505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TEAR GLAND","code_information":[{"code":"68510","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVAL OF TEAR SAC","code_information":[{"code":"68520","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"BIOPSY OF TEAR SAC","code_information":[{"code":"68525","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"CLEARANCE OF TEAR DUCT","code_information":[{"code":"68530","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2694,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"REMOVE TEAR GLAND LESION","code_information":[{"code":"68540","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REMOVE TEAR GLAND LESION","code_information":[{"code":"68550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"minimum":6172,"maximum":28005,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16951,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16025,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10450,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26243,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24605,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26030.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18352,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21880,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19420,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27400.31,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28005,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17388,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17388,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6172,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15222.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16287.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15679.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15983.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16135.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15983.51,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITH CC","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"minimum":4801,"maximum":18040,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9463,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8946,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5939,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18040,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16913,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16879.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11239,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13400,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11036,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17768.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15634,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9707,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9707,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4801,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9871.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10562.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10167.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10364.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10463.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10364.72,"methodology":"case rate"}]}]},{"description":"REPAIR TEAR DUCTS","code_information":[{"code":"68700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"REVISE TEAR DUCT OPENING","code_information":[{"code":"68705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"CREATE TEAR SAC DRAIN","code_information":[{"code":"68720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"CREATE TEAR DUCT DRAIN","code_information":[{"code":"68745","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"CREATE TEAR DUCT DRAIN","code_information":[{"code":"68750","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":8255.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8255.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5641.18,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5765.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3371.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3607.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3472.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3539.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3708.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3573.71,"methodology":"case rate"}]}]},{"description":"CLOSE TEAR DUCT OPENING","code_information":[{"code":"68760","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"CLOSE TEAR DUCT OPENING","code_information":[{"code":"68761","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"CLOSE TEAR SYSTEM FISTULA","code_information":[{"code":"68770","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"minimum":3124,"maximum":16436,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6510,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6154,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4437,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16436,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15410,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13271.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9365,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11165,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8245,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13969.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10755,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6678,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6678,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3124,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7760.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8304.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7993.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8148.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8226.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8148.91,"methodology":"case rate"}]}]},{"description":"DILATE TEAR DUCT OPENING","code_information":[{"code":"68801","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":873.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":356.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":381.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":374.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.17,"methodology":"case rate"}]}]},{"description":"PROBE NASOLACRIMAL DUCT","code_information":[{"code":"68810","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":1836.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"PROBE NASOLACRIMAL DUCT","code_information":[{"code":"68811","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"PROBE NASOLACRIMAL DUCT","code_information":[{"code":"68815","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"PROBE NL DUCT W/BALLOON","code_information":[{"code":"68816","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":5107.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5107.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3409.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3566.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2085.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2231.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2148.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2190.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2294.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2210.91,"methodology":"case rate"}]}]},{"description":"EXPLORE/IRRIGATE TEAR DUCTS","code_information":[{"code":"68840","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"INJECTION FOR TEAR SAC X-RAY","code_information":[{"code":"68850","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TEAR DUCT SYSTEM SURGERY","code_information":[{"code":"68899","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":654.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":457.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":267.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":285.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":275.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":280.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":293.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":283.3,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS WITH MCC","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":6548,"maximum":19127.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10520,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9945,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6672,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11982,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11234,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18171.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12399,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14783,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12399,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19127.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17380,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10791,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6548,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10626.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11370.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10945.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11157.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11264.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11157.97,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":4584,"maximum":14876.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7215,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6820,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4584,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7191,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6742,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14132.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8600,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10253,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8519,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14876.12,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7401,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7401,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4639,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8264.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8843.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8512.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8677.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8760.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8677.74,"methodology":"case rate"}]}]},{"description":"DRAIN EXTERNAL EAR LESION","code_information":[{"code":"69000","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"DRAIN EXTERNAL EAR LESION","code_information":[{"code":"69005","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6901","type":"APR-DRG"}],"standard_charges":[{"minimum":6327,"maximum":6327,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6327,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6327,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6327,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6902","type":"APR-DRG"}],"standard_charges":[{"minimum":14062,"maximum":14062,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14062,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14062,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14062,"methodology":"case rate"}]}]},{"description":"DRAIN OUTER EAR CANAL LESION","code_information":[{"code":"69020","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1540.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1026.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1075.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":629.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":673.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":647.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":660.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":691.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":666.78,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6903","type":"APR-DRG"}],"standard_charges":[{"minimum":45195,"maximum":45195,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45195,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45195,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45195,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA","code_information":[{"code":"6904","type":"APR-DRG"}],"standard_charges":[{"minimum":45195,"maximum":45195,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45195,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45195,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45195,"methodology":"case rate"}]}]},{"description":"PIERCE EARLOBES","code_information":[{"code":"69090","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"minimum":7268,"maximum":7268,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7268,"methodology":"case rate"}]}]},{"description":"BIOPSY OF EXTERNAL EAR","code_information":[{"code":"69100","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"BIOPSY OF EXTERNAL EAR CANAL","code_information":[{"code":"69105","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6911","type":"APR-DRG"}],"standard_charges":[{"minimum":6549,"maximum":6549,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6549,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6549,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6549,"methodology":"case rate"}]}]},{"description":"REMOVE EXTERNAL EAR PARTIAL","code_information":[{"code":"69110","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6912","type":"APR-DRG"}],"standard_charges":[{"minimum":8036,"maximum":8036,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8036,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8036,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8036,"methodology":"case rate"}]}]},{"description":"REMOVAL OF EXTERNAL EAR","code_information":[{"code":"69120","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6913","type":"APR-DRG"}],"standard_charges":[{"minimum":12842,"maximum":12842,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12842,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12842,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12842,"methodology":"case rate"}]}]},{"description":"LYMPHOMA MYELOMA AND NON-ACUTE LEUKEMIA","code_information":[{"code":"6914","type":"APR-DRG"}],"standard_charges":[{"minimum":24725,"maximum":24725,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24725,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24725,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24725,"methodology":"case rate"}]}]},{"description":"REMOVE EAR CANAL LESION(S)","code_information":[{"code":"69140","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE EAR CANAL LESION(S)","code_information":[{"code":"69145","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":6265.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6265.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4145.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4375.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2558.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2737.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2635.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2686.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2814.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2712.32,"methodology":"case rate"}]}]},{"description":"EXTENSIVE EAR CANAL SURGERY","code_information":[{"code":"69150","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXTENSIVE EAR/NECK SURGERY","code_information":[{"code":"69155","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"minimum":6774,"maximum":6774,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6774,"methodology":"case rate"}]}]},{"description":"CLEAR OUTER EAR CANAL","code_information":[{"code":"69200","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"CLEAR OUTER EAR CANAL","code_information":[{"code":"69205","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3547.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3547.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2365.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2477.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1448.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1549.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1492.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1520.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1593.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1535.47,"methodology":"case rate"}]}]},{"description":"REMOVE IMPACTED EAR WAX UNI","code_information":[{"code":"69209","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6921","type":"APR-DRG"}],"standard_charges":[{"minimum":4535,"maximum":4535,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4535,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4535,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4535,"methodology":"case rate"}]}]},{"description":"HC REMOVAL IMPACTED CERUMEN","code_information":[{"code":"69210","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":193.59,"maximum":193.59,"gross_charge":239,"discounted_cash":70.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193.59,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL IMPACTED CERUMEN","code_information":[{"code":"69210","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"gross_charge":239,"discounted_cash":70.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":167.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6922","type":"APR-DRG"}],"standard_charges":[{"minimum":7690,"maximum":7690,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7690,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7690,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7690,"methodology":"case rate"}]}]},{"description":"CLEAN OUT MASTOID CAVITY","code_information":[{"code":"69220","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"CLEAN OUT MASTOID CAVITY","code_information":[{"code":"69222","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3073,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6923","type":"APR-DRG"}],"standard_charges":[{"minimum":10688,"maximum":10688,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10688,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10688,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10688,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"6924","type":"APR-DRG"}],"standard_charges":[{"minimum":24795,"maximum":24795,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24795,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24795,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24795,"methodology":"case rate"}]}]},{"description":"URINARY STONES WITH MCC","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"minimum":5681,"maximum":22598.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13217,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12495,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8046,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17961,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16840,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21468.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15466,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18439,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14953,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22598.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21837,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13559,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13559,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5681,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12554.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13433.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12931.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13182.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13307.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13182.21,"methodology":"case rate"}]}]},{"description":"REVISE EXTERNAL EAR","code_information":[{"code":"69300","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REBUILD OUTER EAR CANAL","code_information":[{"code":"69310","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REBUILD OUTER EAR CANAL","code_information":[{"code":"69320","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OUTER EAR SURGERY PROCEDURE","code_information":[{"code":"69399","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":298,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":244.01,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"URINARY STONES WITHOUT MCC","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"minimum":4359,"maximum":14630.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7024,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6640,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4447,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10008,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9383,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13899.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8616,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10272,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8264,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14630.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11605,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7205,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7205,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4359,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8128.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8697.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8372.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8534.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8616.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8534.74,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6941","type":"APR-DRG"}],"standard_charges":[{"minimum":4707,"maximum":4707,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4707,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4707,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4707,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6942","type":"APR-DRG"}],"standard_charges":[{"minimum":7083,"maximum":7083,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7083,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7083,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7083,"methodology":"case rate"}]}]},{"description":"INCISION OF EARDRUM","code_information":[{"code":"69420","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2360,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"INCISION OF EARDRUM","code_information":[{"code":"69421","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVE VENTILATING TUBE","code_information":[{"code":"69424","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6943","type":"APR-DRG"}],"standard_charges":[{"minimum":7851,"maximum":7851,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7851,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7851,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7851,"methodology":"case rate"}]}]},{"description":"CREATE EARDRUM OPENING","code_information":[{"code":"69433","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1114.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":802.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":778.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":455.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":487.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":468.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":478.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":500.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":482.61,"methodology":"case rate"}]}]},{"description":"CREATE EARDRUM OPENING","code_information":[{"code":"69436","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR","code_information":[{"code":"6944","type":"APR-DRG"}],"standard_charges":[{"minimum":14582,"maximum":14582,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14582,"methodology":"case rate"}]}]},{"description":"EXPLORATION OF MIDDLE EAR","code_information":[{"code":"69440","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"EARDRUM REVISION","code_information":[{"code":"69450","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"minimum":5732,"maximum":23704,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10138,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9584,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6795,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23704,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22224,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17704.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12412,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14798,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12627,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18636.5,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16749,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10399,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5732,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10353.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11078.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10664.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10871.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10974.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10871.3,"methodology":"case rate"}]}]},{"description":"MASTOIDECTOMY","code_information":[{"code":"69501","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MASTOIDECTOMY","code_information":[{"code":"69502","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE MASTOID STRUCTURES","code_information":[{"code":"69505","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6951","type":"APR-DRG"}],"standard_charges":[{"minimum":4161,"maximum":4161,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4161,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4161,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4161,"methodology":"case rate"}]}]},{"description":"EXTENSIVE MASTOID SURGERY","code_information":[{"code":"69511","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6952","type":"APR-DRG"}],"standard_charges":[{"minimum":7359,"maximum":7359,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7359,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7359,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7359,"methodology":"case rate"}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6953","type":"APR-DRG"}],"standard_charges":[{"minimum":19908,"maximum":19908,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19908,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19908,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19908,"methodology":"case rate"}]}]},{"description":"EXTENSIVE MASTOID SURGERY","code_information":[{"code":"69530","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE PART OF TEMPORAL BONE","code_information":[{"code":"69535","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY FOR ACUTE LEUKEMIA","code_information":[{"code":"6954","type":"APR-DRG"}],"standard_charges":[{"minimum":37598,"maximum":37598,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37598,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37598,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37598,"methodology":"case rate"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69540","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69550","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69552","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE EAR LESION","code_information":[{"code":"69554","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":3088,"maximum":13594.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6219,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5879,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3932,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8333,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7812,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12915.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7491,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8931,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7307,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13594.92,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10274,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6379,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6379,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3088,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7552.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8081.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7779.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7930.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8005.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7930.37,"methodology":"case rate"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69601","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69602","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69603","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69604","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MASTOID SURGERY REVISION","code_information":[{"code":"69605","type":"CPT"}],"standard_charges":[{"minimum":3752,"maximum":5503.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6961","type":"APR-DRG"}],"standard_charges":[{"minimum":4575,"maximum":4575,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4575,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4575,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4575,"methodology":"case rate"}]}]},{"description":"REPAIR OF EARDRUM","code_information":[{"code":"69610","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6962","type":"APR-DRG"}],"standard_charges":[{"minimum":8969,"maximum":8969,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8969,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8969,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8969,"methodology":"case rate"}]}]},{"description":"REPAIR OF EARDRUM","code_information":[{"code":"69620","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1782,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2194,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1791.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2360,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2469.9,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6963","type":"APR-DRG"}],"standard_charges":[{"minimum":8995,"maximum":8995,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8995,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8995,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8995,"methodology":"case rate"}]}]},{"description":"REPAIR EARDRUM STRUCTURES","code_information":[{"code":"69631","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69632","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69633","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR EARDRUM STRUCTURES","code_information":[{"code":"69635","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69636","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REBUILD EARDRUM STRUCTURES","code_information":[{"code":"69637","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OTHER CHEMOTHERAPY","code_information":[{"code":"6964","type":"APR-DRG"}],"standard_charges":[{"minimum":23229,"maximum":23229,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23229,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23229,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23229,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69641","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69642","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69643","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69644","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69645","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR  MASTOID","code_information":[{"code":"69646","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RELEASE MIDDLE EAR BONE","code_information":[{"code":"69650","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR BONE","code_information":[{"code":"69660","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR BONE","code_information":[{"code":"69661","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REVISE MIDDLE EAR BONE","code_information":[{"code":"69662","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR MIDDLE EAR STRUCTURES","code_information":[{"code":"69666","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REPAIR MIDDLE EAR STRUCTURES","code_information":[{"code":"69667","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2510.09,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3324,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3112,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3481.21,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"REMOVE MASTOID AIR CELLS","code_information":[{"code":"69670","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE MIDDLE EAR NERVE","code_information":[{"code":"69676","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"URETHRAL STRICTURE","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"minimum":3615,"maximum":17179.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9005,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8513,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6324,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9381,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8795,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16320.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10727,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12789,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11752,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17179.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14878,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9238,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3615,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10212.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9830.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10021.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10116.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10021.39,"methodology":"case rate"}]}]},{"description":"CLOSE MASTOID FISTULA","code_information":[{"code":"69700","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3243.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1922,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.77,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"NPS SURG DILAT EUST TUBE UNI","code_information":[{"code":"69705","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"NPS SURG DILAT EUST TUBE BI","code_information":[{"code":"69706","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"IMPLANT/REPLACE HEARING AID","code_information":[{"code":"69710","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":4782,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1993,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2005.1,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2694,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2519,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REMOVE/REPAIR HEARING AID","code_information":[{"code":"69711","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"IMPLANT TEMPLE BONE W/STIMUL","code_information":[{"code":"69714","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":28169.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28169.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19202.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19670.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11503.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12308.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11848.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12078.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12653.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12193.66,"methodology":"case rate"}]}]},{"description":"TEMPLE BNE IMPLNT W/STIMULAT","code_information":[{"code":"69715","type":"CPT"}],"standard_charges":[{"minimum":2496,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TEMPLE BONE IMPLANT REVISION","code_information":[{"code":"69717","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":15639.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15639.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10438,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10921.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6386.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6833.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6578.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6706.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7025.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6769.99,"methodology":"case rate"}]}]},{"description":"REVISE TEMPLE BONE IMPLANT","code_information":[{"code":"69718","type":"CPT"}],"standard_charges":[{"minimum":2496,"maximum":11095,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7671,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":11095,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10053,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9652.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE FACIAL NERVE","code_information":[{"code":"69720","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RELEASE FACIAL NERVE","code_information":[{"code":"69725","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR FACIAL NERVE","code_information":[{"code":"69740","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REPAIR FACIAL NERVE","code_information":[{"code":"69745","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"MIDDLE EAR SURGERY PROCEDURE","code_information":[{"code":"69799","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":8221,"maximum":25032.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15110,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14284,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9399,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18599,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17438,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23780.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17321,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20651,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17467,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25032.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24963,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15500,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15500,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8221,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13906.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14880.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14323.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14602.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14741.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14602.08,"methodology":"case rate"}]}]},{"description":"INCISE INNER EAR","code_information":[{"code":"69801","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3964.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2704,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3243.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2225.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2264.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2836,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2852.76,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3544,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3964.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1324.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1417.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1364.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1390.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1456.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1403.78,"methodology":"case rate"}]}]},{"description":"EXPLORE INNER EAR","code_information":[{"code":"69805","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"EXPLORE INNER EAR","code_information":[{"code":"69806","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":5800,"maximum":17388.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9168,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8667,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5800,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14625,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13712,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16519.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10940,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13043,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10778,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17388.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15147,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9404,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5847,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9660.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10336.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9950.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10143.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10240.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10143.48,"methodology":"case rate"}]}]},{"description":"REMOVE INNER EAR","code_information":[{"code":"69905","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE INNER EAR  MASTOID","code_information":[{"code":"69910","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"INCISE INNER EAR NERVE","code_information":[{"code":"69915","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":7100.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7100.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4697.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4958.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2899.43,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3102.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2986.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3044.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3189.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3073.4,"methodology":"case rate"}]}]},{"description":"IMPLANT COCHLEAR DEVICE","code_information":[{"code":"69930","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":69637.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69637.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":69637.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48927.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48628.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3951,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4865,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3974.13,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5257,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4917,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5503.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15476,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28437.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30428.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29290.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29859.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31281.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30143.71,"methodology":"case rate"}]}]},{"description":"INNER EAR SURGERY PROCEDURE","code_information":[{"code":"69949","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"INCISE INNER EAR NERVE","code_information":[{"code":"69950","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RELEASE FACIAL NERVE","code_information":[{"code":"69955","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"RELEASE INNER EAR CANAL","code_information":[{"code":"69960","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"REMOVE INNER EAR LESION","code_information":[{"code":"69970","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":12951.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12951.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8544.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9043.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5288.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5659.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5447.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5553.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5817.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5606.17,"methodology":"case rate"}]}]},{"description":"TEMPORAL BONE SURGERY","code_information":[{"code":"69979","type":"CPT"}],"standard_charges":[{"minimum":0.65,"maximum":3196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":508.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":356.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":355.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2496,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3073,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3196,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":207.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":222.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":213.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":217.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":228.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.07,"methodology":"case rate"}]}]},{"description":"MICROSURGERY ADD-ON","code_information":[{"code":"69990","type":"CPT"}],"standard_charges":[{"minimum":167,"maximum":3786,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":3786,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"minimum":4024,"maximum":13622.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6240,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5899,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4024,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13138,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12941.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8007,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9547,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7478,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13622.66,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10310,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6401,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6401,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4137,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7568.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8097.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7795.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7946.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8022.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7946.55,"methodology":"case rate"}]}]},{"description":"HC FB LOCALIZED EYE","code_information":[{"code":"70030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":316.71,"maximum":316.71,"gross_charge":391,"discounted_cash":115.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":316.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":316.71,"methodology":"fee schedule"}]}]},{"description":"HC FB LOCALIZED EYE","code_information":[{"code":"70030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.74,"maximum":316.71,"gross_charge":391,"discounted_cash":115.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":316.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":316.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR MANDIBLE 4VW/MORE","code_information":[{"code":"70110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":498.15,"maximum":498.15,"gross_charge":615,"discounted_cash":182.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.15,"methodology":"fee schedule"}]}]},{"description":"HC XR MANDIBLE 4VW/MORE","code_information":[{"code":"70110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.93,"maximum":498.15,"gross_charge":615,"discounted_cash":182.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR FACIAL BONES 1-3 VWS","code_information":[{"code":"70140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":665.01,"maximum":665.01,"gross_charge":821,"discounted_cash":243.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":665.01,"methodology":"fee schedule"}]}]},{"description":"HC XR FACIAL BONES 1-3 VWS","code_information":[{"code":"70140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.03,"maximum":665.01,"gross_charge":821,"discounted_cash":243.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":665.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR FACIAL BONES 3+VWS","code_information":[{"code":"70150","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":831.87,"maximum":831.87,"gross_charge":1027,"discounted_cash":304,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.87,"methodology":"fee schedule"}]}]},{"description":"HC XR FACIAL BONES 3+VWS","code_information":[{"code":"70150","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":47.89,"maximum":831.87,"gross_charge":1027,"discounted_cash":304,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR NASAL BONES 3+VWS","code_information":[{"code":"70160","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":593.73,"maximum":593.73,"gross_charge":733,"discounted_cash":216.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":593.73,"methodology":"fee schedule"}]}]},{"description":"HC XR NASAL BONES 3+VWS","code_information":[{"code":"70160","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":40.53,"maximum":593.73,"gross_charge":733,"discounted_cash":216.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR ORBITS 4+VIEWS","code_information":[{"code":"70200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":210.6,"maximum":210.6,"gross_charge":260,"discounted_cash":76.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"}]}]},{"description":"HC XR ORBITS 4+VIEWS","code_information":[{"code":"70200","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39,"maximum":306,"gross_charge":260,"discounted_cash":76.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SINUSES 1-2 VIEWS","code_information":[{"code":"70210","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":381.51,"maximum":381.51,"gross_charge":471,"discounted_cash":139.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.51,"methodology":"fee schedule"}]}]},{"description":"HC XR SINUSES 1-2 VIEWS","code_information":[{"code":"70210","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.43,"maximum":381.51,"gross_charge":471,"discounted_cash":139.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR SINUSES PARNSAL 3+VWS","code_information":[{"code":"70220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":813.24,"maximum":813.24,"gross_charge":1004,"discounted_cash":297.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":813.24,"methodology":"fee schedule"}]}]},{"description":"HC XR SINUSES PARNSAL 3+VWS","code_information":[{"code":"70220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.22,"maximum":813.24,"gross_charge":1004,"discounted_cash":297.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":813.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"70250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":405,"maximum":405,"gross_charge":500,"discounted_cash":148,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405,"methodology":"fee schedule"}]}]},{"description":"HC XR SKULL 1-3 VIEWS","code_information":[{"code":"70250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.97,"maximum":405,"gross_charge":500,"discounted_cash":148,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SKULLCOMPLETE 4+VWS","code_information":[{"code":"70260","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":862.65,"maximum":862.65,"gross_charge":1065,"discounted_cash":315.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":862.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":862.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":862.65,"methodology":"fee schedule"}]}]},{"description":"HC XR SKULLCOMPLETE 4+VWS","code_information":[{"code":"70260","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":49.02,"maximum":862.65,"gross_charge":1065,"discounted_cash":315.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":862.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":862.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":862.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR TMJ JOINT BILAT","code_information":[{"code":"70330","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":351.54,"maximum":351.54,"gross_charge":434,"discounted_cash":128.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.54,"methodology":"fee schedule"}]}]},{"description":"HC XR TMJ JOINT BILAT","code_information":[{"code":"70330","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":58.64,"maximum":351.54,"gross_charge":434,"discounted_cash":128.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC MR TMJ BILATERAL","code_information":[{"code":"70336","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3325.86,"maximum":3325.86,"gross_charge":4106,"discounted_cash":1215.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3325.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3325.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3325.86,"methodology":"fee schedule"}]}]},{"description":"HC MR TMJ BILATERAL","code_information":[{"code":"70336","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3325.86,"gross_charge":4106,"discounted_cash":1215.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3325.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3325.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3325.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":609.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":482.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":427.64,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2463.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"70360","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":451.98,"maximum":451.98,"gross_charge":558,"discounted_cash":165.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.98,"methodology":"fee schedule"}]}]},{"description":"HC XR NECK SOFT TISSUE","code_information":[{"code":"70360","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.18,"maximum":451.98,"gross_charge":558,"discounted_cash":165.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC CT BRAIN","code_information":[{"code":"70450","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2538.54,"maximum":2538.54,"gross_charge":3134,"discounted_cash":927.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2538.54,"methodology":"fee schedule"}]}]},{"description":"HC CT BRAIN","code_information":[{"code":"70450","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2538.54,"gross_charge":3134,"discounted_cash":927.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":197.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":161.3,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1880.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT BRAIN CONTRAST","code_information":[{"code":"70460","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2792.88,"maximum":2792.88,"gross_charge":3448,"discounted_cash":1020.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2792.88,"methodology":"fee schedule"}]}]},{"description":"HC CT BRAIN CONTRAST","code_information":[{"code":"70460","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2792.88,"gross_charge":3448,"discounted_cash":1020.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":273.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":216.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":227.93,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2068.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":689.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":689.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT BRAIN WOW CONTRAST","code_information":[{"code":"70470","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3173.58,"maximum":3173.58,"gross_charge":3918,"discounted_cash":1159.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3173.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3173.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3173.58,"methodology":"fee schedule"}]}]},{"description":"HC CT BRAIN WOW CONTRAST","code_information":[{"code":"70470","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3173.58,"gross_charge":3918,"discounted_cash":1159.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3173.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3173.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3173.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":338.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":268.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":266.85,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2350.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT ORBIT MD/IN EAR WO CONTR","code_information":[{"code":"70480","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2055.78,"maximum":2055.78,"gross_charge":2538,"discounted_cash":751.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2055.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2055.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2055.78,"methodology":"fee schedule"}]}]},{"description":"HC CT ORBIT MD/IN EAR WO CONTR","code_information":[{"code":"70480","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2055.78,"gross_charge":2538,"discounted_cash":751.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2055.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2055.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2055.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":454.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":360.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":279.54,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1522.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT ORBIT MD/IN EAR W/CONTR","code_information":[{"code":"70481","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2343.33,"maximum":2343.33,"gross_charge":2893,"discounted_cash":856.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2343.33,"methodology":"fee schedule"}]}]},{"description":"HC CT ORBIT MD/IN EAR W/CONTR","code_information":[{"code":"70481","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2343.33,"gross_charge":2893,"discounted_cash":856.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":543.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":430.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":310.47,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1735.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT ORBIT MD/IN EAR WOW CONT","code_information":[{"code":"70482","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2857.68,"maximum":2857.68,"gross_charge":3528,"discounted_cash":1044.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2857.68,"methodology":"fee schedule"}]}]},{"description":"HC CT ORBIT MD/IN EAR WOW CONT","code_information":[{"code":"70482","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2857.68,"gross_charge":3528,"discounted_cash":1044.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":610.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":483.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":343.86,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2116.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT MAXILLOFACIAL WO CONTR","code_information":[{"code":"70486","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1825.74,"maximum":1825.74,"gross_charge":2254,"discounted_cash":667.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1825.74,"methodology":"fee schedule"}]}]},{"description":"HC CT MAXILLOFACIAL WO CONTR","code_information":[{"code":"70486","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1825.74,"gross_charge":2254,"discounted_cash":667.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1825.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":363.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":288.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":193.83,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1352.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT MAXILLOFACIALCONTRAST","code_information":[{"code":"70487","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2410.56,"maximum":2410.56,"gross_charge":2976,"discounted_cash":880.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2410.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2410.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2410.56,"methodology":"fee schedule"}]}]},{"description":"HC CT MAXILLOFACIALCONTRAST","code_information":[{"code":"70487","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2410.56,"gross_charge":2976,"discounted_cash":880.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2410.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2410.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2410.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":450.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":356.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":233.27,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1785.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT MAXILLOFACWOW CONTR","code_information":[{"code":"70488","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2665.71,"maximum":2665.71,"gross_charge":3291,"discounted_cash":974.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2665.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2665.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2665.71,"methodology":"fee schedule"}]}]},{"description":"HC CT MAXILLOFACWOW CONTR","code_information":[{"code":"70488","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2665.71,"gross_charge":3291,"discounted_cash":974.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2665.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2665.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2665.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":556.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":440.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":283.85,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1974.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":625.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":658.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT NECK SFT TISSUE WO CONTR","code_information":[{"code":"70490","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2771.82,"maximum":2771.82,"gross_charge":3422,"discounted_cash":1012.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2771.82,"methodology":"fee schedule"}]}]},{"description":"HC CT NECK SFT TISSUE WO CONTR","code_information":[{"code":"70490","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2771.82,"gross_charge":3422,"discounted_cash":1012.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":341.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":230.49,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2053.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT NECK SFT TISSUE W/CONTR","code_information":[{"code":"70491","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3339.63,"maximum":3339.63,"gross_charge":4123,"discounted_cash":1220.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3339.63,"methodology":"fee schedule"}]}]},{"description":"HC CT NECK SFT TISSUE W/CONTR","code_information":[{"code":"70491","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3339.63,"gross_charge":4123,"discounted_cash":1220.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3339.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":428.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":339.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":283.01,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2473.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT NECK SFT TISSUE WOW CONT","code_information":[{"code":"70492","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3506.49,"maximum":3506.49,"gross_charge":4329,"discounted_cash":1281.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3506.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3506.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3506.49,"methodology":"fee schedule"}]}]},{"description":"HC CT NECK SFT TISSUE WOW CONT","code_information":[{"code":"70492","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3506.49,"gross_charge":4329,"discounted_cash":1281.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3506.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3506.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3506.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":532.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":421.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":341.51,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2597.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":865.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":865.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT ANGIO BRAIN","code_information":[{"code":"70496","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3571.29,"maximum":3571.29,"gross_charge":4409,"discounted_cash":1305.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3571.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3571.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3571.29,"methodology":"fee schedule"}]}]},{"description":"HC CT ANGIO BRAIN","code_information":[{"code":"70496","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3571.29,"gross_charge":4409,"discounted_cash":1305.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3571.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3571.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3571.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":873.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":691.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":412.91,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2645.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":837.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT ANGIO CAROTID","code_information":[{"code":"70498","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3427.11,"maximum":3427.11,"gross_charge":4231,"discounted_cash":1252.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3427.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3427.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3427.11,"methodology":"fee schedule"}]}]},{"description":"HC CT ANGIO CAROTID","code_information":[{"code":"70498","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3427.11,"gross_charge":4231,"discounted_cash":1252.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3427.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3427.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3427.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":916.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":725.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":412.43,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2538.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC MR ORBIT FACE NECK","code_information":[{"code":"70540","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3176.01,"maximum":3176.01,"gross_charge":3921,"discounted_cash":1160.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3176.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3176.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3176.01,"methodology":"fee schedule"}]}]},{"description":"HC MR ORBIT FACE NECK","code_information":[{"code":"70540","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3176.01,"gross_charge":3921,"discounted_cash":1160.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3176.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3176.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3176.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":715.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":566.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":362.27,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2352.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":588.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":784.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR ORBITFACENECKW/CNTRST","code_information":[{"code":"70542","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1104.84,"maximum":1104.84,"gross_charge":1364,"discounted_cash":403.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1104.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1104.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1104.84,"methodology":"fee schedule"}]}]},{"description":"HC MR ORBITFACENECKW/CNTRST","code_information":[{"code":"70542","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":204.6,"maximum":2459,"gross_charge":1364,"discounted_cash":403.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1104.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1104.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1104.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1364,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":807,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":639,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":430.16,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":818.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR ORBIT FACE NECK WOW CONT","code_information":[{"code":"70543","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4603.23,"maximum":4603.23,"gross_charge":5683,"discounted_cash":1682.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4603.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4603.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4603.23,"methodology":"fee schedule"}]}]},{"description":"HC MR ORBIT FACE NECK WOW CONT","code_information":[{"code":"70543","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4603.23,"gross_charge":5683,"discounted_cash":1682.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4603.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4603.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4603.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":969.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":767.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":541.88,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3409.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":852.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MR ORBIT FACE NECK W/WO LIMITED","code_information":[{"code":"70543","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2302.02,"maximum":2302.02,"gross_charge":2842,"discounted_cash":841.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2302.02,"methodology":"fee schedule"}]}]},{"description":"MR ORBIT FACE NECK W/WO LIMITED","code_information":[{"code":"70543","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2459,"gross_charge":2842,"discounted_cash":841.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2302.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":969.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":767.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":541.88,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1705.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA HEAD","code_information":[{"code":"70544","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3495.15,"maximum":3495.15,"gross_charge":4315,"discounted_cash":1277.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3495.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3495.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3495.15,"methodology":"fee schedule"}]}]},{"description":"HC MRA HEAD","code_information":[{"code":"70544","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3495.15,"gross_charge":4315,"discounted_cash":1277.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3495.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3495.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3495.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":839.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":665.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":340.07,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2589,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":819.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":863,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":647.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":863,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRA HEAD W/CONTRAST","code_information":[{"code":"70545","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3984.39,"maximum":3984.39,"gross_charge":4919,"discounted_cash":1456.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3984.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3984.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3984.39,"methodology":"fee schedule"}]}]},{"description":"HC MRA HEAD W/CONTRAST","code_information":[{"code":"70545","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":3984.39,"gross_charge":4919,"discounted_cash":1456.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3984.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3984.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3984.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":826.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":654.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":355.13,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2951.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA HEAD WOW CONTRAST","code_information":[{"code":"70546","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4753.08,"maximum":4753.08,"gross_charge":5868,"discounted_cash":1736.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4753.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4753.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4753.08,"methodology":"fee schedule"}]}]},{"description":"HC MRA HEAD WOW CONTRAST","code_information":[{"code":"70546","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4753.08,"gross_charge":5868,"discounted_cash":1736.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4753.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4753.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4753.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1263.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1000.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":513.87,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3520.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA NECK","code_information":[{"code":"70547","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":782.46,"maximum":782.46,"gross_charge":966,"discounted_cash":285.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":782.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":782.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":782.46,"methodology":"fee schedule"}]}]},{"description":"HC MRA NECK","code_information":[{"code":"70547","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":144.9,"maximum":2459,"gross_charge":966,"discounted_cash":285.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":782.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":782.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":782.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":966,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":842.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":667.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":341.52,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":579.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRA NECK W/CONTRAST","code_information":[{"code":"70548","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3129.03,"maximum":3129.03,"gross_charge":3863,"discounted_cash":1143.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3129.03,"methodology":"fee schedule"}]}]},{"description":"HC MRA NECK W/CONTRAST","code_information":[{"code":"70548","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":3129.03,"gross_charge":3863,"discounted_cash":1143.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":891.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":706.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":382.11,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2317.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA NECK WOW CONTRAST","code_information":[{"code":"70549","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4254.93,"maximum":4254.93,"gross_charge":5253,"discounted_cash":1554.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4254.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4254.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4254.93,"methodology":"fee schedule"}]}]},{"description":"HC MRA NECK WOW CONTRAST","code_information":[{"code":"70549","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4254.93,"gross_charge":5253,"discounted_cash":1554.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4254.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4254.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4254.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1273.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1008.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":540.21,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3151.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":998.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR BRAIN W/O CONTRAST","code_information":[{"code":"70551","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4479.3,"maximum":4479.3,"gross_charge":5530,"discounted_cash":1636.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4479.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4479.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4479.3,"methodology":"fee schedule"}]}]},{"description":"HC MR BRAIN W/O CONTRAST","code_information":[{"code":"70551","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":4479.3,"gross_charge":5530,"discounted_cash":1636.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4479.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4479.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4479.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":415.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":329.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":311.1,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3318,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1050.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":829.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRIG LIMITED BRAIN","code_information":[{"code":"70551","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":2239.65,"maximum":2239.65,"gross_charge":2765,"discounted_cash":818.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2239.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2239.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2239.65,"methodology":"fee schedule"}]}]},{"description":"HC MRIG LIMITED BRAIN","code_information":[{"code":"70551","type":"CPT"},{"code":"0611","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2459,"gross_charge":2765,"discounted_cash":818.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2239.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2239.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2239.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":415.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":329.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":311.1,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":553,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":553,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR BRAIN W/CONTRAST","code_information":[{"code":"70552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4750.65,"maximum":4750.65,"gross_charge":5865,"discounted_cash":1736.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4750.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4750.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4750.65,"methodology":"fee schedule"}]}]},{"description":"HC MR BRAIN W/CONTRAST","code_information":[{"code":"70552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4750.65,"gross_charge":5865,"discounted_cash":1736.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4750.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4750.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4750.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":592.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":469.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":429.59,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3519,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MRI BRAIN LIMITED W/CONTRAST","code_information":[{"code":"70552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2375.73,"maximum":2375.73,"gross_charge":2933,"discounted_cash":868.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2375.73,"methodology":"fee schedule"}]}]},{"description":"MRI BRAIN LIMITED W/CONTRAST","code_information":[{"code":"70552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2459,"gross_charge":2933,"discounted_cash":868.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2375.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":592.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":469.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":429.59,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1759.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR BRAIN WOW CONTRAST","code_information":[{"code":"70553","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":6786.18,"maximum":6786.18,"gross_charge":8378,"discounted_cash":2479.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6786.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6786.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6786.18,"methodology":"fee schedule"}]}]},{"description":"HC MR BRAIN WOW CONTRAST","code_information":[{"code":"70553","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":6786.18,"gross_charge":8378,"discounted_cash":2479.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6786.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6786.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6786.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":677.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":536.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":508.74,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5026.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1591.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1256.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1675.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES WITH CC/MCC","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"minimum":11146,"maximum":28820,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17444,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16491,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11146,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19633,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18407,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26633.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21567,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25713,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20714,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28035.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28820,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17894,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17894,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11284,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15575.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16665.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16042.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16353.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16509.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16353.83,"methodology":"case rate"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"minimum":6849,"maximum":22737.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13326,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12598,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8286,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17574,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16477,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21601.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16048,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19133,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15399,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22737.98,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22017,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13670,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13670,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6849,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12632.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13516.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13011.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13263.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13390.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13263.83,"methodology":"case rate"}]}]},{"description":"PENIS PROCEDURES WITH CC/MCC","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"minimum":8966,"maximum":33372,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20199,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19096,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12333,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27007,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25321,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30000.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26071,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31083,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22919,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31579.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33372,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20721,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20721,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8966,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17544.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18772.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18070.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18421.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18596.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18421.25,"methodology":"case rate"}]}]},{"description":"PENIS PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"minimum":5719,"maximum":22956.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13496,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12759,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7370,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21737,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20380,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21808.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15580,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18575,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13697,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22956.54,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22297,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13844,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13844,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5719,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12753.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13646.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13136.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13391.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13518.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13391.32,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7101","type":"APR-DRG"}],"standard_charges":[{"minimum":7527,"maximum":7527,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7527,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7527,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7527,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7102","type":"APR-DRG"}],"standard_charges":[{"minimum":12123,"maximum":12123,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12123,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12123,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12123,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7103","type":"APR-DRG"}],"standard_charges":[{"minimum":23651,"maximum":23651,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23651,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23651,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23651,"methodology":"case rate"}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE","code_information":[{"code":"7104","type":"APR-DRG"}],"standard_charges":[{"minimum":47050,"maximum":47050,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47050,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47050,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47050,"methodology":"case rate"}]}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"71045","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":370.98,"maximum":370.98,"gross_charge":458,"discounted_cash":135.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.98,"methodology":"fee schedule"}]}]},{"description":"HC XR CHEST 1 VIEW","code_information":[{"code":"71045","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":16.9,"maximum":370.98,"gross_charge":458,"discounted_cash":135.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"71046","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":556.47,"maximum":556.47,"gross_charge":687,"discounted_cash":203.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.47,"methodology":"fee schedule"}]}]},{"description":"HC XR CHEST 2 VIEWS","code_information":[{"code":"71046","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":31.15,"maximum":556.47,"gross_charge":687,"discounted_cash":203.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":556.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"CHEST XRAY 3 VIEWS","code_information":[{"code":"71047","type":"CPT"},{"code":"0324","type":"RC"}],"standard_charges":[{"minimum":271.35,"maximum":271.35,"gross_charge":335,"discounted_cash":99.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":271.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":271.35,"methodology":"fee schedule"}]}]},{"description":"CHEST XRAY 3 VIEWS","code_information":[{"code":"71047","type":"CPT"},{"code":"0324","type":"RC"}],"standard_charges":[{"minimum":39.72,"maximum":306,"gross_charge":335,"discounted_cash":99.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":271.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":271.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR CHEST 4+ VIEWS","code_information":[{"code":"71048","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":319.14,"maximum":319.14,"gross_charge":394,"discounted_cash":116.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.14,"methodology":"fee schedule"}]}]},{"description":"HC XR CHEST 4+ VIEWS","code_information":[{"code":"71048","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":40.87,"maximum":319.14,"gross_charge":394,"discounted_cash":116.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"TESTES PROCEDURES WITH CC/MCC","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"minimum":11067,"maximum":28374,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17174,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16236,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12061,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26868,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25190,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26303.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22087,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26333,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22414,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27688.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28374,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17618,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17618,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11067,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15382.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16459.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15843.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16151.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16305.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16151.47,"methodology":"case rate"}]}]},{"description":"HC RIBS UNILATERAL","code_information":[{"code":"71100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":660.96,"maximum":660.96,"gross_charge":816,"discounted_cash":241.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":660.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":660.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":660.96,"methodology":"fee schedule"}]}]},{"description":"HC RIBS UNILATERAL","code_information":[{"code":"71100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.87,"maximum":660.96,"gross_charge":816,"discounted_cash":241.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":660.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":660.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":660.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR RIBS+CHEST UNIL 3 VWS","code_information":[{"code":"71101","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":971.19,"maximum":971.19,"gross_charge":1199,"discounted_cash":354.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":971.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":971.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":971.19,"methodology":"fee schedule"}]}]},{"description":"HC XR RIBS+CHEST UNIL 3 VWS","code_information":[{"code":"71101","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.79,"maximum":971.19,"gross_charge":1199,"discounted_cash":354.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":971.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":971.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":971.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7111","type":"APR-DRG"}],"standard_charges":[{"minimum":7799,"maximum":7799,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7799,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7799,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7799,"methodology":"case rate"}]}]},{"description":"HC XR RIBS BILAT 3 VIEWS","code_information":[{"code":"71110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1155.87,"maximum":1155.87,"gross_charge":1427,"discounted_cash":422.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1155.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1155.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1155.87,"methodology":"fee schedule"}]}]},{"description":"HC XR RIBS BILAT 3 VIEWS","code_information":[{"code":"71110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.93,"maximum":1155.87,"gross_charge":1427,"discounted_cash":422.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1155.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1155.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1155.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR RIBS+CHEST BIL MIN 4VWS","code_information":[{"code":"71111","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1291.95,"maximum":1291.95,"gross_charge":1595,"discounted_cash":472.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1291.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1291.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1291.95,"methodology":"fee schedule"}]}]},{"description":"HC XR RIBS+CHEST BIL MIN 4VWS","code_information":[{"code":"71111","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":60.35,"maximum":1291.95,"gross_charge":1595,"discounted_cash":472.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1291.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1291.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1291.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":77.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":71.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":319,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":319,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7112","type":"APR-DRG"}],"standard_charges":[{"minimum":11640,"maximum":11640,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"}]}]},{"description":"HC XR STERNUM 2VW/MORE","code_information":[{"code":"71120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":580.77,"maximum":580.77,"gross_charge":717,"discounted_cash":212.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":580.77,"methodology":"fee schedule"}]}]},{"description":"HC XR STERNUM 2VW/MORE","code_information":[{"code":"71120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.87,"maximum":580.77,"gross_charge":717,"discounted_cash":212.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":580.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7113","type":"APR-DRG"}],"standard_charges":[{"minimum":24673,"maximum":24673,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24673,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24673,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24673,"methodology":"case rate"}]}]},{"description":"HC XR STERNOCLAV JNTS 3+VIEWS","code_information":[{"code":"71130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":377.46,"maximum":377.46,"gross_charge":466,"discounted_cash":137.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":377.46,"methodology":"fee schedule"}]}]},{"description":"HC XR STERNOCLAV JNTS 3+VIEWS","code_information":[{"code":"71130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.22,"maximum":377.46,"gross_charge":466,"discounted_cash":137.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMA OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE","code_information":[{"code":"7114","type":"APR-DRG"}],"standard_charges":[{"minimum":61419,"maximum":61419,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61419,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61419,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61419,"methodology":"case rate"}]}]},{"description":"TESTES PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"minimum":6436,"maximum":17963.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9615,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9089,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6752,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12037,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11286,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17065.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13420,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16000,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12547,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17963.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15885,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9863,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9863,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6436,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9979.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10678.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10279.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10478.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10578.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10478.72,"methodology":"case rate"}]}]},{"description":"HC CT CHEST WO CONTRAST","code_information":[{"code":"71250","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3326.67,"maximum":3326.67,"gross_charge":4107,"discounted_cash":1215.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3326.67,"methodology":"fee schedule"}]}]},{"description":"HC CT CHEST WO CONTRAST","code_information":[{"code":"71250","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":3326.67,"gross_charge":4107,"discounted_cash":1215.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":341.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":221.3,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2464.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT CHEST W CONTRAST","code_information":[{"code":"71260","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3858.84,"maximum":3858.84,"gross_charge":4764,"discounted_cash":1410.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3858.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3858.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3858.84,"methodology":"fee schedule"}]}]},{"description":"HC CT CHEST W CONTRAST","code_information":[{"code":"71260","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3858.84,"gross_charge":4764,"discounted_cash":1410.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3858.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3858.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3858.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":430.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":273.48,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2858.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":952.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":952.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT CHEST WOW CONTRAST","code_information":[{"code":"71270","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4391.82,"maximum":4391.82,"gross_charge":5422,"discounted_cash":1604.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4391.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4391.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4391.82,"methodology":"fee schedule"}]}]},{"description":"HC CT CHEST WOW CONTRAST","code_information":[{"code":"71270","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":4391.82,"gross_charge":5422,"discounted_cash":1604.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4391.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4391.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4391.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":535.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":423.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":323.31,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3253.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1030.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1084.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"CT LOW DOSE LUNG SCREENING ANNUAL FOLLOWUP","code_information":[{"code":"71271","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":486,"maximum":486,"gross_charge":600,"discounted_cash":177.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"}]}]},{"description":"CT LOW DOSE LUNG SCREENING ANNUAL FOLLOWUP","code_information":[{"code":"71271","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":90,"maximum":1467,"gross_charge":600,"discounted_cash":177.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":600,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":234.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":185.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":404.79,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":360,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CTA CHEST","code_information":[{"code":"71275","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4540.05,"maximum":4540.05,"gross_charge":5605,"discounted_cash":1659.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4540.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4540.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4540.05,"methodology":"fee schedule"}]}]},{"description":"HC CTA CHEST","code_information":[{"code":"71275","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":4540.05,"gross_charge":5605,"discounted_cash":1659.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4540.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4540.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4540.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":674.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":534.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":422.04,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3363,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1121,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY WITH CC/MCC","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"minimum":8013,"maximum":22315.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12998,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12288,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8242,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16488,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15459,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21200.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16018,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19097,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15316,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22315.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21475,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13334,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13334,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8013,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12397.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13265.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12769.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13017.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13141.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13017.63,"methodology":"case rate"}]}]},{"description":"TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"minimum":4689,"maximum":16461.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8447,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7986,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5446,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10326,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9682,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15638.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10357,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12348,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10120,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16461.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13956,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8665,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8665,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4689,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9145.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9785.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9419.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9602.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9693.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9602.52,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"minimum":12542,"maximum":33538,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20300,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19191,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12542,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22609,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21198,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30123.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24139,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28779,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23307,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31708.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33538,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20824,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20824,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14550,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17615.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18849.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18144.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18496.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18672.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18496.78,"methodology":"case rate"}]}]},{"description":"HC MR CHEST","code_information":[{"code":"71550","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3526.74,"maximum":3526.74,"gross_charge":4354,"discounted_cash":1288.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3526.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3526.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3526.74,"methodology":"fee schedule"}]}]},{"description":"HC MR CHEST","code_information":[{"code":"71550","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3526.74,"gross_charge":4354,"discounted_cash":1288.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3526.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3526.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3526.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":835.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":661.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":547.95,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2612.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":870.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR CHESTW/CONTRAST","code_information":[{"code":"71551","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3071.52,"maximum":3071.52,"gross_charge":3792,"discounted_cash":1122.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3071.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3071.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3071.52,"methodology":"fee schedule"}]}]},{"description":"HC MR CHESTW/CONTRAST","code_information":[{"code":"71551","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":561,"maximum":3071.52,"gross_charge":3792,"discounted_cash":1122.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3071.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3071.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3071.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":935.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":740.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":605.09,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2275.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":758.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC MR CHEST WOW CONTRAST","code_information":[{"code":"71552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3792.42,"maximum":3792.42,"gross_charge":4682,"discounted_cash":1385.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3792.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3792.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3792.42,"methodology":"fee schedule"}]}]},{"description":"HC MR CHEST WOW CONTRAST","code_information":[{"code":"71552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":3792.42,"gross_charge":4682,"discounted_cash":1385.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3792.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3792.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3792.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1167.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":924.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":766.62,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2809.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":889.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MR CHEST W/WO LIMITED","code_information":[{"code":"71552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1896.21,"maximum":1896.21,"gross_charge":2341,"discounted_cash":692.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1896.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1896.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1896.21,"methodology":"fee schedule"}]}]},{"description":"MR CHEST W/WO LIMITED","code_information":[{"code":"71552","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2459,"gross_charge":2341,"discounted_cash":692.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1896.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1896.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1896.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1167.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":924.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":766.62,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1404.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"minimum":8080,"maximum":22007.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12758,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12061,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8080,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17944,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16824,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20906.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16937,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15016,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22007.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21078,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13087,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13087,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13168,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12226.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13082.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12593,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12837.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12959.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12837.53,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"minimum":9000,"maximum":27556,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16679,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15768,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10304,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25934,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24315,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25698.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19135,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22814,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19149,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27051.09,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27556,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17110,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17110,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9000,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15028.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16080.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15479.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15779.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15930.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15779.8,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"minimum":6680,"maximum":19840.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11074,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10469,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6680,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10283,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9641,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18848.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13717,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16354,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12414,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19840.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11359,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11359,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8336,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11022.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11793.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11353.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11573.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11683.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11573.47,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7201","type":"APR-DRG"}],"standard_charges":[{"minimum":4227,"maximum":4227,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4227,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4227,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4227,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7202","type":"APR-DRG"}],"standard_charges":[{"minimum":6205,"maximum":6205,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6205,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6205,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6205,"methodology":"case rate"}]}]},{"description":"HC XR SPINE 1 VIEW","code_information":[{"code":"72020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":260.82,"maximum":260.82,"gross_charge":322,"discounted_cash":95.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.82,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE 1 VIEW","code_information":[{"code":"72020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":24.68,"maximum":306,"gross_charge":322,"discounted_cash":95.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7203","type":"APR-DRG"}],"standard_charges":[{"minimum":10681,"maximum":10681,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10681,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10681,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10681,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA AND DISSEMINATED INFECTIONS","code_information":[{"code":"7204","type":"APR-DRG"}],"standard_charges":[{"minimum":22998,"maximum":22998,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22998,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22998,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22998,"methodology":"case rate"}]}]},{"description":"HC XR SPINECERVICAL 3/- VIEWS","code_information":[{"code":"72040","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":277.83,"maximum":277.83,"gross_charge":343,"discounted_cash":101.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":277.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":277.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":277.83,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINECERVICAL 3/- VIEWS","code_information":[{"code":"72040","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.83,"maximum":306,"gross_charge":343,"discounted_cash":101.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":277.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":277.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":277.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR SPINE CERVICAL 4/5 VIEWS","code_information":[{"code":"72050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":925.83,"maximum":925.83,"gross_charge":1143,"discounted_cash":338.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":925.83,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE CERVICAL 4/5 VIEWS","code_information":[{"code":"72050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":52.41,"maximum":925.83,"gross_charge":1143,"discounted_cash":338.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":925.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":73.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":81.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":70.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SPINE CERVICAL 6/+ VIEWS","code_information":[{"code":"72052","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1176.12,"maximum":1176.12,"gross_charge":1452,"discounted_cash":429.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1176.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1176.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1176.12,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE CERVICAL 6/+ VIEWS","code_information":[{"code":"72052","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":70.54,"maximum":1176.12,"gross_charge":1452,"discounted_cash":429.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1176.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1176.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1176.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"72072","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":380.7,"maximum":380.7,"gross_charge":470,"discounted_cash":139.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.7,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE THORACIC 3 VIEWS","code_information":[{"code":"72072","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.79,"maximum":380.7,"gross_charge":470,"discounted_cash":139.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"XR THORACIC SPINE 4 VIEWS MIN","code_information":[{"code":"72074","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":369.36,"maximum":369.36,"gross_charge":456,"discounted_cash":134.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":369.36,"methodology":"fee schedule"}]}]},{"description":"XR THORACIC SPINE 4 VIEWS MIN","code_information":[{"code":"72074","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":54.12,"maximum":369.36,"gross_charge":456,"discounted_cash":134.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SPINE THRCOLUMBAR 2 VW","code_information":[{"code":"72080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":417.96,"maximum":417.96,"gross_charge":516,"discounted_cash":152.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.96,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE THRCOLUMBAR 2 VW","code_information":[{"code":"72080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.39,"maximum":417.96,"gross_charge":516,"discounted_cash":152.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"XR SPINE SCOLIOSIS STUDY","code_information":[{"code":"72082","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":337.77,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"}]}]},{"description":"XR SPINE SCOLIOSIS STUDY","code_information":[{"code":"72082","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":62.55,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":91.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":72.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":102.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":113.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SPINE LUMBAR 2- 3 VIEWS","code_information":[{"code":"72100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":679.59,"maximum":679.59,"gross_charge":839,"discounted_cash":248.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":679.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.59,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE LUMBAR 2- 3 VIEWS","code_information":[{"code":"72100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.83,"maximum":679.59,"gross_charge":839,"discounted_cash":248.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":679.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7211","type":"APR-DRG"}],"standard_charges":[{"minimum":6235,"maximum":6235,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6235,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6235,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6235,"methodology":"case rate"}]}]},{"description":"HC XR SPINE LUMBAR 4-5 VIEW","code_information":[{"code":"72110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1501.74,"maximum":1501.74,"gross_charge":1854,"discounted_cash":548.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1501.74,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE LUMBAR 4-5 VIEW","code_information":[{"code":"72110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":53.56,"maximum":1501.74,"gross_charge":1854,"discounted_cash":548.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":53.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SPINE LUMBAR 7VW BENDING","code_information":[{"code":"72114","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":999.54,"maximum":999.54,"gross_charge":1234,"discounted_cash":365.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":999.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":999.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":999.54,"methodology":"fee schedule"}]}]},{"description":"HC XR SPINE LUMBAR 7VW BENDING","code_information":[{"code":"72114","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":76.19,"maximum":999.54,"gross_charge":1234,"discounted_cash":365.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":999.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":999.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":999.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":96.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7212","type":"APR-DRG"}],"standard_charges":[{"minimum":7503,"maximum":7503,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7503,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7503,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7503,"methodology":"case rate"}]}]},{"description":"HC SPINE FLEX EXT ONLY C T OR L","code_information":[{"code":"72120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":510.3,"maximum":510.3,"gross_charge":630,"discounted_cash":186.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":510.3,"methodology":"fee schedule"}]}]},{"description":"HC SPINE FLEX EXT ONLY C T OR L","code_information":[{"code":"72120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":46.18,"maximum":510.3,"gross_charge":630,"discounted_cash":186.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT SPINE CERVICAL WO CONTR","code_information":[{"code":"72125","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3196.26,"maximum":3196.26,"gross_charge":3946,"discounted_cash":1168.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3196.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3196.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3196.26,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE CERVICAL WO CONTR","code_information":[{"code":"72125","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":3196.26,"gross_charge":3946,"discounted_cash":1168.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3196.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3196.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3196.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":345.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":273.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":217.01,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2367.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":749.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":789.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT SPINE CERVICAL W CONTR","code_information":[{"code":"72126","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4186.89,"maximum":4186.89,"gross_charge":5169,"discounted_cash":1530.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4186.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4186.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4186.89,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE CERVICAL W CONTR","code_information":[{"code":"72126","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":272.4,"maximum":4186.89,"gross_charge":5169,"discounted_cash":1530.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4186.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4186.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4186.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":433.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":342.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":272.4,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3101.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":982.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1033.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CT SPINE CERVICAL WOW CONTR","code_information":[{"code":"72127","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4538.43,"maximum":4538.43,"gross_charge":5603,"discounted_cash":1658.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4538.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4538.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4538.43,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE CERVICAL WOW CONTR","code_information":[{"code":"72127","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":4538.43,"gross_charge":5603,"discounted_cash":1658.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4538.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4538.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4538.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":538.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":426.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":320.27,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3361.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1064.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":840.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT SPINE THORACIC WO CONTR","code_information":[{"code":"72128","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2905.47,"maximum":2905.47,"gross_charge":3587,"discounted_cash":1061.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2905.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2905.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2905.47,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE THORACIC WO CONTR","code_information":[{"code":"72128","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2905.47,"gross_charge":3587,"discounted_cash":1061.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2905.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2905.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2905.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":344.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":272.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":217.01,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2152.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":681.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT SPINE THORACIC W CONTR","code_information":[{"code":"72129","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3806.19,"maximum":3806.19,"gross_charge":4699,"discounted_cash":1390.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3806.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3806.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3806.19,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE THORACIC W CONTR","code_information":[{"code":"72129","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3806.19,"gross_charge":4699,"discounted_cash":1390.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3806.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3806.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3806.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":433.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":342.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":274.35,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2819.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":892.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":939.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":939.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7213","type":"APR-DRG"}],"standard_charges":[{"minimum":14498,"maximum":14498,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14498,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14498,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14498,"methodology":"case rate"}]}]},{"description":"HC CT SPINE THORACIC WOW CONTR","code_information":[{"code":"72130","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4126.14,"maximum":4126.14,"gross_charge":5094,"discounted_cash":1507.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4126.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4126.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4126.14,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE THORACIC WOW CONTR","code_information":[{"code":"72130","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":4126.14,"gross_charge":5094,"discounted_cash":1507.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4126.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4126.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4126.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":546.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":432.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":320.76,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3056.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":967.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1018.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1018.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT SPINE LUMBAR WO CONTR","code_information":[{"code":"72131","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2421.09,"maximum":2421.09,"gross_charge":2989,"discounted_cash":884.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2421.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2421.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2421.09,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE LUMBAR WO CONTR","code_information":[{"code":"72131","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2421.09,"gross_charge":2989,"discounted_cash":884.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2421.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2421.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2421.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":342.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":271.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":216.03,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1793.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":567.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT SPINE LUMBAR W CONTRAST","code_information":[{"code":"72132","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3171.15,"maximum":3171.15,"gross_charge":3915,"discounted_cash":1158.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3171.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3171.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3171.15,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE LUMBAR W CONTRAST","code_information":[{"code":"72132","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":272.9,"maximum":3171.15,"gross_charge":3915,"discounted_cash":1158.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3171.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3171.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3171.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":431.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":341.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":272.9,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2349,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CT SPINE LUMBAR WOW CONTR","code_information":[{"code":"72133","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":3437.64,"maximum":3437.64,"gross_charge":4244,"discounted_cash":1256.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3437.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3437.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3437.64,"methodology":"fee schedule"}]}]},{"description":"HC CT SPINE LUMBAR WOW CONTR","code_information":[{"code":"72133","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3437.64,"gross_charge":4244,"discounted_cash":1256.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3437.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3437.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3437.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":539.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":427.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":318.81,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2546.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":806.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"POST-OPERATIVE POST-TRAUMATIC OTHER DEVICE INFECTIONS","code_information":[{"code":"7214","type":"APR-DRG"}],"standard_charges":[{"minimum":26309,"maximum":26309,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26309,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26309,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26309,"methodology":"case rate"}]}]},{"description":"HC MR SPINE CERVICAL","code_information":[{"code":"72141","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4718.25,"maximum":4718.25,"gross_charge":5825,"discounted_cash":1724.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4718.25,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE CERVICAL","code_information":[{"code":"72141","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":4718.25,"gross_charge":5825,"discounted_cash":1724.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":409.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":324.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":303.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3495,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":873.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRIG LIMITED CERVICAL","code_information":[{"code":"72141","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":2359.53,"maximum":2359.53,"gross_charge":2913,"discounted_cash":862.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2359.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2359.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2359.53,"methodology":"fee schedule"}]}]},{"description":"HC MRIG LIMITED CERVICAL","code_information":[{"code":"72141","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2459,"gross_charge":2913,"discounted_cash":862.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2359.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2359.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2359.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":409.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":324.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":303.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":436.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR SPINE CERVICAL W CONTR","code_information":[{"code":"72142","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4718.25,"maximum":4718.25,"gross_charge":5825,"discounted_cash":1724.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4718.25,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE CERVICAL W CONTR","code_information":[{"code":"72142","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4718.25,"gross_charge":5825,"discounted_cash":1724.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4718.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":595.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":471.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":438.81,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3495,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1106.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":873.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR SPINE THORACIC","code_information":[{"code":"72146","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3872.61,"maximum":3872.61,"gross_charge":4781,"discounted_cash":1415.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3872.61,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE THORACIC","code_information":[{"code":"72146","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3872.61,"gross_charge":4781,"discounted_cash":1415.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":409.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":324.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":303.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2868.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRIG LIMITED THORACIC","code_information":[{"code":"72146","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":3872.61,"maximum":3872.61,"gross_charge":4781,"discounted_cash":1415.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3872.61,"methodology":"fee schedule"}]}]},{"description":"HC MRIG LIMITED THORACIC","code_information":[{"code":"72146","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3872.61,"gross_charge":4781,"discounted_cash":1415.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3872.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":409.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":324.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":303.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":908.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR SPINE THORACIC W CONTR","code_information":[{"code":"72147","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4289.76,"maximum":4289.76,"gross_charge":5296,"discounted_cash":1567.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4289.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4289.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4289.76,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE THORACIC W CONTR","code_information":[{"code":"72147","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4289.76,"gross_charge":5296,"discounted_cash":1567.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4289.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4289.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4289.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":465.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":435.9,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3177.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR SPINE LUMBAR","code_information":[{"code":"72148","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3893.67,"maximum":3893.67,"gross_charge":4807,"discounted_cash":1422.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3893.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3893.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3893.67,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE LUMBAR","code_information":[{"code":"72148","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3893.67,"gross_charge":4807,"discounted_cash":1422.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3893.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3893.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3893.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":409.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":324.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":303.54,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2884.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRIG LIMITED LUMBAR","code_information":[{"code":"72148","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":1947.24,"maximum":1947.24,"gross_charge":2404,"discounted_cash":711.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1947.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1947.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1947.24,"methodology":"fee schedule"}]}]},{"description":"HC MRIG LIMITED LUMBAR","code_information":[{"code":"72148","type":"CPT"},{"code":"0612","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2459,"gross_charge":2404,"discounted_cash":711.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1947.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1947.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1947.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":409.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":324.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":303.54,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":360.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":480.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR SPINE LUMBAR W CONTR","code_information":[{"code":"72149","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4283.28,"maximum":4283.28,"gross_charge":5288,"discounted_cash":1565.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4283.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4283.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4283.28,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE LUMBAR W CONTR","code_information":[{"code":"72149","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4283.28,"gross_charge":5288,"discounted_cash":1565.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4283.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4283.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4283.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":584.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":462.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":432.02,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3172.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":793.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1057.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR SPINE CERVL WOW CONTR","code_information":[{"code":"72156","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":7218.72,"maximum":7218.72,"gross_charge":8912,"discounted_cash":2637.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7218.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7218.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7218.72,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE CERVL WOW CONTR","code_information":[{"code":"72156","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":7218.72,"gross_charge":8912,"discounted_cash":2637.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7218.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7218.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7218.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":678.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":536.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":512.63,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5347.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1693.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1782.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1336.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1782.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR SPINE THOR WOW CONTR","code_information":[{"code":"72157","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":5957.55,"maximum":5957.55,"gross_charge":7355,"discounted_cash":2177.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5957.55,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE THOR WOW CONTR","code_information":[{"code":"72157","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":5957.55,"gross_charge":7355,"discounted_cash":2177.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":678.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":537.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":513.59,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4413,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1471,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1471,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR SPINE LUMBAR WOW CONTR","code_information":[{"code":"72158","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":5957.55,"maximum":5957.55,"gross_charge":7355,"discounted_cash":2177.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5957.55,"methodology":"fee schedule"}]}]},{"description":"HC MR SPINE LUMBAR WOW CONTR","code_information":[{"code":"72158","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":5957.55,"gross_charge":7355,"discounted_cash":2177.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5957.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":673.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":533.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":511.65,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4413,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1397.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1471,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1471,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC XR PELVIS 1-2VIEW","code_information":[{"code":"72170","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":221.13,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"}]}]},{"description":"HC XR PELVIS 1-2VIEW","code_information":[{"code":"72170","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":31.47,"maximum":306,"gross_charge":273,"discounted_cash":80.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR PELVIS 3VW/MORE","code_information":[{"code":"72190","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":515.16,"maximum":515.16,"gross_charge":636,"discounted_cash":188.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":515.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":515.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":515.16,"methodology":"fee schedule"}]}]},{"description":"HC XR PELVIS 3VW/MORE","code_information":[{"code":"72190","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":50.72,"maximum":515.16,"gross_charge":636,"discounted_cash":188.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":515.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":515.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":515.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CTA PELVIS WOW CONTR","code_information":[{"code":"72191","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2884.41,"maximum":2884.41,"gross_charge":3561,"discounted_cash":1054.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2884.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2884.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2884.41,"methodology":"fee schedule"}]}]},{"description":"HC CTA PELVIS WOW CONTR","code_information":[{"code":"72191","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2884.41,"gross_charge":3561,"discounted_cash":1054.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2884.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2884.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2884.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":724.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":573.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":448.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2136.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"72192","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1371.33,"maximum":1371.33,"gross_charge":1693,"discounted_cash":501.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1371.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1371.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1371.33,"methodology":"fee schedule"}]}]},{"description":"HC CT PELVIS WO CONTRAST","code_information":[{"code":"72192","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1467,"gross_charge":1693,"discounted_cash":501.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1371.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1371.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1371.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":235.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":186.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":203.42,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1015.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"72193","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1604.61,"maximum":1604.61,"gross_charge":1981,"discounted_cash":586.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1604.61,"methodology":"fee schedule"}]}]},{"description":"HC CT PELVIS W CONTRAST","code_information":[{"code":"72193","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":1604.61,"gross_charge":1981,"discounted_cash":586.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1604.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":430.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":335.9,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1188.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT PELVIS WOW CONTRAST","code_information":[{"code":"72194","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1988.55,"maximum":1988.55,"gross_charge":2455,"discounted_cash":726.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1988.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1988.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1988.55,"methodology":"fee schedule"}]}]},{"description":"HC CT PELVIS WOW CONTRAST","code_information":[{"code":"72194","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":1988.55,"gross_charge":2455,"discounted_cash":726.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1988.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1988.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1988.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":522.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":413.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":377.09,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1473,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":491,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":491,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC MR PELVIS","code_information":[{"code":"72195","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3802.95,"maximum":3802.95,"gross_charge":4695,"discounted_cash":1389.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3802.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3802.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3802.95,"methodology":"fee schedule"}]}]},{"description":"HC MR PELVIS","code_information":[{"code":"72195","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3802.95,"gross_charge":4695,"discounted_cash":1389.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3802.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3802.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3802.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":740.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":586.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":369.75,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2817,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":939,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":939,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRI SACRUM/COCCCYX LIMITED","code_information":[{"code":"72195","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1901.88,"maximum":1901.88,"gross_charge":2348,"discounted_cash":695.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.88,"methodology":"fee schedule"}]}]},{"description":"HC MRI SACRUM/COCCCYX LIMITED","code_information":[{"code":"72195","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2459,"gross_charge":2348,"discounted_cash":695.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":740.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":586.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":369.75,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1408.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR PELVIS W/CONTRAST","code_information":[{"code":"72196","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3565.62,"maximum":3565.62,"gross_charge":4402,"discounted_cash":1303,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3565.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3565.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3565.62,"methodology":"fee schedule"}]}]},{"description":"HC MR PELVIS W/CONTRAST","code_information":[{"code":"72196","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":3565.62,"gross_charge":4402,"discounted_cash":1303,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3565.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3565.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3565.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":820.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":649.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":431.75,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2641.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":836.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":660.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRI SACRUM/COCCCYX W CONTRAST LIMITED","code_information":[{"code":"72196","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1807.11,"maximum":1807.11,"gross_charge":2231,"discounted_cash":660.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.11,"methodology":"fee schedule"}]}]},{"description":"HC MRI SACRUM/COCCCYX W CONTRAST LIMITED","code_information":[{"code":"72196","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2459,"gross_charge":2231,"discounted_cash":660.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":820.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":649.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":431.75,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR PELVIS WOW CONTRAST","code_information":[{"code":"72197","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4753.89,"maximum":4753.89,"gross_charge":5869,"discounted_cash":1737.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4753.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4753.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4753.89,"methodology":"fee schedule"}]}]},{"description":"HC MR PELVIS WOW CONTRAST","code_information":[{"code":"72197","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4753.89,"gross_charge":5869,"discounted_cash":1737.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4753.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4753.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4753.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":986.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":543.62,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3521.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1115.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRI SACRUM/COCCCYX W/O W/CONT LIMITED","code_information":[{"code":"72197","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2377.35,"maximum":2377.35,"gross_charge":2935,"discounted_cash":868.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2377.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2377.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2377.35,"methodology":"fee schedule"}]}]},{"description":"HC MRI SACRUM/COCCCYX W/O W/CONT LIMITED","code_information":[{"code":"72197","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2459,"gross_charge":2935,"discounted_cash":868.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2377.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2377.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2377.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":986.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":543.62,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1761,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":587,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":587,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"minimum":10651,"maximum":29271,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15541,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14692,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10651,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29271,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27444,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24307.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18350,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21878,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19794,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25587.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25676,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15942,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15942,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11615,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14215.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15210.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14641.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14925.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15068.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14925.86,"methodology":"case rate"}]}]},{"description":"HC XR SACROILIAC JNT 3VW/MORE","code_information":[{"code":"72202","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":439.83,"maximum":439.83,"gross_charge":543,"discounted_cash":160.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.83,"methodology":"fee schedule"}]}]},{"description":"HC XR SACROILIAC JNT 3VW/MORE","code_information":[{"code":"72202","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.1,"maximum":439.83,"gross_charge":543,"discounted_cash":160.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7221","type":"APR-DRG"}],"standard_charges":[{"minimum":2963,"maximum":2963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2963,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2963,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2963,"methodology":"case rate"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7222","type":"APR-DRG"}],"standard_charges":[{"minimum":4292,"maximum":4292,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"}]}]},{"description":"HC XR SACRUM&COCCYX 2VW/MORE","code_information":[{"code":"72220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":602.64,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"}]}]},{"description":"HC XR SACRUM&COCCYX 2VW/MORE","code_information":[{"code":"72220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7223","type":"APR-DRG"}],"standard_charges":[{"minimum":5072,"maximum":5072,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5072,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5072,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5072,"methodology":"case rate"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"7224","type":"APR-DRG"}],"standard_charges":[{"minimum":6831,"maximum":6831,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6831,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6831,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6831,"methodology":"case rate"}]}]},{"description":"HC XR MYELOGRAPHY 2+REGIONS","code_information":[{"code":"72270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1840.32,"maximum":1840.32,"gross_charge":2272,"discounted_cash":672.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1840.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1840.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1840.32,"methodology":"fee schedule"}]}]},{"description":"HC XR MYELOGRAPHY 2+REGIONS","code_information":[{"code":"72270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":148.54,"maximum":1840.32,"gross_charge":2272,"discounted_cash":672.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1840.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1840.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1840.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":263.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":148.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":165.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":200.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC XR DISCOGRAM LUMBAR","code_information":[{"code":"72295","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1722.87,"maximum":1722.87,"gross_charge":2127,"discounted_cash":629.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1722.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1722.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1722.87,"methodology":"fee schedule"}]}]},{"description":"HC XR DISCOGRAM LUMBAR","code_information":[{"code":"72295","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":89.78,"maximum":4275.26,"gross_charge":2127,"discounted_cash":629.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1722.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1722.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1722.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4275.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2817.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":89.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2985.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":128.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":143.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1745.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1868.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1798.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1833.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1920.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1850.6,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM WITH CC","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"minimum":4853,"maximum":24196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10094,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9542,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6331,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24196,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22686,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17650.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12456,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14851,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11765,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18579.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16676,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10354,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10354,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4853,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10322.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11044.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10631.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10838.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10941.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10838.24,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7231","type":"APR-DRG"}],"standard_charges":[{"minimum":2551,"maximum":2551,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2551,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2551,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2551,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7232","type":"APR-DRG"}],"standard_charges":[{"minimum":4762,"maximum":4762,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4762,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4762,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4762,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7233","type":"APR-DRG"}],"standard_charges":[{"minimum":5300,"maximum":5300,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5300,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5300,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5300,"methodology":"case rate"}]}]},{"description":"VIRAL ILLNESS","code_information":[{"code":"7234","type":"APR-DRG"}],"standard_charges":[{"minimum":11455,"maximum":11455,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11455,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11455,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11455,"methodology":"case rate"}]}]},{"description":"MALIGNANCY MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"minimum":4599,"maximum":17469,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6549,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6192,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4599,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17469,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16378,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13319.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8270,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9860,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8547,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14020.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10820,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6718,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6718,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4853,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7789.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8334.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8022.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8178.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8256.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8178.59,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7241","type":"APR-DRG"}],"standard_charges":[{"minimum":4655,"maximum":4655,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4655,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7242","type":"APR-DRG"}],"standard_charges":[{"minimum":4828,"maximum":4828,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4828,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7243","type":"APR-DRG"}],"standard_charges":[{"minimum":10706,"maximum":10706,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10706,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10706,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10706,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES","code_information":[{"code":"7244","type":"APR-DRG"}],"standard_charges":[{"minimum":14417,"maximum":14417,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14417,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14417,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14417,"methodology":"case rate"}]}]},{"description":"BENIGN PROSTATIC HYPERTROPHY WITH MCC","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"minimum":4723,"maximum":20195.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11349,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10730,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7050,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16804,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15755,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19185.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13504,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16100,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13101,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20195.23,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18751,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11642,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11642,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4723,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11219.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12004.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11556.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11780.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11892.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11780.55,"methodology":"case rate"}]}]},{"description":"BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"minimum":3389,"maximum":14203.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6691,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6326,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4152,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8457,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7929,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13492.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8340,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9944,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7717,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14203.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6864,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6864,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3389,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7890.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8442.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8127.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8285.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8364.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8285.17,"methodology":"case rate"}]}]},{"description":"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"minimum":5502,"maximum":22586.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13208,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12487,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9209,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10229,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9591,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21457.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15530,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18516,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17115,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22586.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21822,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13549,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13549,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5502,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12548.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13426.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12924.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13175.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13300.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13175.47,"methodology":"case rate"}]}]},{"description":"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":4546,"maximum":15043.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7345,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6944,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4546,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7352,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6893,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14291.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8882,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10589,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8447,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15043.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7534,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7534,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4945,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8357.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8942.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8608.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8775.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8859.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8775.55,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"minimum":5138,"maximum":18325.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9896,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9355,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5704,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12449,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11672,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17409.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11650,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13890,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10599,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18325.44,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16350,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10151,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10151,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5138,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10180.8,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10893.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10486.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10689.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10791.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10689.84,"methodology":"case rate"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"minimum":3218,"maximum":12613.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5455,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5157,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3532,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12440,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11664,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11982.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7089,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8451,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6563,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12613.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9013,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5596,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5596,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3218,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7007.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7497.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7217.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7357.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7427.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7357.69,"methodology":"case rate"}]}]},{"description":"HC XR CLAVICLE COMPLETE","code_information":[{"code":"73000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":676.35,"maximum":676.35,"gross_charge":835,"discounted_cash":247.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":676.35,"methodology":"fee schedule"}]}]},{"description":"HC XR CLAVICLE COMPLETE","code_information":[{"code":"73000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.18,"maximum":676.35,"gross_charge":835,"discounted_cash":247.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"73010","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":404.19,"maximum":404.19,"gross_charge":499,"discounted_cash":147.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":404.19,"methodology":"fee schedule"}]}]},{"description":"HC XR SCAPULA COMPLETE","code_information":[{"code":"73010","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.99,"maximum":404.19,"gross_charge":499,"discounted_cash":147.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR SHOULDER 1 VIEW UNILT","code_information":[{"code":"73020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":566.19,"maximum":566.19,"gross_charge":699,"discounted_cash":206.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":566.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":566.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":566.19,"methodology":"fee schedule"}]}]},{"description":"HC XR SHOULDER 1 VIEW UNILT","code_information":[{"code":"73020","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":25.8,"maximum":566.19,"gross_charge":699,"discounted_cash":206.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":566.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":566.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":566.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS","code_information":[{"code":"73030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":735.48,"maximum":735.48,"gross_charge":908,"discounted_cash":268.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":735.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":735.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":735.48,"methodology":"fee schedule"}]}]},{"description":"HC RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS","code_information":[{"code":"73030","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":33.74,"maximum":735.48,"gross_charge":908,"discounted_cash":268.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":735.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":735.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":735.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR ACRIOCLAVICLAR JNT BILAT","code_information":[{"code":"73050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":468.18,"maximum":468.18,"gross_charge":578,"discounted_cash":171.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":468.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":468.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":468.18,"methodology":"fee schedule"}]}]},{"description":"HC XR ACRIOCLAVICLAR JNT BILAT","code_information":[{"code":"73050","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.14,"maximum":468.18,"gross_charge":578,"discounted_cash":171.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":468.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":468.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":468.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"73060","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":546.75,"maximum":546.75,"gross_charge":675,"discounted_cash":199.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":546.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":546.75,"methodology":"fee schedule"}]}]},{"description":"HC XR HUMERUS MIN 2 VIEWS","code_information":[{"code":"73060","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":546.75,"gross_charge":675,"discounted_cash":199.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":546.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":546.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":546.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":135,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":135,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":281.88,"maximum":281.88,"gross_charge":348,"discounted_cash":103.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.88,"methodology":"fee schedule"}]}]},{"description":"HC XR ELBOW 2 VIEWS","code_information":[{"code":"73070","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":306,"gross_charge":348,"discounted_cash":103.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC ELBOW UNILATERAL","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":531.36,"maximum":531.36,"gross_charge":656,"discounted_cash":194.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":531.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.36,"methodology":"fee schedule"}]}]},{"description":"HC ELBOW UNILATERAL","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.97,"maximum":531.36,"gross_charge":656,"discounted_cash":194.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":531.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR ELBOW MIN 3 VIEWS","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":797.04,"maximum":797.04,"gross_charge":984,"discounted_cash":291.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.04,"methodology":"fee schedule"}]}]},{"description":"HC XR ELBOW MIN 3 VIEWS","code_information":[{"code":"73080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.97,"maximum":797.04,"gross_charge":984,"discounted_cash":291.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":642.33,"maximum":642.33,"gross_charge":793,"discounted_cash":234.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":642.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":642.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":642.33,"methodology":"fee schedule"}]}]},{"description":"HC XR FOREARM 2 VIEWS","code_information":[{"code":"73090","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":31.47,"maximum":642.33,"gross_charge":793,"discounted_cash":234.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":642.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":642.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":642.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR UPPR EXTRM INFANT MIN 2V","code_information":[{"code":"73092","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC XR UPPR EXTRM INFANT MIN 2V","code_information":[{"code":"73092","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":27.75,"maximum":306,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":289.98,"maximum":289.98,"gross_charge":358,"discounted_cash":105.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.98,"methodology":"fee schedule"}]}]},{"description":"HC XR WRIST 2 VIEWS","code_information":[{"code":"73100","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.99,"maximum":306,"gross_charge":358,"discounted_cash":105.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC WRIST- MIN 3 VIEWS UNILATERAL","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":877.23,"maximum":877.23,"gross_charge":1083,"discounted_cash":320.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":877.23,"methodology":"fee schedule"}]}]},{"description":"HC WRIST- MIN 3 VIEWS UNILATERAL","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":46.76,"maximum":877.23,"gross_charge":1083,"discounted_cash":320.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR WRIST 3VW/MORE UNILAT","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":588.06,"maximum":588.06,"gross_charge":726,"discounted_cash":214.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":588.06,"methodology":"fee schedule"}]}]},{"description":"HC XR WRIST 3VW/MORE UNILAT","code_information":[{"code":"73110","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":46.76,"maximum":588.06,"gross_charge":726,"discounted_cash":214.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":151.47,"maximum":151.47,"gross_charge":187,"discounted_cash":55.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.47,"methodology":"fee schedule"}]}]},{"description":"HC XR HAND 2 VIEWS","code_information":[{"code":"73120","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":28.05,"maximum":306,"gross_charge":187,"discounted_cash":55.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR HAND 3 VIEWS","code_information":[{"code":"73130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":581.58,"maximum":581.58,"gross_charge":718,"discounted_cash":212.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":581.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":581.58,"methodology":"fee schedule"}]}]},{"description":"HC XR HAND 3 VIEWS","code_information":[{"code":"73130","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.83,"maximum":581.58,"gross_charge":718,"discounted_cash":212.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":581.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":581.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC FINGER UNILATERAL","code_information":[{"code":"73140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":562.14,"maximum":562.14,"gross_charge":694,"discounted_cash":205.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":562.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":562.14,"methodology":"fee schedule"}]}]},{"description":"HC FINGER UNILATERAL","code_information":[{"code":"73140","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.22,"maximum":562.14,"gross_charge":694,"discounted_cash":205.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":562.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":562.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC CT UPPER EXTREM WO CONTR","code_information":[{"code":"73200","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1901.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"}]}]},{"description":"HC CT UPPER EXTREM WO CONTR","code_information":[{"code":"73200","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":341.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":248.57,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1408.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC EXTREMITY UPPER W/O CONT UNI","code_information":[{"code":"73200","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1901.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"}]}]},{"description":"HC EXTREMITY UPPER W/O CONT UNI","code_information":[{"code":"73200","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":341.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":248.57,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1408.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT UPPER EXTREM W CONTR","code_information":[{"code":"73201","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2813.13,"maximum":2813.13,"gross_charge":3473,"discounted_cash":1028.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2813.13,"methodology":"fee schedule"}]}]},{"description":"HC CT UPPER EXTREM W CONTR","code_information":[{"code":"73201","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":302,"maximum":2813.13,"gross_charge":3473,"discounted_cash":1028.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":426.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":337.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":309.18,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2083.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CT UPPER EXTREM WOW CONTR","code_information":[{"code":"73202","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2813.13,"maximum":2813.13,"gross_charge":3473,"discounted_cash":1028.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2813.13,"methodology":"fee schedule"}]}]},{"description":"HC CT UPPER EXTREM WOW CONTR","code_information":[{"code":"73202","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2813.13,"gross_charge":3473,"discounted_cash":1028.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2813.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":576.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":456.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":384.86,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2083.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CTA UPPER EXTREM WOW CONTR","code_information":[{"code":"73206","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2120.58,"maximum":2120.58,"gross_charge":2618,"discounted_cash":774.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2120.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2120.58,"methodology":"fee schedule"}]}]},{"description":"HC CTA UPPER EXTREM WOW CONTR","code_information":[{"code":"73206","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2120.58,"gross_charge":2618,"discounted_cash":774.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2120.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2120.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2120.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":473.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":456.26,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CTA UPPER EXTREMITY BILAT","code_information":[{"code":"73206","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":3180.87,"maximum":3180.87,"gross_charge":3927,"discounted_cash":1162.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3180.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3180.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3180.87,"methodology":"fee schedule"}]}]},{"description":"HC CTA UPPER EXTREMITY BILAT","code_information":[{"code":"73206","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":3180.87,"gross_charge":3927,"discounted_cash":1162.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3180.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3180.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3180.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":597.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":473.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":456.26,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2356.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC MR UPPER EXTREM WO CONTR","code_information":[{"code":"73218","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3312.09,"maximum":3312.09,"gross_charge":4089,"discounted_cash":1210.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3312.09,"methodology":"fee schedule"}]}]},{"description":"HC MR UPPER EXTREM WO CONTR","code_information":[{"code":"73218","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3312.09,"gross_charge":4089,"discounted_cash":1210.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3312.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":729.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":578.02,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":488.04,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2453.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":817.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":817.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR UPPER EXTREM WOW CONTR","code_information":[{"code":"73220","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4371.57,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"}]}]},{"description":"HC MR UPPER EXTREM WOW CONTR","code_information":[{"code":"73220","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":986.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":664.04,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3238.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MRI BRACHIAL PLEXUS","code_information":[{"code":"73220","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4139.91,"maximum":4139.91,"gross_charge":5111,"discounted_cash":1512.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4139.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4139.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4139.91,"methodology":"fee schedule"}]}]},{"description":"MRI BRACHIAL PLEXUS","code_information":[{"code":"73220","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4139.91,"gross_charge":5111,"discounted_cash":1512.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4139.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4139.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4139.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":986.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":664.04,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3066.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":971.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":766.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR UPPER EXTREM JNT WO CONT","code_information":[{"code":"73221","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2619.54,"maximum":2619.54,"gross_charge":3234,"discounted_cash":957.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2619.54,"methodology":"fee schedule"}]}]},{"description":"HC MR UPPER EXTREM JNT WO CONT","code_information":[{"code":"73221","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2619.54,"gross_charge":3234,"discounted_cash":957.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":451.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":357.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.61,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1940.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR UPPER EXTREM JNT W CONT","code_information":[{"code":"73222","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3877.47,"maximum":3877.47,"gross_charge":4787,"discounted_cash":1416.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3877.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3877.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3877.47,"methodology":"fee schedule"}]}]},{"description":"HC MR UPPER EXTREM JNT W CONT","code_information":[{"code":"73222","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":506.39,"maximum":3877.47,"gross_charge":4787,"discounted_cash":1416.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3877.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3877.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3877.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":750.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":594.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":506.39,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2872.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC MR UPPER EXTREM JNT WOW CON","code_information":[{"code":"73223","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4270.32,"maximum":4270.32,"gross_charge":5272,"discounted_cash":1560.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4270.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4270.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4270.32,"methodology":"fee schedule"}]}]},{"description":"HC MR UPPER EXTREM JNT WOW CON","code_information":[{"code":"73223","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4270.32,"gross_charge":5272,"discounted_cash":1560.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4270.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4270.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4270.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":915.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":724.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":627.35,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3163.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1054.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":790.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1054.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"minimum":11318,"maximum":31229,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18902,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17870,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12349,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25641,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24040,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28415.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23620,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28161,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22949,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29910.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31229,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19390,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19390,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11318,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16617.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17780.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17115.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17447.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17614.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17447.91,"methodology":"case rate"}]}]},{"description":"PELVIC EVISCERATION RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"minimum":7160,"maximum":20909,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10912,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10316,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7160,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20909,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19603,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18650.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13751,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16395,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13305,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19632.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18028,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11193,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11193,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7492,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10906.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11670.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11233.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11452.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11561.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11452.06,"methodology":"case rate"}]}]},{"description":"HC HIP 1 VIEW UNILATERAL","code_information":[{"code":"73501","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC HIP 1 VIEW UNILATERAL","code_information":[{"code":"73501","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":31.45,"maximum":306,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR HIP UNI 2-3 VWS","code_information":[{"code":"73502","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":217.89,"maximum":217.89,"gross_charge":269,"discounted_cash":79.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.89,"methodology":"fee schedule"}]}]},{"description":"HC XR HIP UNI 2-3 VWS","code_information":[{"code":"73502","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":40.35,"maximum":306,"gross_charge":269,"discounted_cash":79.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR HIP BILAT 2 VWS","code_information":[{"code":"73521","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":298.08,"maximum":298.08,"gross_charge":368,"discounted_cash":108.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.08,"methodology":"fee schedule"}]}]},{"description":"HC XR HIP BILAT 2 VWS","code_information":[{"code":"73521","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.89,"maximum":306,"gross_charge":368,"discounted_cash":108.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR HIP BILAT 3-4 VWS","code_information":[{"code":"73522","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":891.81,"maximum":891.81,"gross_charge":1101,"discounted_cash":325.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891.81,"methodology":"fee schedule"}]}]},{"description":"HC XR HIP BILAT 3-4 VWS","code_information":[{"code":"73522","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":52.96,"maximum":891.81,"gross_charge":1101,"discounted_cash":325.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":82.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC FEMUR BILATERAL","code_information":[{"code":"73552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":272.16,"maximum":272.16,"gross_charge":336,"discounted_cash":99.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.16,"methodology":"fee schedule"}]}]},{"description":"HC FEMUR BILATERAL","code_information":[{"code":"73552","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":35.97,"maximum":306,"gross_charge":336,"discounted_cash":99.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC KNEE BILATERAL","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":726.57,"maximum":726.57,"gross_charge":897,"discounted_cash":265.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":726.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":726.57,"methodology":"fee schedule"}]}]},{"description":"HC KNEE BILATERAL","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.3,"maximum":726.57,"gross_charge":897,"discounted_cash":265.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":726.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":726.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR KNEE 1 OR 2 VIEWS","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":484.38,"maximum":484.38,"gross_charge":598,"discounted_cash":177.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":484.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":484.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":484.38,"methodology":"fee schedule"}]}]},{"description":"HC XR KNEE 1 OR 2 VIEWS","code_information":[{"code":"73560","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.3,"maximum":484.38,"gross_charge":598,"discounted_cash":177.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":484.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":484.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":484.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC PATELLA 3 VIEW UNILATERAL","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":334.53,"maximum":334.53,"gross_charge":413,"discounted_cash":122.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.53,"methodology":"fee schedule"}]}]},{"description":"HC PATELLA 3 VIEW UNILATERAL","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":43.93,"maximum":334.53,"gross_charge":413,"discounted_cash":122.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC XR KNEE 3 VIEWS","code_information":[{"code":"73562","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":306,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC KNEE 4 VIEW BIL","code_information":[{"code":"73564","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":334.53,"maximum":334.53,"gross_charge":413,"discounted_cash":122.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.53,"methodology":"fee schedule"}]}]},{"description":"HC KNEE 4 VIEW BIL","code_information":[{"code":"73564","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":50.72,"maximum":334.53,"gross_charge":413,"discounted_cash":122.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR KNEE STANDING AP","code_information":[{"code":"73565","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":774.36,"maximum":774.36,"gross_charge":956,"discounted_cash":282.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":774.36,"methodology":"fee schedule"}]}]},{"description":"HC XR KNEE STANDING AP","code_information":[{"code":"73565","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.66,"maximum":774.36,"gross_charge":956,"discounted_cash":282.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":774.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR LEG TIBIA & FIBULA 2 VWS","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":621.27,"maximum":621.27,"gross_charge":767,"discounted_cash":227.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":621.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":621.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":621.27,"methodology":"fee schedule"}]}]},{"description":"HC XR LEG TIBIA & FIBULA 2 VWS","code_information":[{"code":"73590","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":30.34,"maximum":621.27,"gross_charge":767,"discounted_cash":227.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":621.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":621.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":621.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR LWR EXTREM INFNT MIN 2VWS","code_information":[{"code":"73592","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":323.19,"maximum":323.19,"gross_charge":399,"discounted_cash":118.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.19,"methodology":"fee schedule"}]}]},{"description":"HC XR LWR EXTREM INFNT MIN 2VWS","code_information":[{"code":"73592","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":323.19,"gross_charge":399,"discounted_cash":118.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"minimum":16930,"maximum":58478,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35395,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33462,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22084,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39507,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37041,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48570.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46103,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54966,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41041,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":51126.97,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58478,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36309,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36309,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16930,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28403.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30392.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29255.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29824.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30108.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29824.07,"methodology":"case rate"}]}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":493.29,"maximum":493.29,"gross_charge":609,"discounted_cash":180.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"}]}]},{"description":"HC XR ANKLE 2 VIEWS","code_information":[{"code":"73600","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":493.29,"gross_charge":609,"discounted_cash":180.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC ANKLE 3 VIEWS","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":456.84,"maximum":456.84,"gross_charge":564,"discounted_cash":166.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.84,"methodology":"fee schedule"}]}]},{"description":"HC ANKLE 3 VIEWS","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.97,"maximum":456.84,"gross_charge":564,"discounted_cash":166.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR ANKLE MIN 3 VIEWS","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":685.26,"maximum":685.26,"gross_charge":846,"discounted_cash":250.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":685.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":685.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":685.26,"methodology":"fee schedule"}]}]},{"description":"HC XR ANKLE MIN 3 VIEWS","code_information":[{"code":"73610","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":39.97,"maximum":685.26,"gross_charge":846,"discounted_cash":250.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":685.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":685.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":685.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":496.53,"maximum":496.53,"gross_charge":613,"discounted_cash":181.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":496.53,"methodology":"fee schedule"}]}]},{"description":"HC XR FOOT 2 VIEWS","code_information":[{"code":"73620","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":31.47,"maximum":496.53,"gross_charge":613,"discounted_cash":181.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC FOOT 3 VIEWS","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":516.78,"maximum":516.78,"gross_charge":638,"discounted_cash":188.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":516.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":516.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":516.78,"methodology":"fee schedule"}]}]},{"description":"HC FOOT 3 VIEWS","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":37.14,"maximum":516.78,"gross_charge":638,"discounted_cash":188.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":516.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":516.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":516.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":775.17,"maximum":775.17,"gross_charge":957,"discounted_cash":283.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":775.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":775.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":775.17,"methodology":"fee schedule"}]}]},{"description":"HC XR FOOT MIN 3 VIEWS","code_information":[{"code":"73630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":37.14,"maximum":775.17,"gross_charge":957,"discounted_cash":283.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":775.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":775.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":775.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC OSCALCIS 2 VIEWS BILAT","code_information":[{"code":"73650","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":421.2,"maximum":421.2,"gross_charge":520,"discounted_cash":153.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.2,"methodology":"fee schedule"}]}]},{"description":"HC OSCALCIS 2 VIEWS BILAT","code_information":[{"code":"73650","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":421.2,"gross_charge":520,"discounted_cash":153.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"73660","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":429.3,"maximum":429.3,"gross_charge":530,"discounted_cash":156.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.3,"methodology":"fee schedule"}]}]},{"description":"HC XR TOE(S) MIN 2 VIEWS","code_information":[{"code":"73660","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":38.26,"maximum":429.3,"gross_charge":530,"discounted_cash":156.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"minimum":9486,"maximum":29678,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17964,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16982,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11214,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23699,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22220,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27268.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21872,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26077,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20839,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28703.49,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29678,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18427,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18427,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9486,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15946.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17062.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16424.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16743.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16903.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16743.7,"methodology":"case rate"}]}]},{"description":"HC CT LOWER EXTREM WO CONTR","code_information":[{"code":"73700","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1901.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"}]}]},{"description":"HC CT LOWER EXTREM WO CONTR","code_information":[{"code":"73700","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":341.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":216.03,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1408.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC EXTREMITY LWR W/O CONT BIL","code_information":[{"code":"73700","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":1901.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"}]}]},{"description":"HC EXTREMITY LWR W/O CONT BIL","code_information":[{"code":"73700","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1901.07,"gross_charge":2347,"discounted_cash":694.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1901.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":341.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":270.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":216.03,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1408.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT LOWER EXTREM W CONTR","code_information":[{"code":"73701","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2718.36,"maximum":2718.36,"gross_charge":3356,"discounted_cash":993.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2718.36,"methodology":"fee schedule"}]}]},{"description":"HC CT LOWER EXTREM W CONTR","code_information":[{"code":"73701","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2718.36,"gross_charge":3356,"discounted_cash":993.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":433.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":342.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":269.85,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2013.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC EXTREMITY LWR W/CONT BIL","code_information":[{"code":"73701","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2718.36,"maximum":2718.36,"gross_charge":3356,"discounted_cash":993.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2718.36,"methodology":"fee schedule"}]}]},{"description":"HC EXTREMITY LWR W/CONT BIL","code_information":[{"code":"73701","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2718.36,"gross_charge":3356,"discounted_cash":993.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2718.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":433.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":342.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":269.85,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2013.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT LOWER EXTREM WOW CONTR","code_information":[{"code":"73702","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2451.87,"maximum":2451.87,"gross_charge":3027,"discounted_cash":896,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2451.87,"methodology":"fee schedule"}]}]},{"description":"HC CT LOWER EXTREM WOW CONTR","code_information":[{"code":"73702","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2451.87,"gross_charge":3027,"discounted_cash":896,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":451.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1816.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC EXTREMITY LWR W/WO CONT BIL","code_information":[{"code":"73702","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2451.87,"maximum":2451.87,"gross_charge":3027,"discounted_cash":896,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2451.87,"methodology":"fee schedule"}]}]},{"description":"HC EXTREMITY LWR W/WO CONT BIL","code_information":[{"code":"73702","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2451.87,"gross_charge":3027,"discounted_cash":896,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2451.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":570.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":451.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1816.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CTA LOWER EXTREM WOW CONT","code_information":[{"code":"73706","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2113.29,"maximum":2113.29,"gross_charge":2609,"discounted_cash":772.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2113.29,"methodology":"fee schedule"}]}]},{"description":"HC CTA LOWER EXTREM WOW CONT","code_information":[{"code":"73706","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2113.29,"gross_charge":2609,"discounted_cash":772.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":535.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":493.67,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1565.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CTA LOWER EXTREMITY BILAT","code_information":[{"code":"73706","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":2113.29,"maximum":2113.29,"gross_charge":2609,"discounted_cash":772.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2113.29,"methodology":"fee schedule"}]}]},{"description":"HC CTA LOWER EXTREMITY BILAT","code_information":[{"code":"73706","type":"CPT"},{"code":"0352","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2113.29,"gross_charge":2609,"discounted_cash":772.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2113.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":676.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":535.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":493.67,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1565.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC MR LOWER EXTREM WO CONTR","code_information":[{"code":"73718","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3619.08,"maximum":3619.08,"gross_charge":4468,"discounted_cash":1322.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3619.08,"methodology":"fee schedule"}]}]},{"description":"HC MR LOWER EXTREM WO CONTR","code_information":[{"code":"73718","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3619.08,"gross_charge":4468,"discounted_cash":1322.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":729.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":578.02,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":357.9,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2680.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR LOWER EXTREM W CONTR","code_information":[{"code":"73719","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3619.08,"maximum":3619.08,"gross_charge":4468,"discounted_cash":1322.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3619.08,"methodology":"fee schedule"}]}]},{"description":"HC MR LOWER EXTREM W CONTR","code_information":[{"code":"73719","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":3619.08,"gross_charge":4468,"discounted_cash":1322.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3619.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":821.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":650.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":423.36,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2680.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR LOWER EXTREM WOW CONTR","code_information":[{"code":"73720","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4761.18,"maximum":4761.18,"gross_charge":5878,"discounted_cash":1739.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4761.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4761.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4761.18,"methodology":"fee schedule"}]}]},{"description":"HC MR LOWER EXTREM WOW CONTR","code_information":[{"code":"73720","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4761.18,"gross_charge":5878,"discounted_cash":1739.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4761.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4761.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4761.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":993.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":787.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":542.85,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3526.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1116.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR LOWER EXTREM JNT WO CONT","code_information":[{"code":"73721","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2259.9,"maximum":2259.9,"gross_charge":2790,"discounted_cash":825.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2259.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2259.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2259.9,"methodology":"fee schedule"}]}]},{"description":"HC MR LOWER EXTREM JNT WO CONT","code_information":[{"code":"73721","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2459,"gross_charge":2790,"discounted_cash":825.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2259.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2259.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2259.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":452.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":358.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":318.57,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1674,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":558,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":558,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR LOWER EXTREM JNT W CONTR","code_information":[{"code":"73722","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3954.42,"maximum":3954.42,"gross_charge":4882,"discounted_cash":1445.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3954.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3954.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3954.42,"methodology":"fee schedule"}]}]},{"description":"HC MR LOWER EXTREM JNT W CONTR","code_information":[{"code":"73722","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":507.36,"maximum":3954.42,"gross_charge":4882,"discounted_cash":1445.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3954.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3954.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3954.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":762.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":604.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":507.36,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2929.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":976.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":976.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC MR LOWER EXTREM JNT WOW CON","code_information":[{"code":"73723","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":5513.67,"maximum":5513.67,"gross_charge":6807,"discounted_cash":2014.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5513.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5513.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5513.67,"methodology":"fee schedule"}]}]},{"description":"HC MR LOWER EXTREM JNT WOW CON","code_information":[{"code":"73723","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":5513.67,"gross_charge":6807,"discounted_cash":2014.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5513.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5513.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5513.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":918.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":727.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":626.37,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4084.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1293.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1361.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1361.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"minimum":7140,"maximum":23135.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13635,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12891,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7753,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15452,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14487,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21978.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15174,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18091,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14407,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23135.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22528,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13987,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13987,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7140,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12853.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13752.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13238.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13495.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13624.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13495.86,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"minimum":15230,"maximum":59121,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35784,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33830,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20545,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24970,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23411,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49046.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42180,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50289,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38181,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":51627.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59121,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36708,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36708,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15230,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28682.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30689.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29542.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30116.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30402.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30116.15,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"minimum":10153,"maximum":27004,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16345,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15452,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10153,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16126,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15120,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25289.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19482,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23228,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18867,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26620.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27004,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16767,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10668,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14789.41,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15824.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15233.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15528.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15676.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15528.89,"methodology":"case rate"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7401","type":"APR-DRG"}],"standard_charges":[{"minimum":7010,"maximum":7010,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7010,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7010,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7010,"methodology":"case rate"}]}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"74018","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":616.41,"maximum":616.41,"gross_charge":761,"discounted_cash":225.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":616.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":616.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":616.41,"methodology":"fee schedule"}]}]},{"description":"HC XR ABDOMEN 1 VIEW","code_information":[{"code":"74018","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":28.88,"maximum":616.41,"gross_charge":761,"discounted_cash":225.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":616.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":616.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":616.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"74019","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":702.27,"maximum":702.27,"gross_charge":867,"discounted_cash":256.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":702.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":702.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":702.27,"methodology":"fee schedule"}]}]},{"description":"HC XR ABDOMEN 2 VIEWS","code_information":[{"code":"74019","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":34.58,"maximum":702.27,"gross_charge":867,"discounted_cash":256.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":702.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":702.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":702.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7402","type":"APR-DRG"}],"standard_charges":[{"minimum":7010,"maximum":7010,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7010,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7010,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7010,"methodology":"case rate"}]}]},{"description":"HC XR ABDOMEN+CHEST ACUTE","code_information":[{"code":"74022","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":733.05,"maximum":733.05,"gross_charge":905,"discounted_cash":267.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":733.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":733.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":733.05,"methodology":"fee schedule"}]}]},{"description":"HC XR ABDOMEN+CHEST ACUTE","code_information":[{"code":"74022","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":53.56,"maximum":733.05,"gross_charge":905,"discounted_cash":267.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":733.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":733.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":733.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":53.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":181,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":181,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7403","type":"APR-DRG"}],"standard_charges":[{"minimum":17747,"maximum":17747,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17747,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17747,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17747,"methodology":"case rate"}]}]},{"description":"MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE","code_information":[{"code":"7404","type":"APR-DRG"}],"standard_charges":[{"minimum":42385,"maximum":42385,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42385,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42385,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42385,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"minimum":5789,"maximum":21478.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12347,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11673,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7382,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13292,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12463,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20404.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14191,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16919,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13718,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21478.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12666,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12666,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5789,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11932.64,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12767.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12290.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12529.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12648.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12529.28,"methodology":"case rate"}]}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"74150","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1715.58,"maximum":1715.58,"gross_charge":2118,"discounted_cash":626.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1715.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1715.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1715.58,"methodology":"fee schedule"}]}]},{"description":"HC CT ABDOMEN WO CONTRAST","code_information":[{"code":"74150","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1715.58,"gross_charge":2118,"discounted_cash":626.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1715.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1715.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1715.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":229.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":181.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":209.12,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1270.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"74160","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2173.23,"maximum":2173.23,"gross_charge":2683,"discounted_cash":794.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2173.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2173.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2173.23,"methodology":"fee schedule"}]}]},{"description":"HC CT ABDOMEN W CONTRAST","code_information":[{"code":"74160","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2173.23,"gross_charge":2683,"discounted_cash":794.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2173.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2173.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2173.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":428.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":339.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":343.58,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1609.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":509.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT ABDOMEN WOW CONTRAST","code_information":[{"code":"74170","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2287.44,"maximum":2287.44,"gross_charge":2824,"discounted_cash":835.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2287.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2287.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2287.44,"methodology":"fee schedule"}]}]},{"description":"HC CT ABDOMEN WOW CONTRAST","code_information":[{"code":"74170","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":2287.44,"gross_charge":2824,"discounted_cash":835.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2287.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2287.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2287.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":504.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":399.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.9,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1694.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CTA ABD&PELV W/WO CONTR","code_information":[{"code":"74174","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":6987.87,"maximum":6987.87,"gross_charge":8627,"discounted_cash":2553.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6987.87,"methodology":"fee schedule"}]}]},{"description":"HC CTA ABD&PELV W/WO CONTR","code_information":[{"code":"74174","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":302,"maximum":6987.87,"gross_charge":8627,"discounted_cash":2553.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1054.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":562.89,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5176.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1639.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1725.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1725.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CTA ABDOMEN WOW CONTR","code_information":[{"code":"74175","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4681.8,"maximum":4681.8,"gross_charge":5780,"discounted_cash":1710.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4681.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4681.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4681.8,"methodology":"fee schedule"}]}]},{"description":"HC CTA ABDOMEN WOW CONTR","code_information":[{"code":"74175","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":4681.8,"gross_charge":5780,"discounted_cash":1710.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4681.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4681.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4681.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":709.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":561.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":449.72,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3468,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1156,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":867,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1156,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT ABD&PEL WO CONTRAST","code_information":[{"code":"74176","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1662.12,"maximum":1662.12,"gross_charge":2052,"discounted_cash":607.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1662.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1662.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1662.12,"methodology":"fee schedule"}]}]},{"description":"HC CT ABD&PEL WO CONTRAST","code_information":[{"code":"74176","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":1662.12,"gross_charge":2052,"discounted_cash":607.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1662.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1662.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1662.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":313.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":248.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":280.98,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1231.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC CT ABD&PEL W CONTRAST","code_information":[{"code":"74177","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1955.34,"maximum":1955.34,"gross_charge":2414,"discounted_cash":714.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1955.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1955.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1955.34,"methodology":"fee schedule"}]}]},{"description":"HC CT ABD&PEL W CONTRAST","code_information":[{"code":"74177","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":302,"maximum":1955.34,"gross_charge":2414,"discounted_cash":714.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1955.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1955.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1955.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":566.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":448.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":455.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1448.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":458.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CT ABD&PEL WOW CONTRAST","code_information":[{"code":"74178","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2208.87,"maximum":2208.87,"gross_charge":2727,"discounted_cash":807.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2208.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2208.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2208.87,"methodology":"fee schedule"}]}]},{"description":"HC CT ABD&PEL WOW CONTRAST","code_information":[{"code":"74178","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":302,"maximum":2208.87,"gross_charge":2727,"discounted_cash":807.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2208.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2208.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2208.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":672.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":532.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":511.49,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1636.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR ABDOMEN","code_information":[{"code":"74181","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3239.19,"maximum":3239.19,"gross_charge":3999,"discounted_cash":1183.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3239.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239.19,"methodology":"fee schedule"}]}]},{"description":"HC MR ABDOMEN","code_information":[{"code":"74181","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3239.19,"gross_charge":3999,"discounted_cash":1183.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3239.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3239.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3239.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":642.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":508.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":314.12,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2399.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":759.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MR ABD W CONTRAST","code_information":[{"code":"74182","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1666.17,"maximum":1666.17,"gross_charge":2057,"discounted_cash":608.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1666.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1666.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1666.17,"methodology":"fee schedule"}]}]},{"description":"HC MR ABD W CONTRAST","code_information":[{"code":"74182","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":308.55,"maximum":2459,"gross_charge":2057,"discounted_cash":608.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1666.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1666.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1666.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":919.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":728.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":488.07,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1234.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR ABD WOW CONTRAST","code_information":[{"code":"74183","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4627.53,"maximum":4627.53,"gross_charge":5713,"discounted_cash":1691.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4627.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4627.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4627.53,"methodology":"fee schedule"}]}]},{"description":"HC MR ABD WOW CONTRAST","code_information":[{"code":"74183","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4627.53,"gross_charge":5713,"discounted_cash":1691.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4627.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4627.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4627.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":990.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":784.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":544.59,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3427.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1085.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"MR ABDOMEN W/WO LIMITED","code_information":[{"code":"74183","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2314.17,"maximum":2314.17,"gross_charge":2857,"discounted_cash":845.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2314.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2314.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2314.17,"methodology":"fee schedule"}]}]},{"description":"MR ABDOMEN W/WO LIMITED","code_information":[{"code":"74183","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2459,"gross_charge":2857,"discounted_cash":845.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2314.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2314.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2314.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":990.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":784.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":544.59,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1714.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":571.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":571.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":6979,"maximum":27128,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16420,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15523,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10124,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15176,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14228,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25382.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19479,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23224,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18813,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26718.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27128,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16844,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16844,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6979,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14843.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15882.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15288.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15585.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15733.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15585.54,"methodology":"case rate"}]}]},{"description":"HC XR ESOPHAGUS SINGLE CONTRAST","code_information":[{"code":"74220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1067.58,"maximum":1067.58,"gross_charge":1318,"discounted_cash":390.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1067.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1067.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1067.58,"methodology":"fee schedule"}]}]},{"description":"HC XR ESOPHAGUS SINGLE CONTRAST","code_information":[{"code":"74220","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":110.74,"maximum":1067.58,"gross_charge":1318,"discounted_cash":390.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1067.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1067.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1067.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":139.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":132.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":147.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":134.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC FL ESOPHOGRAM W/AIR","code_information":[{"code":"74221","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":937.98,"maximum":937.98,"gross_charge":1158,"discounted_cash":342.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":937.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":937.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":937.98,"methodology":"fee schedule"}]}]},{"description":"HC FL ESOPHOGRAM W/AIR","code_information":[{"code":"74221","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":117.69,"maximum":937.98,"gross_charge":1158,"discounted_cash":342.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":937.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":937.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":937.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":117.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":147.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":163.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":151.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC XR ESOPH SWALLOW FUNC W/VID","code_information":[{"code":"74230","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1327.59,"maximum":1327.59,"gross_charge":1639,"discounted_cash":485.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1327.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1327.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1327.59,"methodology":"fee schedule"}]}]},{"description":"HC XR ESOPH SWALLOW FUNC W/VID","code_information":[{"code":"74230","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":105.07,"maximum":1327.59,"gross_charge":1639,"discounted_cash":485.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1327.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1327.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1327.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":132.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":205.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":179.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC XR UGI W/O KUB","code_information":[{"code":"74240","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":748.44,"maximum":748.44,"gross_charge":924,"discounted_cash":273.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":748.44,"methodology":"fee schedule"}]}]},{"description":"HC XR UGI W/O KUB","code_information":[{"code":"74240","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":129.41,"maximum":748.44,"gross_charge":924,"discounted_cash":273.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":748.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":129.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":159.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":177.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":167.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC XR UGI AIR CONTR W/O KUB","code_information":[{"code":"74246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1129.95,"maximum":1129.95,"gross_charge":1395,"discounted_cash":412.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1129.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1129.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1129.95,"methodology":"fee schedule"}]}]},{"description":"HC XR UGI AIR CONTR W/O KUB","code_information":[{"code":"74246","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":153.19,"maximum":1129.95,"gross_charge":1395,"discounted_cash":412.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1129.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1129.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1129.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":193.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":153.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":186.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":193.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":279,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC SMALL BOWEL","code_information":[{"code":"74248","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":648,"maximum":648,"gross_charge":800,"discounted_cash":236.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":648,"methodology":"fee schedule"}]}]},{"description":"HC SMALL BOWEL","code_information":[{"code":"74248","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":75.79,"maximum":648,"gross_charge":800,"discounted_cash":236.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":648,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":95.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":384,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":448,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":115.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160,"methodology":"fee schedule"}]}]},{"description":"HC XR SMALL BOWEL ONLY","code_information":[{"code":"74250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":841.59,"maximum":841.59,"gross_charge":1039,"discounted_cash":307.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":841.59,"methodology":"fee schedule"}]}]},{"description":"HC XR SMALL BOWEL ONLY","code_information":[{"code":"74250","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":137.35,"maximum":841.59,"gross_charge":1039,"discounted_cash":307.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":173.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":137.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":159.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":178.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":168.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC CT VIRT COLONOSCOPY DX","code_information":[{"code":"74261","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1009.26,"maximum":1009.26,"gross_charge":1246,"discounted_cash":368.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1009.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1009.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1009.26,"methodology":"fee schedule"}]}]},{"description":"HC CT VIRT COLONOSCOPY DX","code_information":[{"code":"74261","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1467,"gross_charge":1246,"discounted_cash":368.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1009.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1009.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1009.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":877.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":695.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":663.29,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":747.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR COLON","code_information":[{"code":"74270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":927.45,"maximum":927.45,"gross_charge":1145,"discounted_cash":338.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":927.45,"methodology":"fee schedule"}]}]},{"description":"HC XR COLON","code_information":[{"code":"74270","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":927.45,"gross_charge":1145,"discounted_cash":338.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":251.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":199.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":204.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":227.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":215.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":229,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":229,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC XR COLON WITH AIR","code_information":[{"code":"74280","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":927.45,"maximum":927.45,"gross_charge":1145,"discounted_cash":338.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":927.45,"methodology":"fee schedule"}]}]},{"description":"HC XR COLON WITH AIR","code_information":[{"code":"74280","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":927.45,"gross_charge":1145,"discounted_cash":338.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":927.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":349.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":277.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":317.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":353.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":308.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":229,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":229,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":5270,"maximum":19456.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10775,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10187,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6602,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11868,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11127,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18483.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12653,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15086,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12268,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19456.33,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17802,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11053,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11053,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5270,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10809.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11565.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11133.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11349.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11457.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11349.53,"methodology":"case rate"}]}]},{"description":"HC XR CHOLANGIOGRAM OPER","code_information":[{"code":"74300","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1168.02,"maximum":1168.02,"gross_charge":1442,"discounted_cash":426.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1168.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1168.02,"methodology":"fee schedule"}]}]},{"description":"HC XR CHOLANGIOGRAM OPER","code_information":[{"code":"74300","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.41,"maximum":1168.02,"gross_charge":1442,"discounted_cash":426.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1168.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1168.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1168.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":692.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":807.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRA-OP CHOLANGIOGRAM-ADD SET","code_information":[{"code":"74301","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":292.41,"maximum":292.41,"gross_charge":361,"discounted_cash":106.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.41,"methodology":"fee schedule"}]}]},{"description":"HC INTRA-OP CHOLANGIOGRAM-ADD SET","code_information":[{"code":"74301","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":32.14,"maximum":306,"gross_charge":361,"discounted_cash":106.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":173.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":202.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.2,"methodology":"fee schedule"}]}]},{"description":"HC XR ERCP BILIARY & PANCR DCT","code_information":[{"code":"74330","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":536.22,"maximum":536.22,"gross_charge":662,"discounted_cash":195.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":536.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":536.22,"methodology":"fee schedule"}]}]},{"description":"HC XR ERCP BILIARY & PANCR DCT","code_information":[{"code":"74330","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":99.3,"maximum":536.22,"gross_charge":662,"discounted_cash":195.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":536.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":536.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":253.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":201.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":317.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":370.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.4,"methodology":"fee schedule"}]}]},{"description":"HC X-RAY GUIDE FOR GI TUBE","code_information":[{"code":"74340","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":349.92,"maximum":349.92,"gross_charge":432,"discounted_cash":127.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.92,"methodology":"fee schedule"}]}]},{"description":"HC X-RAY GUIDE FOR GI TUBE","code_information":[{"code":"74340","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":349.92,"gross_charge":432,"discounted_cash":127.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":211.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":207.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":241.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"}]}]},{"description":"XRAY GUIDED INTRALUMINAL DIL","code_information":[{"code":"74360","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":280.26,"maximum":280.26,"gross_charge":346,"discounted_cash":102.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":280.26,"methodology":"fee schedule"}]}]},{"description":"XRAY GUIDED INTRALUMINAL DIL","code_information":[{"code":"74360","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":51.9,"maximum":306,"gross_charge":346,"discounted_cash":102.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":252.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":200.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":166.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":193.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.2,"methodology":"fee schedule"}]}]},{"description":"HC DILATATION BILIARY","code_information":[{"code":"74363","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1543.86,"maximum":1543.86,"gross_charge":1906,"discounted_cash":564.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1543.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1543.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1543.86,"methodology":"fee schedule"}]}]},{"description":"HC DILATATION BILIARY","code_information":[{"code":"74363","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":129.66,"maximum":1543.86,"gross_charge":1906,"discounted_cash":564.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1543.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1543.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1543.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":163.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":129.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":914.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1067.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":381.2,"methodology":"fee schedule"}]}]},{"description":"D&C CONIZATION LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"minimum":7088,"maximum":29019,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17564,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16605,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10695,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16960,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15901,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26780.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20519,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24463,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19874,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28190.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29019,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18018,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18018,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7088,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15661.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16757.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16130.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16444.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16600.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16444.21,"methodology":"case rate"}]}]},{"description":"HC XR IVP W/WO TOMO/KUB","code_information":[{"code":"74400","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1432.89,"maximum":1432.89,"gross_charge":1769,"discounted_cash":523.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1432.89,"methodology":"fee schedule"}]}]},{"description":"HC XR IVP W/WO TOMO/KUB","code_information":[{"code":"74400","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":143,"maximum":1432.89,"gross_charge":1769,"discounted_cash":523.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":180.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":143,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":206.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":230.46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":176.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"HC XR PYELOGRAM RETROGRADE","code_information":[{"code":"74420","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1174.5,"maximum":1174.5,"gross_charge":1450,"discounted_cash":429.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1174.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1174.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1174.5,"methodology":"fee schedule"}]}]},{"description":"HC XR PYELOGRAM RETROGRADE","code_information":[{"code":"74420","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":96.55,"maximum":1174.5,"gross_charge":1450,"discounted_cash":429.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1174.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1174.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1174.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":211.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":96.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":107.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":103.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":290,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":290,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC XR URINARY TRACT","code_information":[{"code":"74425","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":822.15,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"}]}]},{"description":"HC XR URINARY TRACT","code_information":[{"code":"74425","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":83.37,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":105.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":83.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":233.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":179.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC XR CYSTOGRAMSTATIC","code_information":[{"code":"74430","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":725.76,"maximum":725.76,"gross_charge":896,"discounted_cash":265.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":725.76,"methodology":"fee schedule"}]}]},{"description":"HC XR CYSTOGRAMSTATIC","code_information":[{"code":"74430","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":41.1,"maximum":781.88,"gross_charge":896,"discounted_cash":265.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC XR URETHROGRAM RETRO","code_information":[{"code":"74450","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":682.83,"maximum":682.83,"gross_charge":843,"discounted_cash":249.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":682.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":682.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":682.83,"methodology":"fee schedule"}]}]},{"description":"HC XR URETHROGRAM RETRO","code_information":[{"code":"74450","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":92.98,"maximum":682.83,"gross_charge":843,"discounted_cash":249.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":682.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":682.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":682.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":117.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":119.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC VOIDING URETHROCYSTOGRAM","code_information":[{"code":"74455","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":867.51,"maximum":867.51,"gross_charge":1071,"discounted_cash":317.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":867.51,"methodology":"fee schedule"}]}]},{"description":"HC VOIDING URETHROCYSTOGRAM","code_information":[{"code":"74455","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":108.47,"maximum":867.51,"gross_charge":1071,"discounted_cash":317.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":867.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":136.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":108.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":180.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":134.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC DILATION URTR/URT RS&I","code_information":[{"code":"74485","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1043.28,"maximum":1043.28,"gross_charge":1288,"discounted_cash":381.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1043.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1043.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1043.28,"methodology":"fee schedule"}]}]},{"description":"HC DILATION URTR/URT RS&I","code_information":[{"code":"74485","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":112.43,"maximum":4484.85,"gross_charge":1288,"discounted_cash":381.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1043.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1043.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1043.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4484.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2971.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":141.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":112.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3131.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":145.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":162.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":158.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1959.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1886.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1923.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2014.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1941.34,"methodology":"case rate"}]}]},{"description":"D&C CONIZATION LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"minimum":4547,"maximum":17445.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9212,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8709,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5885,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11997,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11248,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16573.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12439,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14830,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10937,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17445.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15219,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9450,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9450,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4547,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9691.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10370.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9982.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10176.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10273.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10176.53,"methodology":"case rate"}]}]},{"description":"VAGINA CERVIX AND VULVA PROCEDURES WITH CC/MCC","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"minimum":6785,"maximum":24959.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15053,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14231,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9522,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17029,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15966,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23711.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16899,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20148,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17696,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24959.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24870,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15441,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15441,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6785,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13866.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14836.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14282.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14559.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14698.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14559.59,"methodology":"case rate"}]}]},{"description":"VAGINA CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"minimum":5026,"maximum":16640.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8586,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8117,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5040,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14499,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13594,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15808.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10578,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12611,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9367,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16640.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14186,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8808,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8808,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5026,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9244.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9891.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9522.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9707.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9799.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9707.07,"methodology":"case rate"}]}]},{"description":"HC XR HYSTEROSALPINGOGRAM","code_information":[{"code":"74740","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":620.46,"maximum":620.46,"gross_charge":766,"discounted_cash":226.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":620.46,"methodology":"fee schedule"}]}]},{"description":"HC XR HYSTEROSALPINGOGRAM","code_information":[{"code":"74740","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":94.32,"maximum":620.46,"gross_charge":766,"discounted_cash":226.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":620.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":118.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":94.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":142.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":158.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":124.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"minimum":5449,"maximum":21348.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12246,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11577,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7982,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14126,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13244,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20280.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15319,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18263,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14833,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21348.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20232,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12562,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12562,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5449,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11860.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12690.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12215.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12453.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12571.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12453.05,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"minimum":11808,"maximum":38443,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23269,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21998,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14301,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19236,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18036,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33751.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27306,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32555,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26577,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35528.12,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38443,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23869,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23869,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11808,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19737.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21119.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20329.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20724.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20922.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20724.74,"methodology":"case rate"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"minimum":6391,"maximum":20506.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11591,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10958,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7727,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12117,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11361,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19480.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15424,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18390,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14359,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20506.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19150,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11890,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11890,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6391,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11392.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12189.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11734.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11961.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12075.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11961.99,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7501","type":"APR-DRG"}],"standard_charges":[{"minimum":5645,"maximum":5645,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7502","type":"APR-DRG"}],"standard_charges":[{"minimum":5645,"maximum":5645,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5645,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7503","type":"APR-DRG"}],"standard_charges":[{"minimum":8362,"maximum":8362,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8362,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8362,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8362,"methodology":"case rate"}]}]},{"description":"SCHIZOPHRENIA","code_information":[{"code":"7504","type":"APR-DRG"}],"standard_charges":[{"minimum":14009,"maximum":14009,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14009,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14009,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14009,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7511","type":"APR-DRG"}],"standard_charges":[{"minimum":4424,"maximum":4424,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4424,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4424,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4424,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7512","type":"APR-DRG"}],"standard_charges":[{"minimum":5225,"maximum":5225,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5225,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5225,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5225,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7513","type":"APR-DRG"}],"standard_charges":[{"minimum":8500,"maximum":8500,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8500,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8500,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8500,"methodology":"case rate"}]}]},{"description":"MAJOR DEPRESSIVE DISORDERS AND OTHER OR UNSPECIFIED PSYCHOSES","code_information":[{"code":"7514","type":"APR-DRG"}],"standard_charges":[{"minimum":15744,"maximum":15744,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15744,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15744,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15744,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7521","type":"APR-DRG"}],"standard_charges":[{"minimum":1724,"maximum":1724,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1724,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7522","type":"APR-DRG"}],"standard_charges":[{"minimum":2610,"maximum":2610,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2610,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2610,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2610,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7523","type":"APR-DRG"}],"standard_charges":[{"minimum":7021,"maximum":7021,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7021,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7021,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7021,"methodology":"case rate"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"7524","type":"APR-DRG"}],"standard_charges":[{"minimum":27795,"maximum":27795,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27795,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27795,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27795,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7531","type":"APR-DRG"}],"standard_charges":[{"minimum":4677,"maximum":4677,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4677,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4677,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4677,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7532","type":"APR-DRG"}],"standard_charges":[{"minimum":5295,"maximum":5295,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5295,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5295,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5295,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7533","type":"APR-DRG"}],"standard_charges":[{"minimum":6902,"maximum":6902,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6902,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6902,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6902,"methodology":"case rate"}]}]},{"description":"BIPOLAR DISORDERS","code_information":[{"code":"7534","type":"APR-DRG"}],"standard_charges":[{"minimum":11036,"maximum":11036,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11036,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11036,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11036,"methodology":"case rate"}]}]},{"description":"MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"minimum":7632,"maximum":29677,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16264,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15375,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10525,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29677,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27824,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25191.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18774,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22383,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19559,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26516.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26870,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16684,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16684,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7632,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14731.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15762.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15173.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15468.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15615.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15468.17,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7541","type":"APR-DRG"}],"standard_charges":[{"minimum":3959,"maximum":3959,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3959,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3959,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3959,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7542","type":"APR-DRG"}],"standard_charges":[{"minimum":4595,"maximum":4595,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4595,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4595,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4595,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7543","type":"APR-DRG"}],"standard_charges":[{"minimum":4595,"maximum":4595,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4595,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4595,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4595,"methodology":"case rate"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER","code_information":[{"code":"7544","type":"APR-DRG"}],"standard_charges":[{"minimum":10822,"maximum":10822,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10822,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10822,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10822,"methodology":"case rate"}]}]},{"description":"MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WITH CC","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"minimum":6163,"maximum":18431.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9979,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9434,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6163,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15221,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14271,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17510.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11686,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13932,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11452,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18431.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6891,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10239.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10956.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10547.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10751.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10854.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10751.9,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7551","type":"APR-DRG"}],"standard_charges":[{"minimum":4253,"maximum":4253,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7552","type":"APR-DRG"}],"standard_charges":[{"minimum":4253,"maximum":4253,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7553","type":"APR-DRG"}],"standard_charges":[{"minimum":4253,"maximum":4253,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4253,"methodology":"case rate"}]}]},{"description":"ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES","code_information":[{"code":"7554","type":"APR-DRG"}],"standard_charges":[{"minimum":8688,"maximum":8688,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8688,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8688,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8688,"methodology":"case rate"}]}]},{"description":"HC MR CARDIAC WO CONTR","code_information":[{"code":"75557","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":496.53,"maximum":496.53,"gross_charge":613,"discounted_cash":181.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":496.53,"methodology":"fee schedule"}]}]},{"description":"HC MR CARDIAC WO CONTR","code_information":[{"code":"75557","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":91.95,"maximum":2459,"gross_charge":613,"discounted_cash":181.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":613,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":516.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":408.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":448.52,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":367.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC CARDIAC MRI W/STRESS IMG","code_information":[{"code":"75559","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":496.53,"maximum":496.53,"gross_charge":613,"discounted_cash":181.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":496.53,"methodology":"fee schedule"}]}]},{"description":"HC CARDIAC MRI W/STRESS IMG","code_information":[{"code":"75559","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":91.95,"maximum":2459,"gross_charge":613,"discounted_cash":181.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":496.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":613,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":730.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":578.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":621.6,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":367.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC MR CARDIAC WOW CONTR","code_information":[{"code":"75561","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1502.55,"maximum":1502.55,"gross_charge":1855,"discounted_cash":549.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1502.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1502.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1502.55,"methodology":"fee schedule"}]}]},{"description":"HC MR CARDIAC WOW CONTR","code_information":[{"code":"75561","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":278.25,"maximum":2459,"gross_charge":1855,"discounted_cash":549.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1502.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1502.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1502.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":741.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":586.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":586.16,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1113,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":371,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":371,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MR CARDIAC Q-FLOW","code_information":[{"code":"75565","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":90.72,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"}]}]},{"description":"HC MR CARDIAC Q-FLOW","code_information":[{"code":"75565","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":2459,"gross_charge":112,"discounted_cash":33.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":105.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":83.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73.05,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"}]}]},{"description":"HC CT HEART CORON CAL WO CONTR","code_information":[{"code":"75571","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HC CT HEART CORON CAL WO CONTR","code_information":[{"code":"75571","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":10.35,"maximum":1467,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":188.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":149.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":145.64,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC CT HEART WOW/GATING & 3D","code_information":[{"code":"75572","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1605.42,"maximum":1605.42,"gross_charge":1982,"discounted_cash":586.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1605.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1605.42,"methodology":"fee schedule"}]}]},{"description":"HC CT HEART WOW/GATING & 3D","code_information":[{"code":"75572","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":268.07,"maximum":1605.42,"gross_charge":1982,"discounted_cash":586.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1605.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1605.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1605.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":492.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":389.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":348.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1189.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CTA CORNAR STRC&MRPH WO CAL","code_information":[{"code":"75573","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":1321.92,"maximum":1321.92,"gross_charge":1632,"discounted_cash":483.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1321.92,"methodology":"fee schedule"}]}]},{"description":"HC CTA CORNAR STRC&MRPH WO CAL","code_information":[{"code":"75573","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":244.8,"maximum":1467,"gross_charge":1632,"discounted_cash":483.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1321.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":658.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":521.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":469.19,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":979.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC CTA CORONARY W/CAL EVAL","code_information":[{"code":"75574","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2360.34,"maximum":2360.34,"gross_charge":2914,"discounted_cash":862.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2360.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2360.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2360.34,"methodology":"fee schedule"}]}]},{"description":"HC CTA CORONARY W/CAL EVAL","code_information":[{"code":"75574","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":268.07,"maximum":2360.34,"gross_charge":2914,"discounted_cash":862.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2360.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2360.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2360.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":735.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":582.13,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":502.76,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1748.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":553.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC N-INVAS EST C FFR SW ALY CTA","code_information":[{"code":"75580","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":2933.82,"maximum":2933.82,"gross_charge":3622,"discounted_cash":1072.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2933.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2933.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2933.82,"methodology":"fee schedule"}]}]},{"description":"HC N-INVAS EST C FFR SW ALY CTA","code_information":[{"code":"75580","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":543.3,"maximum":2933.82,"gross_charge":3622,"discounted_cash":1072.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2933.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2933.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2933.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2318.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":688.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.4,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"minimum":4248,"maximum":16638.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8584,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8116,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5623,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11188,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10490,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15806.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10774,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12846,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10449,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16638.36,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14183,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8806,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8806,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4248,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9243.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9890.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9520.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9705.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9798.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9705.71,"methodology":"case rate"}]}]},{"description":"HC AORTOGRAM THOR S&I","code_information":[{"code":"75605","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":7614,"maximum":7614,"gross_charge":9400,"discounted_cash":2782.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7614,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7614,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7614,"methodology":"fee schedule"}]}]},{"description":"HC AORTOGRAM THOR S&I","code_information":[{"code":"75605","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":149.96,"maximum":11834.84,"gross_charge":9400,"discounted_cash":2782.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7614,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7614,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7614,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":193.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":153.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":149.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":167.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":182.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1786,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1880,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1410,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1880,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7561","type":"APR-DRG"}],"standard_charges":[{"minimum":4033,"maximum":4033,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4033,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4033,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4033,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7562","type":"APR-DRG"}],"standard_charges":[{"minimum":5827,"maximum":5827,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5827,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5827,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5827,"methodology":"case rate"}]}]},{"description":"HC AORTOGRAM ABD S&I","code_information":[{"code":"75625","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4829.22,"maximum":4829.22,"gross_charge":5962,"discounted_cash":1764.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4829.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4829.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4829.22,"methodology":"fee schedule"}]}]},{"description":"HC AORTOGRAM ABD S&I","code_information":[{"code":"75625","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":137.15,"maximum":6890.9,"gross_charge":5962,"discounted_cash":1764.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4829.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4829.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4829.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":191.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":152.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":137.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":152.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":194.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1132.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7563","type":"APR-DRG"}],"standard_charges":[{"minimum":6956,"maximum":6956,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6956,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6956,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6956,"methodology":"case rate"}]}]},{"description":"HC AORTOGRAM ABD W/ROF S&I","code_information":[{"code":"75630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5022.81,"maximum":5022.81,"gross_charge":6201,"discounted_cash":1835.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5022.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5022.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5022.81,"methodology":"fee schedule"}]}]},{"description":"HC AORTOGRAM ABD W/ROF S&I","code_information":[{"code":"75630","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":144.98,"maximum":6890.9,"gross_charge":6201,"discounted_cash":1835.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5022.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5022.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5022.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":190.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":150.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":144.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":161.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":240.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":930.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC CTA AAA W/BIL.EXT.RUNOFF","code_information":[{"code":"75635","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":4212.81,"maximum":4212.81,"gross_charge":5201,"discounted_cash":1539.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4212.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4212.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4212.81,"methodology":"fee schedule"}]}]},{"description":"HC CTA AAA W/BIL.EXT.RUNOFF","code_information":[{"code":"75635","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":159.16,"maximum":4212.81,"gross_charge":5201,"discounted_cash":1539.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4212.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4212.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4212.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":389.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":268.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":727.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":576.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":272.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":616.94,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3120.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1040.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":159.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":170.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":163.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":167.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":175.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":168.71,"methodology":"case rate"}]}]},{"description":"ACUTE ANXIETY AND DELIRIUM STATES","code_information":[{"code":"7564","type":"APR-DRG"}],"standard_charges":[{"minimum":9142,"maximum":9142,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9142,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9142,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9142,"methodology":"case rate"}]}]},{"description":"INFECTIONS FEMALE REPRODUCTIVE SYSTEM WITH MCC","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"minimum":5929,"maximum":21960.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12722,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12027,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8474,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19318,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18112,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20862.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14832,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17684,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15748,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21960.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21019,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13050,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13050,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5929,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12200.52,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13054.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12566.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12810.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12932.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12810.55,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM SPINAL","code_information":[{"code":"75705","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":15117.84,"maximum":15117.84,"gross_charge":18664,"discounted_cash":5524.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15117.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15117.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15117.84,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM SPINAL","code_information":[{"code":"75705","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":221.14,"maximum":15117.84,"gross_charge":18664,"discounted_cash":5524.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15117.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15117.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15117.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":278.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":221.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":268.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":299.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":348.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3546.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3732.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2799.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3732.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7571","type":"APR-DRG"}],"standard_charges":[{"minimum":3233,"maximum":3233,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3233,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3233,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3233,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM EXTREMITY UNI","code_information":[{"code":"75710","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3991.68,"maximum":3991.68,"gross_charge":4928,"discounted_cash":1458.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3991.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3991.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3991.68,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM EXTREMITY UNI","code_information":[{"code":"75710","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":154.95,"maximum":6890.9,"gross_charge":4928,"discounted_cash":1458.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3991.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3991.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3991.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":241.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":191.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":154.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":172.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":936.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":985.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":985.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM EXTREMITY BIL","code_information":[{"code":"75716","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":6706.8,"maximum":6706.8,"gross_charge":8280,"discounted_cash":2450.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6706.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6706.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6706.8,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM EXTREMITY BIL","code_information":[{"code":"75716","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":158.2,"maximum":6890.9,"gross_charge":8280,"discounted_cash":2450.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6706.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6706.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6706.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":291.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":230.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":158.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":176.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":246.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1573.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1656,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1242,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1656,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7572","type":"APR-DRG"}],"standard_charges":[{"minimum":4155,"maximum":4155,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4155,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4155,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4155,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM VISCERAL S&I","code_information":[{"code":"75726","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4288.95,"maximum":4288.95,"gross_charge":5295,"discounted_cash":1567.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4288.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4288.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4288.95,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM VISCERAL S&I","code_information":[{"code":"75726","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":170.76,"maximum":11834.84,"gross_charge":5295,"discounted_cash":1567.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4288.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4288.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4288.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":215.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":170.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":172.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":191.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":261.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":794.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7573","type":"APR-DRG"}],"standard_charges":[{"minimum":6904,"maximum":6904,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6904,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6904,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6904,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM PELVIC S&I","code_information":[{"code":"75736","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":15089.49,"maximum":15089.49,"gross_charge":18629,"discounted_cash":5514.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15089.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15089.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15089.49,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM PELVIC S&I","code_information":[{"code":"75736","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":187.18,"maximum":15089.49,"gross_charge":18629,"discounted_cash":5514.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15089.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15089.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15089.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":236.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":187.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":192.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":214.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":210.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3539.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3725.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2794.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3725.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"ORGANIC MENTAL HEALTH DISTURBANCES","code_information":[{"code":"7574","type":"APR-DRG"}],"standard_charges":[{"minimum":15932,"maximum":15932,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15932,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15932,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15932,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM PULMONARY UNI","code_information":[{"code":"75741","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3082.05,"maximum":3082.05,"gross_charge":3805,"discounted_cash":1126.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3082.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3082.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3082.05,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM PULMONARY UNI","code_information":[{"code":"75741","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":155.46,"maximum":6890.9,"gross_charge":3805,"discounted_cash":1126.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3082.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3082.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3082.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":196.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":155.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":159.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":177.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":200.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":761,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":761,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM PULMONARY BIL","code_information":[{"code":"75743","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4403.16,"maximum":4403.16,"gross_charge":5436,"discounted_cash":1609.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4403.16,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM PULMONARY BIL","code_information":[{"code":"75743","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":161.36,"maximum":6890.9,"gross_charge":5436,"discounted_cash":1609.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":213.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":169.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":161.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":179.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":227.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1087.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1087.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAMPULMONARY BIL.","code_information":[{"code":"75743","type":"CPT"},{"code":"0323","type":"RC"}],"standard_charges":[{"minimum":4403.16,"maximum":4403.16,"gross_charge":5436,"discounted_cash":1609.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4403.16,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAMPULMONARY BIL.","code_information":[{"code":"75743","type":"CPT"},{"code":"0323","type":"RC"}],"standard_charges":[{"minimum":161.36,"maximum":6890.9,"gross_charge":5436,"discounted_cash":1609.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4403.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":213.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":169.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":161.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":179.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":227.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1032.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1087.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":815.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1087.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC PULMONARY NON SELECTIVE","code_information":[{"code":"75746","type":"CPT"},{"code":"0323","type":"RC"}],"standard_charges":[{"minimum":4535.19,"maximum":4535.19,"gross_charge":5599,"discounted_cash":1657.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4535.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4535.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4535.19,"methodology":"fee schedule"}]}]},{"description":"HC PULMONARY NON SELECTIVE","code_information":[{"code":"75746","type":"CPT"},{"code":"0323","type":"RC"}],"standard_charges":[{"minimum":176.97,"maximum":6890.9,"gross_charge":5599,"discounted_cash":1657.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4535.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4535.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4535.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":223.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":176.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":177.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":197.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":202.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1063.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":839.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC INTERNAL MAMMARY","code_information":[{"code":"75756","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2462.4,"maximum":2462.4,"gross_charge":3040,"discounted_cash":899.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2462.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2462.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2462.4,"methodology":"fee schedule"}]}]},{"description":"HC INTERNAL MAMMARY","code_information":[{"code":"75756","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":197.37,"maximum":6890.9,"gross_charge":3040,"discounted_cash":899.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2462.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2462.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2462.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":248.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":197.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":215.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":239.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":227.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":608,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":456,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":608,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC ANGIOGRAM EA ADDL VESSEL","code_information":[{"code":"75774","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2920.05,"maximum":2920.05,"gross_charge":3605,"discounted_cash":1067.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2920.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2920.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2920.05,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM EA ADDL VESSEL","code_information":[{"code":"75774","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":128.29,"maximum":2920.05,"gross_charge":3605,"discounted_cash":1067.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2920.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2920.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2920.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":161.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1730.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2018.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":151.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":721,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":540.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":721,"methodology":"fee schedule"}]}]},{"description":"INFECTIONS FEMALE REPRODUCTIVE SYSTEM WITH CC","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"minimum":4792,"maximum":17381.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9162,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8662,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5639,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11501,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10783,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16512.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10328,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12314,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10480,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17381.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15138,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9399,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9399,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4792,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9656.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10332.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9946.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10139.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10139.43,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7581","type":"APR-DRG"}],"standard_charges":[{"minimum":4220,"maximum":4220,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7582","type":"APR-DRG"}],"standard_charges":[{"minimum":4220,"maximum":4220,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4220,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM EXTREMITY UNI","code_information":[{"code":"75820","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1483.92,"maximum":1483.92,"gross_charge":1832,"discounted_cash":542.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1483.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1483.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1483.92,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM EXTREMITY UNI","code_information":[{"code":"75820","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":143.58,"maximum":3400.99,"gross_charge":1832,"discounted_cash":542.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1483.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1483.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1483.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":181.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":143.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":163.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":150.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM EXTREMITY BIL","code_information":[{"code":"75822","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1573.02,"maximum":1573.02,"gross_charge":1942,"discounted_cash":574.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1573.02,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM EXTREMITY BIL","code_information":[{"code":"75822","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":148.54,"maximum":3400.99,"gross_charge":1942,"discounted_cash":574.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":207.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":164.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":148.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":165.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":176.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM VENA CAVA INF","code_information":[{"code":"75825","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3522.69,"maximum":3522.69,"gross_charge":4349,"discounted_cash":1287.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3522.69,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM VENA CAVA INF","code_information":[{"code":"75825","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":140.71,"maximum":6890.9,"gross_charge":4349,"discounted_cash":1287.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":181.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":144.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":140.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":156.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":176.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM VENA CAVA SUP","code_information":[{"code":"75827","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3522.69,"maximum":3522.69,"gross_charge":4349,"discounted_cash":1287.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3522.69,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM VENA CAVA SUP","code_information":[{"code":"75827","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":148.1,"maximum":3522.69,"gross_charge":4349,"discounted_cash":1287.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3522.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":186.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":148.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":149.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":167.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":182.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7583","type":"APR-DRG"}],"standard_charges":[{"minimum":5993,"maximum":5993,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5993,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5993,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5993,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM RENAL UNI S&I","code_information":[{"code":"75831","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9267.21,"maximum":9267.21,"gross_charge":11441,"discounted_cash":3386.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9267.21,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM RENAL UNI S&I","code_information":[{"code":"75831","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":153.53,"maximum":9267.21,"gross_charge":11441,"discounted_cash":3386.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":194.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":154.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":170.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":183.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2288.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1716.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2288.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC VENOGRAPHY RENAL BILATERAL","code_information":[{"code":"75833","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9267.21,"maximum":9267.21,"gross_charge":11441,"discounted_cash":3386.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9267.21,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAPHY RENAL BILATERAL","code_information":[{"code":"75833","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":169.6,"maximum":9267.21,"gross_charge":11441,"discounted_cash":3386.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":219.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":169.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":188.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":220.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2288.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1716.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2288.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL DISORDERS","code_information":[{"code":"7584","type":"APR-DRG"}],"standard_charges":[{"minimum":7908,"maximum":7908,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7908,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7908,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7908,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM SINUS/JUGLR S&I","code_information":[{"code":"75860","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1676.7,"maximum":1676.7,"gross_charge":2070,"discounted_cash":612.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1676.7,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM SINUS/JUGLR S&I","code_information":[{"code":"75860","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":154.9,"maximum":6890.9,"gross_charge":2070,"discounted_cash":612.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":195.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":154.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":163.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":182.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":193.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":414,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":414,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM SUP SAGGITAL SINUS","code_information":[{"code":"75870","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9339.3,"maximum":9339.3,"gross_charge":11530,"discounted_cash":3412.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9339.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9339.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9339.3,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM SUP SAGGITAL SINUS","code_information":[{"code":"75870","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":158.29,"maximum":9339.3,"gross_charge":11530,"discounted_cash":3412.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9339.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9339.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9339.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":199.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":158.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":238.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":266.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":252.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2190.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2306,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1729.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2306,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC PERC.TRANSHEP.PORTOGRAPHY","code_information":[{"code":"75887","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5454.54,"maximum":5454.54,"gross_charge":6734,"discounted_cash":1993.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5454.54,"methodology":"fee schedule"}]}]},{"description":"HC PERC.TRANSHEP.PORTOGRAPHY","code_information":[{"code":"75887","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":156.59,"maximum":6890.9,"gross_charge":6734,"discounted_cash":1993.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":197.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":181.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":211.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1010.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM HEPATIC","code_information":[{"code":"75889","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":4505.22,"maximum":4505.22,"gross_charge":5562,"discounted_cash":1646.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4505.22,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM HEPATIC","code_information":[{"code":"75889","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":157.73,"maximum":6890.9,"gross_charge":5562,"discounted_cash":1646.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":198.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":157.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":180.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC VENOGRAM HEPATIC W/O HEMO","code_information":[{"code":"75891","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":9267.21,"maximum":9267.21,"gross_charge":11441,"discounted_cash":3386.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9267.21,"methodology":"fee schedule"}]}]},{"description":"HC VENOGRAM HEPATIC W/O HEMO","code_information":[{"code":"75891","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":158.29,"maximum":9267.21,"gross_charge":11441,"discounted_cash":3386.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9267.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":199.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":158.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":164.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":182.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":192.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2288.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1716.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2288.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"HC ART/VEN BLOOD SAMPLING","code_information":[{"code":"75893","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2378.16,"maximum":2378.16,"gross_charge":2936,"discounted_cash":869.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2378.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2378.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2378.16,"methodology":"fee schedule"}]}]},{"description":"HC ART/VEN BLOOD SAMPLING","code_information":[{"code":"75893","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":159.42,"maximum":11834.84,"gross_charge":2936,"discounted_cash":869.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2378.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2378.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2378.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11834.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8017.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":201.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":159.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8264.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":176.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":196.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":557.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4832.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5171.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4977.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5074.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5316.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5122.88,"methodology":"case rate"}]}]},{"description":"HC TRANSCATH EMBO TX","code_information":[{"code":"75894","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":5771.25,"maximum":5771.25,"gross_charge":7125,"discounted_cash":2109,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5771.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5771.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5771.25,"methodology":"fee schedule"}]}]},{"description":"HC TRANSCATH EMBO TX","code_information":[{"code":"75894","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":306,"maximum":5771.25,"gross_charge":7125,"discounted_cash":2109,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5771.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5771.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5771.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1941.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1539.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3420,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3990,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1425,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM THRU EXT CATH","code_information":[{"code":"75898","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1672.65,"maximum":1672.65,"gross_charge":2065,"discounted_cash":611.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1672.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1672.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1672.65,"methodology":"fee schedule"}]}]},{"description":"HC ANGIOGRAM THRU EXT CATH","code_information":[{"code":"75898","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":66.99,"maximum":6890.9,"gross_charge":2065,"discounted_cash":611.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1672.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1672.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1672.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":87.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":97.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":413,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":413,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"INFECTIONS FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"minimum":3646,"maximum":12995.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5753,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5439,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3671,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7636,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7160,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12346.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6706,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7995,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6823,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12995.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9505,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3646,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7219.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7725.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7436.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7580.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7653.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7580.96,"methodology":"case rate"}]}]},{"description":"HC PERICATH FIBRIN SHTH REM SI","code_information":[{"code":"75901","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1087.02,"maximum":1087.02,"gross_charge":1342,"discounted_cash":397.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1087.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1087.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1087.02,"methodology":"fee schedule"}]}]},{"description":"HC PERICATH FIBRIN SHTH REM SI","code_information":[{"code":"75901","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":201.3,"maximum":1087.02,"gross_charge":1342,"discounted_cash":397.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1087.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1087.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1087.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":308.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":244.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":644.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":751.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":300.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRACATH OBST REM SI","code_information":[{"code":"75902","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":529.74,"maximum":529.74,"gross_charge":654,"discounted_cash":193.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":529.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":529.74,"methodology":"fee schedule"}]}]},{"description":"HC INTRACATH OBST REM SI","code_information":[{"code":"75902","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":88.65,"maximum":529.74,"gross_charge":654,"discounted_cash":193.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":529.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":529.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":111.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":88.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":313.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":366.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.8,"methodology":"fee schedule"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7591","type":"APR-DRG"}],"standard_charges":[{"minimum":4435,"maximum":4435,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4435,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4435,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4435,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7592","type":"APR-DRG"}],"standard_charges":[{"minimum":4767,"maximum":4767,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4767,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7593","type":"APR-DRG"}],"standard_charges":[{"minimum":7554,"maximum":7554,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7554,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7554,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7554,"methodology":"case rate"}]}]},{"description":"EATING DISORDERS","code_information":[{"code":"7594","type":"APR-DRG"}],"standard_charges":[{"minimum":39662,"maximum":39662,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39662,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39662,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39662,"methodology":"case rate"}]}]},{"description":"HC THORACIC AA REPAIR","code_information":[{"code":"75956","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1398.87,"maximum":1398.87,"gross_charge":1727,"discounted_cash":511.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1398.87,"methodology":"fee schedule"}]}]},{"description":"HC THORACIC AA REPAIR","code_information":[{"code":"75956","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":259.05,"maximum":1398.87,"gross_charge":1727,"discounted_cash":511.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1398.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":744.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":589.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":828.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":967.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.4,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR ENDOVASC THOR AO","code_information":[{"code":"75957","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1705.05,"maximum":1705.05,"gross_charge":2105,"discounted_cash":623.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1705.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1705.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1705.05,"methodology":"fee schedule"}]}]},{"description":"HC REPAIR ENDOVASC THOR AO","code_information":[{"code":"75957","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":306,"maximum":1705.05,"gross_charge":2105,"discounted_cash":623.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1705.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1705.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1705.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":637.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":505.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1010.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1178.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":399.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":421,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":421,"methodology":"fee schedule"}]}]},{"description":"HC PLCMT PROX EXT THOR AO","code_information":[{"code":"75958","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1761.75,"maximum":1761.75,"gross_charge":2175,"discounted_cash":643.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1761.75,"methodology":"fee schedule"}]}]},{"description":"HC PLCMT PROX EXT THOR AO","code_information":[{"code":"75958","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":306,"maximum":1761.75,"gross_charge":2175,"discounted_cash":643.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1761.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":424.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":336.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1044,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1218,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":435,"methodology":"fee schedule"}]}]},{"description":"HC PLACE.DISTAL EXT.PROS S&I","code_information":[{"code":"75959","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3665.25,"maximum":3665.25,"gross_charge":4525,"discounted_cash":1339.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3665.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3665.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3665.25,"methodology":"fee schedule"}]}]},{"description":"HC PLACE.DISTAL EXT.PROS S&I","code_information":[{"code":"75959","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":296.6,"maximum":3665.25,"gross_charge":4525,"discounted_cash":1339.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3665.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3665.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3665.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":374.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":296.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2172,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2534,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":859.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":905,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":905,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY TRANSCATHETER","code_information":[{"code":"75970","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":2839.86,"maximum":2839.86,"gross_charge":3506,"discounted_cash":1037.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2839.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2839.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2839.86,"methodology":"fee schedule"}]}]},{"description":"HC BIOPSY TRANSCATHETER","code_information":[{"code":"75970","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":306,"maximum":2839.86,"gross_charge":3506,"discounted_cash":1037.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2839.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2839.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2839.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":827.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":655.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1682.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1963.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":525.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":701.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH CHNG BIL DRAIN S&I","code_information":[{"code":"75984","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":532.17,"maximum":532.17,"gross_charge":657,"discounted_cash":194.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.17,"methodology":"fee schedule"}]}]},{"description":"HC CATH CHNG BIL DRAIN S&I","code_information":[{"code":"75984","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":98.55,"maximum":532.17,"gross_charge":657,"discounted_cash":194.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":152.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":120.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":315.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":367.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":138.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.4,"methodology":"fee schedule"}]}]},{"description":"HC DRAINAGE W/CATH PLMT S&I","code_information":[{"code":"75989","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":568.62,"maximum":568.62,"gross_charge":702,"discounted_cash":207.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":568.62,"methodology":"fee schedule"}]}]},{"description":"HC DRAINAGE W/CATH PLMT S&I","code_information":[{"code":"75989","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":568.62,"gross_charge":702,"discounted_cash":207.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":163.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":129.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":336.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":393.12,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.4,"methodology":"fee schedule"}]}]},{"description":"HC PLEUREX CATH PLACEMENT S&I","code_information":[{"code":"75989","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":568.62,"maximum":568.62,"gross_charge":702,"discounted_cash":207.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":568.62,"methodology":"fee schedule"}]}]},{"description":"HC PLEUREX CATH PLACEMENT S&I","code_information":[{"code":"75989","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":5079,"gross_charge":702,"discounted_cash":207.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":568.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":163.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":129.23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.4,"methodology":"fee schedule"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"minimum":4374,"maximum":16992.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8860,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8376,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5655,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11881,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11140,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16142.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10448,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12457,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10509,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16992.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14637,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9088,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9088,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4374,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9440.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10100.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9723.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9912.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10006.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9912.12,"methodology":"case rate"}]}]},{"description":"HC FLUOROSCOPY UP TO 1HR","code_information":[{"code":"76000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":816.48,"maximum":816.48,"gross_charge":1008,"discounted_cash":298.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":816.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":816.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":816.48,"methodology":"fee schedule"}]}]},{"description":"HC FLUOROSCOPY UP TO 1HR","code_information":[{"code":"76000","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":52.39,"maximum":816.48,"gross_charge":1008,"discounted_cash":298.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":816.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":816.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":816.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7601","type":"APR-DRG"}],"standard_charges":[{"minimum":2732,"maximum":2732,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2732,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2732,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2732,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7602","type":"APR-DRG"}],"standard_charges":[{"minimum":3520,"maximum":3520,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3520,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7603","type":"APR-DRG"}],"standard_charges":[{"minimum":6116,"maximum":6116,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6116,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6116,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6116,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL HEALTH DISORDERS","code_information":[{"code":"7604","type":"APR-DRG"}],"standard_charges":[{"minimum":11121,"maximum":11121,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11121,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11121,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11121,"methodology":"case rate"}]}]},{"description":"HC FISTULAGRAM","code_information":[{"code":"76080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":641.52,"maximum":641.52,"gross_charge":792,"discounted_cash":234.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":641.52,"methodology":"fee schedule"}]}]},{"description":"HC FISTULAGRAM","code_information":[{"code":"76080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":54.68,"maximum":1200.41,"gross_charge":792,"discounted_cash":234.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":641.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":73.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"76098","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"76098","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":3.75,"maximum":1200.41,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"76098","type":"CPT"},{"code":"0329","type":"RC"}],"standard_charges":[{"minimum":1547.1,"maximum":1547.1,"gross_charge":1910,"discounted_cash":565.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1547.1,"methodology":"fee schedule"}]}]},{"description":"HC XR SURGICAL SPECIMEN","code_information":[{"code":"76098","type":"CPT"},{"code":"0329","type":"RC"}],"standard_charges":[{"minimum":17.32,"maximum":1547.1,"gross_charge":1910,"discounted_cash":565.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1547.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":362.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":382,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":382,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"minimum":3407,"maximum":12925.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5698,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5387,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3441,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10074,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9445,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12279.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6115,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7290,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6394,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12925.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9414,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5845,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5845,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3407,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7180.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7683.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7396.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7539.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7611.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7539.81,"methodology":"case rate"}]}]},{"description":"3D IMAGE/NOT REQUIR POST PRCES","code_information":[{"code":"76376","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":275.4,"maximum":275.4,"gross_charge":340,"discounted_cash":100.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":275.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.4,"methodology":"fee schedule"}]}]},{"description":"3D IMAGE/NOT REQUIR POST PRCES","code_information":[{"code":"76376","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":32.27,"maximum":1467,"gross_charge":340,"discounted_cash":100.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":275.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":340,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68,"methodology":"fee schedule"}]}]},{"description":"HC 3-D CONSOLE","code_information":[{"code":"76376","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":299.7,"maximum":299.7,"gross_charge":370,"discounted_cash":109.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"}]}]},{"description":"HC 3-D CONSOLE","code_information":[{"code":"76376","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":32.27,"maximum":1467,"gross_charge":370,"discounted_cash":109.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":370,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"}]}]},{"description":"HC 3D W/O WORKSTATION","code_information":[{"code":"76376","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":299.7,"maximum":299.7,"gross_charge":370,"discounted_cash":109.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"}]}]},{"description":"HC 3D W/O WORKSTATION","code_information":[{"code":"76376","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":32.27,"maximum":698,"gross_charge":370,"discounted_cash":109.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":177.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":207.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"}]}]},{"description":"3D IMAGE/ REQUIR POST PROCESS","code_information":[{"code":"76377","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":737.1,"maximum":737.1,"gross_charge":910,"discounted_cash":269.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":737.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":737.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":737.1,"methodology":"fee schedule"}]}]},{"description":"3D IMAGE/ REQUIR POST PROCESS","code_information":[{"code":"76377","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":83.99,"maximum":1467,"gross_charge":910,"discounted_cash":269.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":737.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":737.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":737.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":83.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":101.72,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":546,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":182,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":182,"methodology":"fee schedule"}]}]},{"description":"HC 3-D INDEP WKSTATION","code_information":[{"code":"76377","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":810,"maximum":810,"gross_charge":1000,"discounted_cash":296,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810,"methodology":"fee schedule"}]}]},{"description":"HC 3-D INDEP WKSTATION","code_information":[{"code":"76377","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":83.99,"maximum":1467,"gross_charge":1000,"discounted_cash":296,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":83.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":101.72,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200,"methodology":"fee schedule"}]}]},{"description":"HC CT LTD/LOCALIZED F/U","code_information":[{"code":"76380","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":741.96,"maximum":741.96,"gross_charge":916,"discounted_cash":271.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":741.96,"methodology":"fee schedule"}]}]},{"description":"HC CT LTD/LOCALIZED F/U","code_information":[{"code":"76380","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":78.72,"maximum":1467,"gross_charge":916,"discounted_cash":271.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":249.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":197.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":201.84,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":549.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC MR SPECTROSCOPY-RESEARCH","code_information":[{"code":"76390","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4340.79,"maximum":4340.79,"gross_charge":5359,"discounted_cash":1586.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4340.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4340.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4340.79,"methodology":"fee schedule"}]}]},{"description":"HC MR SPECTROSCOPY-RESEARCH","code_information":[{"code":"76390","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":78.72,"maximum":4340.79,"gross_charge":5359,"discounted_cash":1586.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4340.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4340.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4340.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":909.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":719.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":588.06,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3215.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1018.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"minimum":4384,"maximum":5963,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4384,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4384,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5963,"methodology":"case rate"}]}]},{"description":"HC U/S HEAD & NECK-SFT TISSUE","code_information":[{"code":"76536","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1025.46,"maximum":1025.46,"gross_charge":1266,"discounted_cash":374.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1025.46,"methodology":"fee schedule"}]}]},{"description":"HC U/S HEAD & NECK-SFT TISSUE","code_information":[{"code":"76536","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1025.46,"gross_charge":1266,"discounted_cash":374.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":188.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":149.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":175.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":195.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":161.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"minimum":4384,"maximum":4859,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4384,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4384,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4859,"methodology":"case rate"}]}]},{"description":"HC U/S CHEST","code_information":[{"code":"76604","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":712.8,"maximum":712.8,"gross_charge":880,"discounted_cash":260.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":712.8,"methodology":"fee schedule"}]}]},{"description":"HC U/S CHEST","code_information":[{"code":"76604","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":712.8,"gross_charge":880,"discounted_cash":260.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":712.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":123.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":100.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":111.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":110.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":176,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":132,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":176,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S BREAST UNI","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":2184.57,"maximum":2184.57,"gross_charge":2697,"discounted_cash":798.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2184.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2184.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2184.57,"methodology":"fee schedule"}]}]},{"description":"HC U/S BREAST UNI","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2184.57,"gross_charge":2697,"discounted_cash":798.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2184.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2184.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2184.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":142.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":141.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":157.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":149.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC US BREAST BIL COMPLETE","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":2728.89,"maximum":2728.89,"gross_charge":3369,"discounted_cash":997.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2728.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2728.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2728.89,"methodology":"fee schedule"}]}]},{"description":"HC US BREAST BIL COMPLETE","code_information":[{"code":"76641","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":2728.89,"gross_charge":3369,"discounted_cash":997.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2728.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2728.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2728.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":142.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":113.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":141.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":157.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":149.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":640.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S BREAST LMTD","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":728.19,"maximum":728.19,"gross_charge":899,"discounted_cash":266.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":728.19,"methodology":"fee schedule"}]}]},{"description":"HC U/S BREAST LMTD","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":78.72,"maximum":728.19,"gross_charge":899,"discounted_cash":266.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":109.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":119.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":122.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC US BREAST BIL LIMITED","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":910.44,"maximum":910.44,"gross_charge":1124,"discounted_cash":332.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":910.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":910.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":910.44,"methodology":"fee schedule"}]}]},{"description":"HC US BREAST BIL LIMITED","code_information":[{"code":"76642","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":78.72,"maximum":910.44,"gross_charge":1124,"discounted_cash":332.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":910.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":910.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":910.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":109.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":119.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":122.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"minimum":3095,"maximum":5228,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5228,"methodology":"case rate"}]}]},{"description":"HC U/S ABDOMINAL COMP","code_information":[{"code":"76700","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1710.72,"maximum":1710.72,"gross_charge":2112,"discounted_cash":625.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1710.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1710.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1710.72,"methodology":"fee schedule"}]}]},{"description":"HC U/S ABDOMINAL COMP","code_information":[{"code":"76700","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1710.72,"gross_charge":2112,"discounted_cash":625.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1710.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1710.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1710.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":202.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":160.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":164.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":182.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S ABDOMINAL LTD","code_information":[{"code":"76705","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":770.31,"maximum":770.31,"gross_charge":951,"discounted_cash":281.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":770.31,"methodology":"fee schedule"}]}]},{"description":"HC U/S ABDOMINAL LTD","code_information":[{"code":"76705","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":770.31,"gross_charge":951,"discounted_cash":281.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":770.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":159.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":126.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":123.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":137.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":127.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S AA SCREENING FOR AAA","code_information":[{"code":"76706","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":630.18,"maximum":630.18,"gross_charge":778,"discounted_cash":230.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":630.18,"methodology":"fee schedule"}]}]},{"description":"HC U/S AA SCREENING FOR AAA","code_information":[{"code":"76706","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":698,"gross_charge":778,"discounted_cash":230.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":133.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":172.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":192.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":158.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S RETROPERITONEAL COMP","code_information":[{"code":"76770","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":693.36,"maximum":693.36,"gross_charge":856,"discounted_cash":253.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":693.36,"methodology":"fee schedule"}]}]},{"description":"HC U/S RETROPERITONEAL COMP","code_information":[{"code":"76770","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":698,"gross_charge":856,"discounted_cash":253.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":193.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":153.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":152.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":170.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":158.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S RETROPERITONEAL LTD","code_information":[{"code":"76775","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":693.36,"maximum":693.36,"gross_charge":856,"discounted_cash":253.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":693.36,"methodology":"fee schedule"}]}]},{"description":"HC U/S RETROPERITONEAL LTD","code_information":[{"code":"76775","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":58.08,"maximum":698,"gross_charge":856,"discounted_cash":253.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S TRANSPLANT KIDNEY","code_information":[{"code":"76776","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":924.21,"maximum":924.21,"gross_charge":1141,"discounted_cash":337.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.21,"methodology":"fee schedule"}]}]},{"description":"HC U/S TRANSPLANT KIDNEY","code_information":[{"code":"76776","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":924.21,"gross_charge":1141,"discounted_cash":337.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":234.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":186.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":235.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":262.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":216.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":3095,"maximum":26573,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9855,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9316,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6920,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26573,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24914,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17358.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12396,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14779,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12861,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18272.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16281,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4858,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10151.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10861.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10455.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10658.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10760.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10658.82,"methodology":"case rate"}]}]},{"description":"US TRANSABD FIRST TRIMESTER","code_information":[{"code":"76801","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":453.6,"maximum":453.6,"gross_charge":560,"discounted_cash":165.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":453.6,"methodology":"fee schedule"}]}]},{"description":"US TRANSABD FIRST TRIMESTER","code_information":[{"code":"76801","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":84,"maximum":698,"gross_charge":560,"discounted_cash":165.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":453.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":123.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":144.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":161.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"US ADDITIONAL GESTATION","code_information":[{"code":"76802","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":684.45,"maximum":684.45,"gross_charge":845,"discounted_cash":250.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.45,"methodology":"fee schedule"}]}]},{"description":"US ADDITIONAL GESTATION","code_information":[{"code":"76802","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":40.53,"maximum":698,"gross_charge":845,"discounted_cash":250.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":405.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":473.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":169,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":169,"methodology":"fee schedule"}]}]},{"description":"HC U/S OB US QUICK LTD","code_information":[{"code":"76815","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":420.39,"maximum":420.39,"gross_charge":519,"discounted_cash":153.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":420.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":420.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":420.39,"methodology":"fee schedule"}]}]},{"description":"HC U/S OB US QUICK LTD","code_information":[{"code":"76815","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":77.85,"maximum":698,"gross_charge":519,"discounted_cash":153.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":420.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":420.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":420.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":116.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":92.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":102.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":114.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S PREGNANCY TRANSVAGINAL","code_information":[{"code":"76817","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":699.84,"maximum":699.84,"gross_charge":864,"discounted_cash":255.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.84,"methodology":"fee schedule"}]}]},{"description":"HC U/S PREGNANCY TRANSVAGINAL","code_information":[{"code":"76817","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":699.84,"gross_charge":864,"discounted_cash":255.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":128.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":101.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":134.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/SENDO VAG (EV)","code_information":[{"code":"76830","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":874.8,"maximum":874.8,"gross_charge":1080,"discounted_cash":319.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":874.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":874.8,"methodology":"fee schedule"}]}]},{"description":"HC U/SENDO VAG (EV)","code_information":[{"code":"76830","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":874.8,"gross_charge":1080,"discounted_cash":319.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":874.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":874.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":184.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":177.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":197.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S PELVIC","code_information":[{"code":"76856","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1595.7,"maximum":1595.7,"gross_charge":1970,"discounted_cash":583.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1595.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1595.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1595.7,"methodology":"fee schedule"}]}]},{"description":"HC U/S PELVIC","code_information":[{"code":"76856","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1595.7,"gross_charge":1970,"discounted_cash":583.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1595.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1595.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1595.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":181.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":143.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":150.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":167.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":153.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":394,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":394,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S PELVIC LTD","code_information":[{"code":"76857","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":175.77,"maximum":175.77,"gross_charge":217,"discounted_cash":64.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":175.77,"methodology":"fee schedule"}]}]},{"description":"HC U/S PELVIC LTD","code_information":[{"code":"76857","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":32.55,"maximum":698,"gross_charge":217,"discounted_cash":64.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":68.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/STESTICULAR(SCROTUM)","code_information":[{"code":"76870","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1335.69,"maximum":1335.69,"gross_charge":1649,"discounted_cash":488.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1335.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1335.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1335.69,"methodology":"fee schedule"}]}]},{"description":"HC U/STESTICULAR(SCROTUM)","code_information":[{"code":"76870","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":66.58,"maximum":1335.69,"gross_charge":1649,"discounted_cash":488.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1335.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1335.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1335.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":83.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":66.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":163.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":146.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":329.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/SPROSTATE","code_information":[{"code":"76872","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":791.37,"maximum":791.37,"gross_charge":977,"discounted_cash":289.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":791.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":791.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":791.37,"methodology":"fee schedule"}]}]},{"description":"HC U/SPROSTATE","code_information":[{"code":"76872","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":93.17,"maximum":791.37,"gross_charge":977,"discounted_cash":289.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":791.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":791.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":791.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":117.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":93.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":247.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":275.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":218.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"PROSTATE VOLUME STUDY","code_information":[{"code":"76873","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":372.6,"maximum":372.6,"gross_charge":460,"discounted_cash":136.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":372.6,"methodology":"fee schedule"}]}]},{"description":"PROSTATE VOLUME STUDY","code_information":[{"code":"76873","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":69,"maximum":698,"gross_charge":460,"discounted_cash":136.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":187.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":148.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":194.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":216.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":248.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC U/S JOINT LMTD(NON-VAS) ACT XTR STRUX","code_information":[{"code":"76882","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":534.6,"maximum":534.6,"gross_charge":660,"discounted_cash":195.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":534.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":534.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":534.6,"methodology":"fee schedule"}]}]},{"description":"HC U/S JOINT LMTD(NON-VAS) ACT XTR STRUX","code_information":[{"code":"76882","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":17.32,"maximum":698,"gross_charge":660,"discounted_cash":195.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":534.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":534.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":534.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":80.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":132,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":132,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"minimum":7725,"maximum":21662.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12490,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11808,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8771,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19784,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18549,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20579.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17957,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21409,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16300,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21662.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20636,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12813,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12813,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7725,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12034.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12877.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12395.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12636.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12756.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12636.52,"methodology":"case rate"}]}]},{"description":"HC U/S PSEUDOANRYSM IMG & COMP","code_information":[{"code":"76936","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1099.98,"maximum":1099.98,"gross_charge":1358,"discounted_cash":401.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1099.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1099.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1099.98,"methodology":"fee schedule"}]}]},{"description":"HC U/S PSEUDOANRYSM IMG & COMP","code_information":[{"code":"76936","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":203.7,"maximum":1099.98,"gross_charge":1358,"discounted_cash":401.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1099.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1099.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1099.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":351.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":278.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":344.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":383.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":376.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC U/S GUIDE VASCULAR ACC","code_information":[{"code":"76937","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":626.94,"maximum":626.94,"gross_charge":774,"discounted_cash":229.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.94,"methodology":"fee schedule"}]}]},{"description":"HC U/S GUIDE VASCULAR ACC","code_information":[{"code":"76937","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":33.18,"maximum":698,"gross_charge":774,"discounted_cash":229.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":371.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":433.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.8,"methodology":"fee schedule"}]}]},{"description":"HC INJ PROC S&I","code_information":[{"code":"76942","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC INJ PROC S&I","code_information":[{"code":"76942","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":17.85,"maximum":698,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"}]}]},{"description":"HC U/S GUIDE NEEDLE PLCMT","code_information":[{"code":"76942","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":963.9,"maximum":963.9,"gross_charge":1190,"discounted_cash":352.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.9,"methodology":"fee schedule"}]}]},{"description":"HC U/S GUIDE NEEDLE PLCMT","code_information":[{"code":"76942","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":63.18,"maximum":963.9,"gross_charge":1190,"discounted_cash":352.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":571.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":666.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":238,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238,"methodology":"fee schedule"}]}]},{"description":"ULTRASND GUIDE INTERSTIT APP","code_information":[{"code":"76965","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":838.35,"maximum":838.35,"gross_charge":1035,"discounted_cash":306.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":838.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":838.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":838.35,"methodology":"fee schedule"}]}]},{"description":"ULTRASND GUIDE INTERSTIT APP","code_information":[{"code":"76965","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":37.14,"maximum":838.35,"gross_charge":1035,"discounted_cash":306.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":838.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":838.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":838.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":496.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":579.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":134.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":207,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":207,"methodology":"fee schedule"}]}]},{"description":"HC U/S GUIDANCE INTRAOP","code_information":[{"code":"76998","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":1013.31,"maximum":1013.31,"gross_charge":1251,"discounted_cash":370.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1013.31,"methodology":"fee schedule"}]}]},{"description":"HC U/S GUIDANCE INTRAOP","code_information":[{"code":"76998","type":"CPT"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":167.94,"maximum":1013.31,"gross_charge":1251,"discounted_cash":370.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":211.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":600.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":700.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.2,"methodology":"fee schedule"}]}]},{"description":"ABORTION WITH D&C ASPIRATION CURETTAGE OR HYSTEROTOMY","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"minimum":3850,"maximum":18037.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9672,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9144,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4538,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12280,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11513,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17135.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9358,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11158,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8433,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18037.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15980,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9922,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3850,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10020.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10722.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10321.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10521.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10622.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10521.89,"methodology":"case rate"}]}]},{"description":"HC XR FLUORO FOR CV ACCESS","code_information":[{"code":"77001","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":707.13,"maximum":707.13,"gross_charge":873,"discounted_cash":258.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"}]}]},{"description":"HC XR FLUORO FOR CV ACCESS","code_information":[{"code":"77001","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":95.44,"maximum":707.13,"gross_charge":873,"discounted_cash":258.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":120.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":95.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":419.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":488.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":132.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.6,"methodology":"fee schedule"}]}]},{"description":"HC XR LOCALIZATION NEEDLE","code_information":[{"code":"77002","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":699.84,"maximum":699.84,"gross_charge":864,"discounted_cash":255.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.84,"methodology":"fee schedule"}]}]},{"description":"HC XR LOCALIZATION NEEDLE","code_information":[{"code":"77002","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":118.1,"maximum":699.84,"gross_charge":864,"discounted_cash":255.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":148.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":118.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":414.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":483.84,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":150.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.8,"methodology":"fee schedule"}]}]},{"description":"HC XR FLUORO LUMBAR PUNCTURE","code_information":[{"code":"77003","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":601.83,"maximum":601.83,"gross_charge":743,"discounted_cash":219.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.83,"methodology":"fee schedule"}]}]},{"description":"HC XR FLUORO LUMBAR PUNCTURE","code_information":[{"code":"77003","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":94.88,"maximum":601.83,"gross_charge":743,"discounted_cash":219.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":356.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":416.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":140.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.6,"methodology":"fee schedule"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7701","type":"APR-DRG"}],"standard_charges":[{"minimum":2759,"maximum":2759,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2759,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2759,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2759,"methodology":"case rate"}]}]},{"description":"HC CT GUIDE FOR NEEDLE PLCMNT","code_information":[{"code":"77012","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":299.7,"maximum":299.7,"gross_charge":370,"discounted_cash":109.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"}]}]},{"description":"HC CT GUIDE FOR NEEDLE PLCMNT","code_information":[{"code":"77012","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":55.5,"maximum":1467,"gross_charge":370,"discounted_cash":109.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":370,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":172.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":213.12,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"}]}]},{"description":"HC CT TUMOR RFA PERC","code_information":[{"code":"77013","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":2482.65,"maximum":2482.65,"gross_charge":3065,"discounted_cash":907.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2482.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2482.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2482.65,"methodology":"fee schedule"}]}]},{"description":"HC CT TUMOR RFA PERC","code_information":[{"code":"77013","type":"CPT"},{"code":"0350","type":"RC"}],"standard_charges":[{"minimum":404.79,"maximum":2482.65,"gross_charge":3065,"discounted_cash":907.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2482.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2482.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2482.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":759,"standard_charge_algorithm": "Lesser of $759.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":975.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":772.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":404.79,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1467,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1389,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1839,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":766,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":613,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":613,"methodology":"fee schedule"}]}]},{"description":"HC CT FIELD PLACEMENT","code_information":[{"code":"77014","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":904.77,"maximum":904.77,"gross_charge":1117,"discounted_cash":330.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":904.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":904.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":904.77,"methodology":"fee schedule"}]}]},{"description":"HC CT FIELD PLACEMENT","code_information":[{"code":"77014","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":152.51,"maximum":904.77,"gross_charge":1117,"discounted_cash":330.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":904.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":904.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":904.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":192.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":152.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":536.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":625.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.4,"methodology":"fee schedule"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7702","type":"APR-DRG"}],"standard_charges":[{"minimum":2759,"maximum":2759,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2759,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2759,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2759,"methodology":"case rate"}]}]},{"description":"HC MR GUIDED BX BREAST NDL PLMT RS&I","code_information":[{"code":"77021","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2001.51,"maximum":2001.51,"gross_charge":2471,"discounted_cash":731.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2001.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2001.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2001.51,"methodology":"fee schedule"}]}]},{"description":"HC MR GUIDED BX BREAST NDL PLMT RS&I","code_information":[{"code":"77021","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":370.65,"maximum":2459,"gross_charge":2471,"discounted_cash":731.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2001.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2001.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2001.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":777.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":615.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":642.8,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1482.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":469.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.2,"methodology":"fee schedule"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7703","type":"APR-DRG"}],"standard_charges":[{"minimum":5172,"maximum":5172,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5172,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5172,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5172,"methodology":"case rate"}]}]},{"description":"DRUG AND ALCOHOL ABUSE OR DEPENDENCE LEFT AGAINST MEDICAL ADVICE","code_information":[{"code":"7704","type":"APR-DRG"}],"standard_charges":[{"minimum":6042,"maximum":6042,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6042,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6042,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6042,"methodology":"case rate"}]}]},{"description":"MRI BREAST BILATERAL WO CONTR","code_information":[{"code":"77047","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1031.13,"maximum":1031.13,"gross_charge":1273,"discounted_cash":376.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1031.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1031.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1031.13,"methodology":"fee schedule"}]}]},{"description":"MRI BREAST BILATERAL WO CONTR","code_information":[{"code":"77047","type":"CPT"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":190.95,"maximum":2459,"gross_charge":1273,"discounted_cash":376.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1031.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1031.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1031.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1273,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":430.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":340.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":350.82,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":763.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC BREAST SCRN TOMOSYNTHESIS BIL","code_information":[{"code":"77063","type":"CPT"},{"code":"0403","type":"RC"}],"standard_charges":[{"minimum":45.36,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"}]}]},{"description":"HC BREAST SCRN TOMOSYNTHESIS BIL","code_information":[{"code":"77063","type":"CPT"},{"code":"0403","type":"RC"}],"standard_charges":[{"minimum":8.4,"maximum":285,"gross_charge":56,"discounted_cash":16.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"}]}]},{"description":"HC MAMMO DIAG UNI & CAD","code_information":[{"code":"77065","type":"CPT"},{"code":"0401","type":"RC"}],"standard_charges":[{"minimum":267.3,"maximum":267.3,"gross_charge":330,"discounted_cash":97.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"}]}]},{"description":"HC MAMMO DIAG UNI & CAD","code_information":[{"code":"77065","type":"CPT"},{"code":"0401","type":"RC"}],"standard_charges":[{"minimum":49.5,"maximum":285,"gross_charge":330,"discounted_cash":97.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":189.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":150.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":186.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":186.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"}]}]},{"description":"HC MAMMO DIAG BIL & CAD","code_information":[{"code":"77066","type":"CPT"},{"code":"0401","type":"RC"}],"standard_charges":[{"minimum":347.49,"maximum":347.49,"gross_charge":429,"discounted_cash":126.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.49,"methodology":"fee schedule"}]}]},{"description":"HC MAMMO DIAG BIL & CAD","code_information":[{"code":"77066","type":"CPT"},{"code":"0401","type":"RC"}],"standard_charges":[{"minimum":64.35,"maximum":347.49,"gross_charge":429,"discounted_cash":126.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":242.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":192.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":237.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":264.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":235.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.8,"methodology":"fee schedule"}]}]},{"description":"HC MAMMO SCRN BIL & CAD","code_information":[{"code":"77067","type":"CPT"},{"code":"0403","type":"RC"}],"standard_charges":[{"minimum":268.92,"maximum":268.92,"gross_charge":332,"discounted_cash":98.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.92,"methodology":"fee schedule"}]}]},{"description":"HC MAMMO SCRN BIL & CAD","code_information":[{"code":"77067","type":"CPT"},{"code":"0403","type":"RC"}],"standard_charges":[{"minimum":49.8,"maximum":285,"gross_charge":332,"discounted_cash":98.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":200.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":158.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":196.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":219.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":190.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.4,"methodology":"fee schedule"}]}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"77072","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":136.89,"maximum":136.89,"gross_charge":169,"discounted_cash":50.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.89,"methodology":"fee schedule"}]}]},{"description":"HC XR BONE AGE STUDY","code_information":[{"code":"77072","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":22.4,"maximum":306,"gross_charge":169,"discounted_cash":50.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR ORTHORENTGENOGRAM","code_information":[{"code":"77073","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":400.14,"maximum":400.14,"gross_charge":494,"discounted_cash":146.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.14,"methodology":"fee schedule"}]}]},{"description":"HC XR ORTHORENTGENOGRAM","code_information":[{"code":"77073","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":400.14,"gross_charge":494,"discounted_cash":146.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR BONE SURVEY COM(NO-INFNT)","code_information":[{"code":"77075","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1496.88,"maximum":1496.88,"gross_charge":1848,"discounted_cash":547.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1496.88,"methodology":"fee schedule"}]}]},{"description":"HC XR BONE SURVEY COM(NO-INFNT)","code_information":[{"code":"77075","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1496.88,"gross_charge":1848,"discounted_cash":547.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1496.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":127.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":134.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":149.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":132.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC XR BONE DENSITY STUDY","code_information":[{"code":"77080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":332.1,"maximum":332.1,"gross_charge":410,"discounted_cash":121.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.1,"methodology":"fee schedule"}]}]},{"description":"HC XR BONE DENSITY STUDY","code_information":[{"code":"77080","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":54.6,"maximum":332.1,"gross_charge":410,"discounted_cash":121.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC DEXA PERIPHERAL WRIST","code_information":[{"code":"77081","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":232.47,"maximum":232.47,"gross_charge":287,"discounted_cash":84.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.47,"methodology":"fee schedule"}]}]},{"description":"HC DEXA PERIPHERAL WRIST","code_information":[{"code":"77081","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":26.38,"maximum":306,"gross_charge":287,"discounted_cash":84.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC DXA BONE DENSITY STUDY","code_information":[{"code":"77085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":417.96,"maximum":417.96,"gross_charge":516,"discounted_cash":152.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.96,"methodology":"fee schedule"}]}]},{"description":"HC DXA BONE DENSITY STUDY","code_information":[{"code":"77085","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":64.75,"maximum":417.96,"gross_charge":516,"discounted_cash":152.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":81.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":74.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC FRACTURE ASSESSMENT VIA DXA","code_information":[{"code":"77086","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":254.34,"maximum":254.34,"gross_charge":314,"discounted_cash":92.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"}]}]},{"description":"HC FRACTURE ASSESSMENT VIA DXA","code_information":[{"code":"77086","type":"CPT"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":42.15,"maximum":306,"gross_charge":314,"discounted_cash":92.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":132.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7721","type":"APR-DRG"}],"standard_charges":[{"minimum":2123,"maximum":2123,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2123,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2123,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2123,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7722","type":"APR-DRG"}],"standard_charges":[{"minimum":3075,"maximum":3075,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3075,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7723","type":"APR-DRG"}],"standard_charges":[{"minimum":3568,"maximum":3568,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3568,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3568,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3568,"methodology":"case rate"}]}]},{"description":"ALCOHOL AND DRUG DEPENDENCE WITH REHABILITATION AND/OR DETOXIFICATION THERAPY","code_information":[{"code":"7724","type":"APR-DRG"}],"standard_charges":[{"minimum":13626,"maximum":13626,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13626,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13626,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13626,"methodology":"case rate"}]}]},{"description":"HC SIMULATION SIMPLE","code_information":[{"code":"77280","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1281.42,"maximum":1281.42,"gross_charge":1582,"discounted_cash":468.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1281.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1281.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1281.42,"methodology":"fee schedule"}]}]},{"description":"HC SIMULATION SIMPLE","code_information":[{"code":"77280","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":118.7,"maximum":1281.42,"gross_charge":1582,"discounted_cash":468.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1281.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1281.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1281.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":468.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":371.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":482.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":537.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":384.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC SIMULATION INTERMEDIATE","code_information":[{"code":"77285","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2110.05,"maximum":2110.05,"gross_charge":2605,"discounted_cash":771.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2110.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2110.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2110.05,"methodology":"fee schedule"}]}]},{"description":"HC SIMULATION INTERMEDIATE","code_information":[{"code":"77285","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":327.28,"maximum":2110.05,"gross_charge":2605,"discounted_cash":771.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2110.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2110.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2110.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":734.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":582.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":818.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":911.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":642.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":494.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":521,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":521,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"HC SIMULATION COMPLEX","code_information":[{"code":"77290","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2512.62,"maximum":2512.62,"gross_charge":3102,"discounted_cash":918.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2512.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2512.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2512.62,"methodology":"fee schedule"}]}]},{"description":"HC SIMULATION COMPLEX","code_information":[{"code":"77290","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":327.28,"maximum":2512.62,"gross_charge":3102,"discounted_cash":918.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2512.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2512.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2512.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":849.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":673.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":834.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":928.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":690.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"HC RESPIRATORY MOTION SIMULATION","code_information":[{"code":"77293","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2660.04,"maximum":2660.04,"gross_charge":3284,"discounted_cash":972.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2660.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2660.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2660.04,"methodology":"fee schedule"}]}]},{"description":"HC RESPIRATORY MOTION SIMULATION","code_information":[{"code":"77293","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":492.6,"maximum":2660.04,"gross_charge":3284,"discounted_cash":972.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2660.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2660.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2660.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":708.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":561.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":692.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":771.47,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":628.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.8,"methodology":"fee schedule"}]}]},{"description":"HC 3D SIM/PLANNING","code_information":[{"code":"77295","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":7058.34,"maximum":7058.34,"gross_charge":8714,"discounted_cash":2579.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7058.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7058.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7058.34,"methodology":"fee schedule"}]}]},{"description":"HC 3D SIM/PLANNING","code_information":[{"code":"77295","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":413.49,"maximum":7058.34,"gross_charge":8714,"discounted_cash":2579.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7058.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7058.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7058.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":521.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":413.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2091.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":522.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":581.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":689.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1655.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1742.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1307.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1742.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1223.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1308.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1259.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1284.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1345.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1296.68,"methodology":"case rate"}]}]},{"description":"HC BASIC DOSIMETRY CALCULAT","code_information":[{"code":"77300","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":528.12,"maximum":528.12,"gross_charge":652,"discounted_cash":193,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":528.12,"methodology":"fee schedule"}]}]},{"description":"HC BASIC DOSIMETRY CALCULAT","code_information":[{"code":"77300","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":55.25,"maximum":743,"gross_charge":652,"discounted_cash":193,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC IMRT PLANNING ADDTL","code_information":[{"code":"77301","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":6793.47,"maximum":6793.47,"gross_charge":8387,"discounted_cash":2482.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6793.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6793.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6793.47,"methodology":"fee schedule"}]}]},{"description":"HC IMRT PLANNING ADDTL","code_information":[{"code":"77301","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":743,"maximum":6793.47,"gross_charge":8387,"discounted_cash":2482.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6793.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6793.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6793.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2995.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3073.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2436.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2091.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2984.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3323.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2655.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1593.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1258.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1677.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1223.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1308.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1259.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1284.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1345.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1296.68,"methodology":"case rate"}]}]},{"description":"HC ISODOSE PLAN SIMPLE","code_information":[{"code":"77306","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1249.02,"maximum":1249.02,"gross_charge":1542,"discounted_cash":456.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1249.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1249.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1249.02,"methodology":"fee schedule"}]}]},{"description":"HC ISODOSE PLAN SIMPLE","code_information":[{"code":"77306","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":115.61,"maximum":1249.02,"gross_charge":1542,"discounted_cash":456.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1249.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1249.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1249.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":145.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":150.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":167.46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":211.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"HC ISODOSE PLAN COMPLEX","code_information":[{"code":"77307","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2447.82,"maximum":2447.82,"gross_charge":3022,"discounted_cash":894.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2447.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2447.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2447.82,"methodology":"fee schedule"}]}]},{"description":"HC ISODOSE PLAN COMPLEX","code_information":[{"code":"77307","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":211.76,"maximum":2447.82,"gross_charge":3022,"discounted_cash":894.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2447.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2447.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2447.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":267.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":211.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":271.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302.84,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":410.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":604.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7731","type":"APR-DRG"}],"standard_charges":[{"minimum":1625,"maximum":1625,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1625,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1625,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1625,"methodology":"case rate"}]}]},{"description":"HC SIMPLE BRACHYTHERAPY PLAN","code_information":[{"code":"77316","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":626.94,"maximum":626.94,"gross_charge":774,"discounted_cash":229.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.94,"methodology":"fee schedule"}]}]},{"description":"HC SIMPLE BRACHYTHERAPY PLAN","code_information":[{"code":"77316","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":116.1,"maximum":801.46,"gross_charge":774,"discounted_cash":229.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":227.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":180.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":287.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":320.29,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":305.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"HC INTERMED BRACHYTHERAPY PLAN","code_information":[{"code":"77317","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1153.44,"maximum":1153.44,"gross_charge":1424,"discounted_cash":421.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1153.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1153.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1153.44,"methodology":"fee schedule"}]}]},{"description":"HC INTERMED BRACHYTHERAPY PLAN","code_information":[{"code":"77317","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":213.6,"maximum":1153.44,"gross_charge":1424,"discounted_cash":421.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1153.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1153.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1153.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":296.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":234.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":377.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":420.23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":400.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":284.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"HC COMPLEX BRACHYTHRPY PLAN","code_information":[{"code":"77318","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1686.42,"maximum":1686.42,"gross_charge":2082,"discounted_cash":616.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1686.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1686.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1686.42,"methodology":"fee schedule"}]}]},{"description":"HC COMPLEX BRACHYTHRPY PLAN","code_information":[{"code":"77318","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":312.3,"maximum":1686.42,"gross_charge":2082,"discounted_cash":616.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1686.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1686.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1686.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":401.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":318.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":511.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":569.89,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":574.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7732","type":"APR-DRG"}],"standard_charges":[{"minimum":5202,"maximum":5202,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5202,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5202,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5202,"methodology":"case rate"}]}]},{"description":"HC SPECIAL TELETHERAPY PLAN","code_information":[{"code":"77321","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2078.46,"maximum":2078.46,"gross_charge":2566,"discounted_cash":759.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2078.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2078.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2078.46,"methodology":"fee schedule"}]}]},{"description":"HC SPECIAL TELETHERAPY PLAN","code_information":[{"code":"77321","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":67.14,"maximum":2078.46,"gross_charge":2566,"discounted_cash":759.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2078.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2078.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2078.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":87.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":97.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":134.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7733","type":"APR-DRG"}],"standard_charges":[{"minimum":5806,"maximum":5806,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5806,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5806,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5806,"methodology":"case rate"}]}]},{"description":"HC SPECIAL DOSIMETRY","code_information":[{"code":"77331","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":683.64,"maximum":683.64,"gross_charge":844,"discounted_cash":249.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":683.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":683.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":683.64,"methodology":"fee schedule"}]}]},{"description":"HC SPECIAL DOSIMETRY","code_information":[{"code":"77331","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":29.2,"maximum":743,"gross_charge":844,"discounted_cash":249.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":683.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":683.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":683.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC TREATMENT DEVICE SIMPLE","code_information":[{"code":"77332","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":459.27,"maximum":459.27,"gross_charge":567,"discounted_cash":167.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":459.27,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT DEVICE SIMPLE","code_information":[{"code":"77332","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":46.7,"maximum":743,"gross_charge":567,"discounted_cash":167.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":103.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":82.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC TREATMENT DEVICE INTERM","code_information":[{"code":"77333","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":696.6,"maximum":696.6,"gross_charge":860,"discounted_cash":254.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.6,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT DEVICE INTERM","code_information":[{"code":"77333","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":14.48,"maximum":743,"gross_charge":860,"discounted_cash":254.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":180.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":168.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":172,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC TREATMENT DEVICE COMP","code_information":[{"code":"77334","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1482.3,"maximum":1482.3,"gross_charge":1830,"discounted_cash":541.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1482.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482.3,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT DEVICE COMP","code_information":[{"code":"77334","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":132.87,"maximum":1482.3,"gross_charge":1830,"discounted_cash":541.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1482.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1482.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1482.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":171.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":132.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":147.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":180.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":366,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":366,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"HC CONT RAD PHYSICS CONSULT","code_information":[{"code":"77336","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":562.95,"maximum":562.95,"gross_charge":695,"discounted_cash":205.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":562.95,"methodology":"fee schedule"}]}]},{"description":"HC CONT RAD PHYSICS CONSULT","code_information":[{"code":"77336","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":104.25,"maximum":743,"gross_charge":695,"discounted_cash":205.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":562.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":148.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":118.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":253.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":281.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"77338","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":488.43,"maximum":488.43,"gross_charge":603,"discounted_cash":178.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":488.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":488.43,"methodology":"fee schedule"}]}]},{"description":"HC DESIGN MLC DEVICE FOR IMRT","code_information":[{"code":"77338","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":90.45,"maximum":801.46,"gross_charge":603,"discounted_cash":178.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":488.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":488.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":801.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":539.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":554.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":439.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":559.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":520.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":579.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":688.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":327.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":350.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":337.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":343.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":360.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":346.92,"methodology":"case rate"}]}]},{"description":"OPIOID ABUSE AND DEPENDENCE","code_information":[{"code":"7734","type":"APR-DRG"}],"standard_charges":[{"minimum":9741,"maximum":9741,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9741,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9741,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9741,"methodology":"case rate"}]}]},{"description":"HC SPECIAL RAD PHYSICS CONSULT","code_information":[{"code":"77370","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":625.32,"maximum":625.32,"gross_charge":772,"discounted_cash":228.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":625.32,"methodology":"fee schedule"}]}]},{"description":"HC SPECIAL RAD PHYSICS CONSULT","code_information":[{"code":"77370","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":115.8,"maximum":743,"gross_charge":772,"discounted_cash":228.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":290.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":197.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":227.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":180.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":202.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":253.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":281.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":168.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":127.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":122.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":124.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":130.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":125.82,"methodology":"case rate"}]}]},{"description":"HC LINEAR ACCELREATED BASED 1 SESSION","code_information":[{"code":"77372","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":10982.79,"maximum":10982.79,"gross_charge":13559,"discounted_cash":4013.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10982.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10982.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10982.79,"methodology":"fee schedule"}]}]},{"description":"HC LINEAR ACCELREATED BASED 1 SESSION","code_information":[{"code":"77372","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1435.64,"maximum":16736.29,"gross_charge":13559,"discounted_cash":4013.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10982.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10982.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10982.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16736.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16736.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11361.86,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2082.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1650.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11686.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5369,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6238,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1435.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14251,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14251,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2576.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2711.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2033.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2711.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6834.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7312.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7039.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7176.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7517.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7244.55,"methodology":"case rate"}]}]},{"description":"HC NR LNR ACCLRTR TX","code_information":[{"code":"77373","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":6312.33,"maximum":6312.33,"gross_charge":7793,"discounted_cash":2306.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6312.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6312.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6312.33,"methodology":"fee schedule"}]}]},{"description":"HC NR LNR ACCLRTR TX","code_information":[{"code":"77373","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":743,"maximum":6312.33,"gross_charge":7793,"discounted_cash":2306.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6312.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6312.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6312.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3844.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3844.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2603.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2493.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1976.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2684.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2422.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2698.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1651.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1480.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1558.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1168.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1558.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1569.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1679.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1616.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1648.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1726.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1664.04,"methodology":"case rate"}]}]},{"description":"HC IMRT DELIVERY/TX SIMPLE","code_information":[{"code":"77385","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2525.58,"maximum":2525.58,"gross_charge":3118,"discounted_cash":922.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2525.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2525.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2525.58,"methodology":"fee schedule"}]}]},{"description":"HC IMRT DELIVERY/TX SIMPLE","code_information":[{"code":"77385","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":467.7,"maximum":2525.58,"gross_charge":3118,"discounted_cash":922.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2525.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2525.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2525.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1266.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1266.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":858.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":795.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":630.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":884.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1077.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1199.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":517.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":553.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":532.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":543.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":568.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":548.21,"methodology":"case rate"}]}]},{"description":"HC IMRT DELIVERY/TX COMPLEX","code_information":[{"code":"77386","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":6825.87,"maximum":6825.87,"gross_charge":8427,"discounted_cash":2494.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6825.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6825.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6825.87,"methodology":"fee schedule"}]}]},{"description":"HC IMRT DELIVERY/TX COMPLEX","code_information":[{"code":"77386","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":517.18,"maximum":6825.87,"gross_charge":8427,"discounted_cash":2494.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6825.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6825.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6825.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1266.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1266.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":858.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":796.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":631.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":884.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1077.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1199.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1601.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1685.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1685.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":517.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":553.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":532.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":543.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":568.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":548.21,"methodology":"case rate"}]}]},{"description":"HC GUIDANCE FOR RADJ TX DLVR","code_information":[{"code":"77387","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":376.65,"maximum":376.65,"gross_charge":465,"discounted_cash":137.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.65,"methodology":"fee schedule"}]}]},{"description":"HC GUIDANCE FOR RADJ TX DLVR","code_information":[{"code":"77387","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":60,"maximum":743,"gross_charge":465,"discounted_cash":137.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":75.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":139.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":155.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"minimum":3095,"maximum":4351,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4351,"methodology":"case rate"}]}]},{"description":"HC RAD TX DEL >=1 MEV SIMPLE","code_information":[{"code":"77402","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":561.33,"maximum":561.33,"gross_charge":693,"discounted_cash":205.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":561.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":561.33,"methodology":"fee schedule"}]}]},{"description":"HC RAD TX DEL >=1 MEV SIMPLE","code_information":[{"code":"77402","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":97.9,"maximum":743,"gross_charge":693,"discounted_cash":205.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":561.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":561.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":561.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":239.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":174.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":278.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":221.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":167.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":245.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":273.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":97.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":104.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":100.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":102.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":107.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":103.77,"methodology":"case rate"}]}]},{"description":"HC RAD TX DEL >=1 MEV INTERMEDIATE","code_information":[{"code":"77407","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":651.24,"maximum":651.24,"gross_charge":804,"discounted_cash":237.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.24,"methodology":"fee schedule"}]}]},{"description":"HC RAD TX DEL >=1 MEV INTERMEDIATE","code_information":[{"code":"77407","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":120.6,"maximum":743,"gross_charge":804,"discounted_cash":237.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":392.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":506.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":401.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":402.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":472.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":526.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":235.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":251.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":242.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":246.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":258.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":249.22,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7741","type":"APR-DRG"}],"standard_charges":[{"minimum":2125,"maximum":2125,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2125,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2125,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2125,"methodology":"case rate"}]}]},{"description":"HC RAD TX DEL >1 MEV COMPLEX","code_information":[{"code":"77412","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":767.88,"maximum":767.88,"gross_charge":948,"discounted_cash":280.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":767.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":767.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":767.88,"methodology":"fee schedule"}]}]},{"description":"HC RAD TX DEL >1 MEV COMPLEX","code_information":[{"code":"77412","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":142.2,"maximum":767.88,"gross_charge":948,"discounted_cash":280.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":767.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":767.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":767.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":392.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":481.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":381.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":402.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":472.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":526.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":235.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":251.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":242.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":246.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":258.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":249.22,"methodology":"case rate"}]}]},{"description":"HC THER RAD PORT FILM","code_information":[{"code":"77417","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":167.67,"maximum":167.67,"gross_charge":207,"discounted_cash":61.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.67,"methodology":"fee schedule"}]}]},{"description":"HC THER RAD PORT FILM","code_information":[{"code":"77417","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":15.33,"maximum":743,"gross_charge":207,"discounted_cash":61.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":115.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7742","type":"APR-DRG"}],"standard_charges":[{"minimum":4383,"maximum":4383,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4383,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4383,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4383,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7743","type":"APR-DRG"}],"standard_charges":[{"minimum":6135,"maximum":6135,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6135,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6135,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6135,"methodology":"case rate"}]}]},{"description":"COCAINE ABUSE AND DEPENDENCE","code_information":[{"code":"7744","type":"APR-DRG"}],"standard_charges":[{"minimum":9636,"maximum":9636,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9636,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9636,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9636,"methodology":"case rate"}]}]},{"description":"HC SPECIAL TREATMENT PROC","code_information":[{"code":"77470","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":981.72,"maximum":981.72,"gross_charge":1212,"discounted_cash":358.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":981.72,"methodology":"fee schedule"}]}]},{"description":"HC SPECIAL TREATMENT PROC","code_information":[{"code":"77470","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":50.97,"maximum":1266.47,"gross_charge":1212,"discounted_cash":358.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1266.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1266.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":858.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":884.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":193.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":517.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":553.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":532.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":543.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":568.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":548.21,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"minimum":3095,"maximum":3808,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3095,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3808,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7751","type":"APR-DRG"}],"standard_charges":[{"minimum":4549,"maximum":4549,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4549,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4549,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4549,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7752","type":"APR-DRG"}],"standard_charges":[{"minimum":6521,"maximum":6521,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6521,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6521,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6521,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7753","type":"APR-DRG"}],"standard_charges":[{"minimum":9830,"maximum":9830,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9830,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9830,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9830,"methodology":"case rate"}]}]},{"description":"ALCOHOL ABUSE AND DEPENDENCE","code_information":[{"code":"7754","type":"APR-DRG"}],"standard_charges":[{"minimum":21141,"maximum":21141,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21141,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21141,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21141,"methodology":"case rate"}]}]},{"description":"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"minimum":3854,"maximum":13845.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6414,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6063,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4072,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6294,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5901,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13153.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7535,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8984,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7567,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13845.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10596,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6579,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6579,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3854,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7692.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8230.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7922.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8076.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8153.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8076.74,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7761","type":"APR-DRG"}],"standard_charges":[{"minimum":3676,"maximum":3676,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3676,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3676,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3676,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7762","type":"APR-DRG"}],"standard_charges":[{"minimum":5041,"maximum":5041,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5041,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5041,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5041,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7763","type":"APR-DRG"}],"standard_charges":[{"minimum":5041,"maximum":5041,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5041,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5041,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5041,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE","code_information":[{"code":"7764","type":"APR-DRG"}],"standard_charges":[{"minimum":9779,"maximum":9779,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9779,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9779,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9779,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"minimum":5217,"maximum":5217,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5217,"methodology":"case rate"}]}]},{"description":"HC HDR SKIN LESION UP TO 2.0CM","code_information":[{"code":"77767","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":543.51,"maximum":543.51,"gross_charge":671,"discounted_cash":198.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":543.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":543.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":543.51,"methodology":"fee schedule"}]}]},{"description":"HC HDR SKIN LESION UP TO 2.0CM","code_information":[{"code":"77767","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":100.65,"maximum":743,"gross_charge":671,"discounted_cash":198.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":543.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":543.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":543.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":392.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":342.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":271.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":402.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":368.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":409.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":332.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":235.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":251.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":242.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":246.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":258.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":249.22,"methodology":"case rate"}]}]},{"description":"HC HDR SKIN LESION TX OVER 2.0","code_information":[{"code":"77768","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":609.12,"maximum":609.12,"gross_charge":752,"discounted_cash":222.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":609.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":609.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":609.12,"methodology":"fee schedule"}]}]},{"description":"HC HDR SKIN LESION TX OVER 2.0","code_information":[{"code":"77768","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":112.8,"maximum":743,"gross_charge":752,"discounted_cash":222.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":609.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":609.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":609.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":575.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":392.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":563.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":446.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":402.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":571.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":636.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":498.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":235.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":251.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":242.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":246.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":258.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":249.22,"methodology":"case rate"}]}]},{"description":"HC HDR RDNCL NTRSTL/ICAV BRCHTX 1 CHAN","code_information":[{"code":"77770","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":1783.62,"maximum":1783.62,"gross_charge":2202,"discounted_cash":651.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1783.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1783.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1783.62,"methodology":"fee schedule"}]}]},{"description":"HC HDR RDNCL NTRSTL/ICAV BRCHTX 1 CHAN","code_information":[{"code":"77770","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":330.3,"maximum":1783.62,"gross_charge":2202,"discounted_cash":651.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1783.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1783.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1783.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1046.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":442.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":350.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1060.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":466.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":519.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":469.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":620.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":663.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":638.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":651.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":682.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":657.51,"methodology":"case rate"}]}]},{"description":"HC HDR RDNCL NTRSTL/ICAV BRCHTX 2-12 CHAN","code_information":[{"code":"77771","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2087.37,"maximum":2087.37,"gross_charge":2577,"discounted_cash":762.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2087.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2087.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2087.37,"methodology":"fee schedule"}]}]},{"description":"HC HDR RDNCL NTRSTL/ICAV BRCHTX 2-12 CHAN","code_information":[{"code":"77771","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":386.55,"maximum":2087.37,"gross_charge":2577,"discounted_cash":762.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2087.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2087.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2087.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1046.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":805.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":638.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1060.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":799.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":890.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":840.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":620.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":663.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":638.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":651.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":682.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":657.51,"methodology":"case rate"}]}]},{"description":"HC HDR RDNCL NTRSTL/ICAV BRCHTX OVER 12 CHAN","code_information":[{"code":"77772","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":2319.03,"maximum":2319.03,"gross_charge":2863,"discounted_cash":847.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2319.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2319.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2319.03,"methodology":"fee schedule"}]}]},{"description":"HC HDR RDNCL NTRSTL/ICAV BRCHTX OVER 12 CHAN","code_information":[{"code":"77772","type":"CPT"},{"code":"0333","type":"RC"}],"standard_charges":[{"minimum":429.45,"maximum":2319.03,"gross_charge":2863,"discounted_cash":847.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2319.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2319.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2319.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1046.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1272.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1008.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1060.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1242.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1383.51,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1264.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":743,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":620.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":663.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":638.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":651.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":682.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":657.51,"methodology":"case rate"}]}]},{"description":"INTERSTITIAL SOURCE APP COMP","code_information":[{"code":"77778","type":"CPT"},{"code":"0342","type":"RC"}],"standard_charges":[{"minimum":2501.28,"maximum":2501.28,"gross_charge":3088,"discounted_cash":914.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2501.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2501.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2501.28,"methodology":"fee schedule"}]}]},{"description":"INTERSTITIAL SOURCE APP COMP","code_information":[{"code":"77778","type":"CPT"},{"code":"0342","type":"RC"}],"standard_charges":[{"minimum":448.22,"maximum":2501.28,"gross_charge":3088,"discounted_cash":914.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2501.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2501.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2501.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1518.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1046.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":565.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":448.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1060.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":808.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":900.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1232.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":620.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":663.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":638.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":651.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":682.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":657.51,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"minimum":4007,"maximum":4007,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4007,"methodology":"case rate"}]}]},{"description":"ABORTION WITHOUT D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"minimum":3191,"maximum":16404.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8403,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7944,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5620,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6875,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6446,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15584.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11010,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13127,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10444,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16404.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13883,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8620,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8620,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3191,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9113.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9751.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9387.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9569.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9660.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9569.46,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"minimum":3850,"maximum":3850,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3850,"methodology":"case rate"}]}]},{"description":"HC THYROID UPTAKE SGL/MULTI","code_information":[{"code":"78012","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":366.93,"maximum":366.93,"gross_charge":453,"discounted_cash":134.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.93,"methodology":"fee schedule"}]}]},{"description":"HC THYROID UPTAKE SGL/MULTI","code_information":[{"code":"78012","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":67.95,"maximum":1067,"gross_charge":453,"discounted_cash":134.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":137.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":109.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":145.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":162.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":113.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC THYROID IMG W/BLD FLOW","code_information":[{"code":"78013","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":912.06,"maximum":912.06,"gross_charge":1126,"discounted_cash":333.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":912.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":912.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":912.06,"methodology":"fee schedule"}]}]},{"description":"HC THYROID IMG W/BLD FLOW","code_information":[{"code":"78013","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":168.9,"maximum":1067,"gross_charge":1126,"discounted_cash":333.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":912.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":912.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":912.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":356.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":282.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":353.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":393.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":267.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC THYR IMG W/UPTK SGL/MULTI","code_information":[{"code":"78014","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1184.22,"maximum":1184.22,"gross_charge":1462,"discounted_cash":432.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1184.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1184.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1184.22,"methodology":"fee schedule"}]}]},{"description":"HC THYR IMG W/UPTK SGL/MULTI","code_information":[{"code":"78014","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":219.3,"maximum":1184.22,"gross_charge":1462,"discounted_cash":432.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1184.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1184.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1184.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":426.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":338.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":437.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":334.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC THYR CA MET IMG WHOLE BDY","code_information":[{"code":"78018","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1428.84,"maximum":1428.84,"gross_charge":1764,"discounted_cash":522.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1428.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1428.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1428.84,"methodology":"fee schedule"}]}]},{"description":"HC THYR CA MET IMG WHOLE BDY","code_information":[{"code":"78018","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":264.6,"maximum":1428.84,"gross_charge":1764,"discounted_cash":522.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1428.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1428.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1428.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":552.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":438.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":553.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":616.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":438.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC PARATHYROID IMG","code_information":[{"code":"78070","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":793.8,"maximum":793.8,"gross_charge":980,"discounted_cash":290.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":793.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":793.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":793.8,"methodology":"fee schedule"}]}]},{"description":"HC PARATHYROID IMG","code_information":[{"code":"78070","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":147,"maximum":1067,"gross_charge":980,"discounted_cash":290.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":793.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":793.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":793.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":526.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":417.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":524.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":583.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":414.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":196,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":196,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC PARATHYRD IMG W/SPECT & CT","code_information":[{"code":"78072","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":510.3,"maximum":510.3,"gross_charge":630,"discounted_cash":186.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":510.3,"methodology":"fee schedule"}]}]},{"description":"HC PARATHYRD IMG W/SPECT & CT","code_information":[{"code":"78072","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":94.5,"maximum":1178.45,"gross_charge":630,"discounted_cash":186.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":510.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":728.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":577.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":751.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":837.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":626.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"minimum":4684,"maximum":4684,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4684,"methodology":"case rate"}]}]},{"description":"HC LYMPH/LYMPH NODE SCAN","code_information":[{"code":"78195","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2229.93,"maximum":2229.93,"gross_charge":2753,"discounted_cash":814.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2229.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2229.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2229.93,"methodology":"fee schedule"}]}]},{"description":"HC LYMPH/LYMPH NODE SCAN","code_information":[{"code":"78195","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":412.95,"maximum":2229.93,"gross_charge":2753,"discounted_cash":814.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2229.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2229.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2229.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":606.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":480.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":603.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":672.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":497.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"minimum":4684,"maximum":4684,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4684,"methodology":"case rate"}]}]},{"description":"HC LIVER SCAN W/STATIC ONLY","code_information":[{"code":"78201","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":887.76,"maximum":887.76,"gross_charge":1096,"discounted_cash":324.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":887.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":887.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":887.76,"methodology":"fee schedule"}]}]},{"description":"HC LIVER SCAN W/STATIC ONLY","code_information":[{"code":"78201","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":164.4,"maximum":1178.45,"gross_charge":1096,"discounted_cash":324.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":887.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":887.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":887.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":336.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":266.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":344.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":383.74,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":266.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC LIVER/SPLEEN IMG STATIC ONLY","code_information":[{"code":"78215","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1396.44,"maximum":1396.44,"gross_charge":1724,"discounted_cash":510.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1396.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1396.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1396.44,"methodology":"fee schedule"}]}]},{"description":"HC LIVER/SPLEEN IMG STATIC ONLY","code_information":[{"code":"78215","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":258.6,"maximum":1396.44,"gross_charge":1724,"discounted_cash":510.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1396.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1396.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1396.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":346.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":274.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":348.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":387.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":272.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":327.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"LIVER/SPLEEN IMG W/VASC FLW","code_information":[{"code":"78216","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1312.2,"maximum":1312.2,"gross_charge":1620,"discounted_cash":479.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1312.2,"methodology":"fee schedule"}]}]},{"description":"LIVER/SPLEEN IMG W/VASC FLW","code_information":[{"code":"78216","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":153.86,"maximum":1312.2,"gross_charge":1620,"discounted_cash":479.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":194.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":153.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":206.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":229.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":180.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC HEPATOBILIARY IMG","code_information":[{"code":"78226","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2252.61,"maximum":2252.61,"gross_charge":2781,"discounted_cash":823.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2252.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2252.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2252.61,"methodology":"fee schedule"}]}]},{"description":"HC HEPATOBILIARY IMG","code_information":[{"code":"78226","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":359.25,"maximum":2252.61,"gross_charge":2781,"discounted_cash":823.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2252.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2252.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2252.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":599.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":475.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":593.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":660.54,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":457.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC HEPATOBILIARY IMG W/PHARM","code_information":[{"code":"78227","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2747.52,"maximum":2747.52,"gross_charge":3392,"discounted_cash":1004.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2747.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2747.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2747.52,"methodology":"fee schedule"}]}]},{"description":"HC HEPATOBILIARY IMG W/PHARM","code_information":[{"code":"78227","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":481.23,"maximum":2747.52,"gross_charge":3392,"discounted_cash":1004.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2747.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2747.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2747.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":822.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":652.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":810.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":902.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":617.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC GASTROESOPHAGEAL REFLX STDY","code_information":[{"code":"78262","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1524.42,"maximum":1524.42,"gross_charge":1882,"discounted_cash":557.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1524.42,"methodology":"fee schedule"}]}]},{"description":"HC GASTROESOPHAGEAL REFLX STDY","code_information":[{"code":"78262","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":282.3,"maximum":1524.42,"gross_charge":1882,"discounted_cash":557.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1524.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":429.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":340.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":419.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":467.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":335.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC GASTRIC EMPTYING IMG STUDY SOL OR LIQ","code_information":[{"code":"78264","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2459.16,"maximum":2459.16,"gross_charge":3036,"discounted_cash":898.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2459.16,"methodology":"fee schedule"}]}]},{"description":"HC GASTRIC EMPTYING IMG STUDY SOL OR LIQ","code_information":[{"code":"78264","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":359.25,"maximum":2459.16,"gross_charge":3036,"discounted_cash":898.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2459.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":505.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":400.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":598.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":666.09,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":465,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC PY TEST","code_information":[{"code":"78267","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":366.93,"maximum":366.93,"gross_charge":453,"discounted_cash":134.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.93,"methodology":"fee schedule"}]}]},{"description":"HC PY TEST","code_information":[{"code":"78267","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.05,"maximum":366.93,"gross_charge":453,"discounted_cash":134.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.91,"standard_charge_algorithm": "Lesser of $18.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.83,"standard_charge_algorithm": "Lesser of $11.83 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.39,"standard_charge_algorithm": "Lesser of $11.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.61,"standard_charge_algorithm": "Lesser of $11.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.17,"standard_charge_algorithm": "Lesser of $12.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.72,"standard_charge_algorithm": "Lesser of $11.72 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HEMORRHAGE IMG RBC","code_information":[{"code":"78278","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1570.59,"maximum":1570.59,"gross_charge":1939,"discounted_cash":573.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1570.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1570.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1570.59,"methodology":"fee schedule"}]}]},{"description":"HC HEMORRHAGE IMG RBC","code_information":[{"code":"78278","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":290.85,"maximum":1570.59,"gross_charge":1939,"discounted_cash":573.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1570.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1570.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1570.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":611.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":484.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":609.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":678.78,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":487.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC INTESTINE IMG MECKEL LOC","code_information":[{"code":"78290","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1157.49,"maximum":1157.49,"gross_charge":1429,"discounted_cash":422.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1157.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1157.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1157.49,"methodology":"fee schedule"}]}]},{"description":"HC INTESTINE IMG MECKEL LOC","code_information":[{"code":"78290","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":214.35,"maximum":1157.49,"gross_charge":1429,"discounted_cash":422.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1157.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1157.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1157.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":611.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":484.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":603.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":672.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":460.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":285.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH MCC","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":10066,"maximum":29218,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16559,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15654,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10066,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29218,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27394,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25551.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20858,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24868,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18707,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26896.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27357,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16986,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16986,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14942.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15988.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15390.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15689.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15838.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15689.42,"methodology":"case rate"}]}]},{"description":"HC BONE &/OR JOINT IMG MLTPLE","code_information":[{"code":"78305","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1030.32,"maximum":1030.32,"gross_charge":1272,"discounted_cash":376.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1030.32,"methodology":"fee schedule"}]}]},{"description":"HC BONE &/OR JOINT IMG MLTPLE","code_information":[{"code":"78305","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":190.8,"maximum":1067,"gross_charge":1272,"discounted_cash":376.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1030.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":386.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":306.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":481.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":536.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC BONE &/OR JNT IMG WHOLE BDY","code_information":[{"code":"78306","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2783.97,"maximum":2783.97,"gross_charge":3437,"discounted_cash":1017.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2783.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2783.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2783.97,"methodology":"fee schedule"}]}]},{"description":"HC BONE &/OR JNT IMG WHOLE BDY","code_information":[{"code":"78306","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":336.72,"maximum":2783.97,"gross_charge":3437,"discounted_cash":1017.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2783.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2783.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2783.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":424.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":336.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":526.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":585.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":421.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":687.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC BONE &/OR JOINT IMG 3-PHASE","code_information":[{"code":"78315","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":3981.15,"maximum":3981.15,"gross_charge":4915,"discounted_cash":1454.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3981.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3981.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3981.15,"methodology":"fee schedule"}]}]},{"description":"HC BONE &/OR JOINT IMG 3-PHASE","code_information":[{"code":"78315","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":359.25,"maximum":3981.15,"gross_charge":4915,"discounted_cash":1454.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3981.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3981.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3981.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":606.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":481.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":602.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":670.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":484.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":933.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":983,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":983,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH CC","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":5818,"maximum":18448,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9735,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9203,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5818,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18448,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17296,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17212.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11285,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13454,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10812,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18118.46,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16084,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9986,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9986,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10065.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10770.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10367.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10569.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10669.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10569.11,"methodology":"case rate"}]}]},{"description":"HC MYOCRD IMG PET RST/STRS W/CT","code_information":[{"code":"78430","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":4710.15,"maximum":4710.15,"gross_charge":5815,"discounted_cash":1721.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4710.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4710.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4710.15,"methodology":"fee schedule"}]}]},{"description":"HC MYOCRD IMG PET RST/STRS W/CT","code_information":[{"code":"78430","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":136.15,"maximum":4710.15,"gross_charge":5815,"discounted_cash":1721.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4710.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4710.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4710.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":171.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3489,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1104.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1163,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":872.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1163,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"HC MYOCRD IMG PET RST&STRS CT","code_information":[{"code":"78431","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":7308.63,"maximum":7308.63,"gross_charge":9023,"discounted_cash":2670.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7308.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7308.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7308.63,"methodology":"fee schedule"}]}]},{"description":"HC MYOCRD IMG PET RST&STRS CT","code_information":[{"code":"78431","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":158.05,"maximum":7308.63,"gross_charge":9023,"discounted_cash":2670.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7308.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7308.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7308.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2250.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2250.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2250.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":199.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":158.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3440.59,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5413.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1714.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1804.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1353.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1804.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2012.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2152.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2072.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2112.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2213.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2132.76,"methodology":"case rate"}]}]},{"description":"PET/CT CARDIAC SARCOIDOSIS","code_information":[{"code":"78432","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":8120.25,"maximum":8120.25,"gross_charge":10025,"discounted_cash":2967.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8120.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8120.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8120.25,"methodology":"fee schedule"}]}]},{"description":"PET/CT CARDIAC SARCOIDOSIS","code_information":[{"code":"78432","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":168.7,"maximum":8120.25,"gross_charge":10025,"discounted_cash":2967.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8120.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8120.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8120.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1850.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1850.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1850.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":212.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":168.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2829.06,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6015,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1904.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2005,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1503.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2005,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1654.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1770.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1704.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1737.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1819.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1753.69,"methodology":"case rate"}]}]},{"description":"HC MYOCRD IMG PET 2RTRACER CT","code_information":[{"code":"78433","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":8932.68,"maximum":8932.68,"gross_charge":11028,"discounted_cash":3264.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8932.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8932.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8932.68,"methodology":"fee schedule"}]}]},{"description":"HC MYOCRD IMG PET 2RTRACER CT","code_information":[{"code":"78433","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":184.32,"maximum":8932.68,"gross_charge":11028,"discounted_cash":3264.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8932.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8932.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8932.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1950.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1950.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1950.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":232.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":184.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2981.95,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6616.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2095.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2205.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1654.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2205.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1743.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1865.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1796.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1831.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1918.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1848.46,"methodology":"case rate"}]}]},{"description":"HC AQMBF PET REST & RX STRESS","code_information":[{"code":"78434","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":4823.55,"maximum":4823.55,"gross_charge":5955,"discounted_cash":1762.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4823.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4823.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4823.55,"methodology":"fee schedule"}]}]},{"description":"HC AQMBF PET REST & RX STRESS","code_information":[{"code":"78434","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":53.2,"maximum":4823.55,"gross_charge":5955,"discounted_cash":1762.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4823.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4823.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4823.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":53.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3573,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1131.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1191,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":893.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1191,"methodology":"fee schedule"}]}]},{"description":"HC MYOCARD IMG SNG SPEC","code_information":[{"code":"78451","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":3747.06,"maximum":3747.06,"gross_charge":4626,"discounted_cash":1369.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3747.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3747.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3747.06,"methodology":"fee schedule"}]}]},{"description":"HC MYOCARD IMG SNG SPEC","code_information":[{"code":"78451","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":446,"maximum":3747.06,"gross_charge":4626,"discounted_cash":1369.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3747.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3747.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3747.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":562.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":446,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":548.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":611.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":473.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":878.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":925.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":925.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC MYOCARD IMG MULT SPEC","code_information":[{"code":"78452","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":4569.21,"maximum":4569.21,"gross_charge":5641,"discounted_cash":1669.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4569.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4569.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4569.21,"methodology":"fee schedule"}]}]},{"description":"HC MYOCARD IMG MULT SPEC","code_information":[{"code":"78452","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":641.66,"maximum":4569.21,"gross_charge":5641,"discounted_cash":1669.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4569.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4569.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4569.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":809.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":641.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":794.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":884.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":658.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC MYOCARD IMG SNGL PHRM PLANR","code_information":[{"code":"78453","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2148.12,"maximum":2148.12,"gross_charge":2652,"discounted_cash":785,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2148.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2148.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2148.12,"methodology":"fee schedule"}]}]},{"description":"HC MYOCARD IMG SNGL PHRM PLANR","code_information":[{"code":"78453","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":397.8,"maximum":2858.12,"gross_charge":2652,"discounted_cash":785,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2148.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2148.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2148.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":522.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":414.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":514.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":573.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":423.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":530.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC PET CARDIAC METABOLIC EVAL","code_information":[{"code":"78459","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":2857.68,"maximum":2857.68,"gross_charge":3528,"discounted_cash":1044.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2857.68,"methodology":"fee schedule"}]}]},{"description":"HC PET CARDIAC METABOLIC EVAL","code_information":[{"code":"78459","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":529.2,"maximum":2858.12,"gross_charge":3528,"discounted_cash":1044.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2857.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2263.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1794.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2442,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2836,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2116.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC INFARCT IMG SPECT","code_information":[{"code":"78469","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1897.02,"maximum":1897.02,"gross_charge":2342,"discounted_cash":693.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1897.02,"methodology":"fee schedule"}]}]},{"description":"HC INFARCT IMG SPECT","code_information":[{"code":"78469","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":290.31,"maximum":1897.02,"gross_charge":2342,"discounted_cash":693.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1897.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":366.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":290.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":362.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":403.57,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":313.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":444.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC CARD IMG EQ REST WM EF","code_information":[{"code":"78472","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1408.59,"maximum":1408.59,"gross_charge":1739,"discounted_cash":514.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1408.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1408.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1408.59,"methodology":"fee schedule"}]}]},{"description":"HC CARD IMG EQ REST WM EF","code_information":[{"code":"78472","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":260.85,"maximum":1408.59,"gross_charge":1739,"discounted_cash":514.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1408.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1408.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1408.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":370.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":293.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":365.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":406.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC PET CARDIAC PERFUS;SINGLE","code_information":[{"code":"78491","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":3492.72,"maximum":3492.72,"gross_charge":4312,"discounted_cash":1276.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3492.72,"methodology":"fee schedule"}]}]},{"description":"HC PET CARDIAC PERFUS;SINGLE","code_information":[{"code":"78491","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":646.8,"maximum":3492.72,"gross_charge":4312,"discounted_cash":1276.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2263.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1794.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2442,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2836,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2587.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":819.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"HC PET CARDIAC PERFUS;MULTI","code_information":[{"code":"78492","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":3492.72,"maximum":3492.72,"gross_charge":4312,"discounted_cash":1276.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3492.72,"methodology":"fee schedule"}]}]},{"description":"HC PET CARDIAC PERFUS;MULTI","code_information":[{"code":"78492","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":646.8,"maximum":3492.72,"gross_charge":4312,"discounted_cash":1276.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3492.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2263.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1794.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2442,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2836,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2587.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":819.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"HC FIRST PASS MUGA","code_information":[{"code":"78496","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":893.43,"maximum":893.43,"gross_charge":1103,"discounted_cash":326.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":893.43,"methodology":"fee schedule"}]}]},{"description":"HC FIRST PASS MUGA","code_information":[{"code":"78496","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":32.6,"maximum":1067,"gross_charge":1103,"discounted_cash":326.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":893.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":529.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":617.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.6,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":4922,"maximum":15695.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7852,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7423,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14153,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13269,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14911.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9859,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11754,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9146,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15695.95,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12972,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8055,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8719.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9330.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8981.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9155.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9243.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9155.97,"methodology":"case rate"}]}]},{"description":"HC PUL VENT IMG AEROSOL/GAS","code_information":[{"code":"78579","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1265.22,"maximum":1265.22,"gross_charge":1562,"discounted_cash":462.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1265.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1265.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1265.22,"methodology":"fee schedule"}]}]},{"description":"HC PUL VENT IMG AEROSOL/GAS","code_information":[{"code":"78579","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":234.3,"maximum":1265.22,"gross_charge":1562,"discounted_cash":462.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1265.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1265.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1265.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":330.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":262.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":332.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":370.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":261.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC PUL PERF IMG PARTICULATE","code_information":[{"code":"78580","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":894.24,"maximum":894.24,"gross_charge":1104,"discounted_cash":326.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":894.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":894.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":894.24,"methodology":"fee schedule"}]}]},{"description":"HC PUL PERF IMG PARTICULATE","code_information":[{"code":"78580","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":165.6,"maximum":1067,"gross_charge":1104,"discounted_cash":326.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":894.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":894.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":894.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":412.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":327.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":407.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":454.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":331.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC PUL PERF IMG PARTIC VENT","code_information":[{"code":"78582","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2181.33,"maximum":2181.33,"gross_charge":2693,"discounted_cash":797.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2181.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2181.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2181.33,"methodology":"fee schedule"}]}]},{"description":"HC PUL PERF IMG PARTIC VENT","code_information":[{"code":"78582","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":403.95,"maximum":2181.33,"gross_charge":2693,"discounted_cash":797.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2181.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2181.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2181.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":576.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":456.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":571.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":636.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":467.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC PUL.QUANT DIFF FUNC W IMG","code_information":[{"code":"78597","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":944.46,"maximum":944.46,"gross_charge":1166,"discounted_cash":345.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":944.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":944.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":944.46,"methodology":"fee schedule"}]}]},{"description":"HC PUL.QUANT DIFF FUNC W IMG","code_information":[{"code":"78597","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":174.9,"maximum":1067,"gross_charge":1166,"discounted_cash":345.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":944.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":944.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":944.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":339.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":269.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":336.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":374.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":281.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC PUL QUANT DIFF FUNC VNT/PRF","code_information":[{"code":"78598","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2573.37,"maximum":2573.37,"gross_charge":3177,"discounted_cash":940.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2573.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2573.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2573.37,"methodology":"fee schedule"}]}]},{"description":"HC PUL QUANT DIFF FUNC VNT/PRF","code_information":[{"code":"78598","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":425.52,"maximum":2573.37,"gross_charge":3177,"discounted_cash":940.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2573.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2573.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2573.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":541.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":429.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":535.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":596.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":425.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":635.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITH MCC","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":9940,"maximum":26026,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14525,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13732,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9940,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26026,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24401,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23066.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17457,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20813,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18471,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24280.53,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23998,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14900,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14900,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13489.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14433.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13893.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14163.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14298.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14163.64,"methodology":"case rate"}]}]},{"description":"HC BRAIN IMG < 4 STATIC W/FLW","code_information":[{"code":"78601","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1380.24,"maximum":1380.24,"gross_charge":1704,"discounted_cash":504.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1380.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1380.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1380.24,"methodology":"fee schedule"}]}]},{"description":"HC BRAIN IMG < 4 STATIC W/FLW","code_information":[{"code":"78601","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":255.6,"maximum":1380.24,"gross_charge":1704,"discounted_cash":504.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1380.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1380.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1380.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":388.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":307.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":389.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":433.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":302.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":340.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC BRAIN PET METABOLIC EVAL","code_information":[{"code":"78608","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":3819.15,"maximum":3819.15,"gross_charge":4715,"discounted_cash":1395.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3819.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3819.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3819.15,"methodology":"fee schedule"}]}]},{"description":"HC BRAIN PET METABOLIC EVAL","code_information":[{"code":"78608","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":707.25,"maximum":3819.15,"gross_charge":4715,"discounted_cash":1395.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3819.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3819.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3819.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2263.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1794.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2442,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2836,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2829,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":895.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":943,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":943,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"HC CSF IMG CISTERNOGRAPHY","code_information":[{"code":"78630","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1581.12,"maximum":1581.12,"gross_charge":1952,"discounted_cash":577.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1581.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1581.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1581.12,"methodology":"fee schedule"}]}]},{"description":"HC CSF IMG CISTERNOGRAPHY","code_information":[{"code":"78630","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":292.8,"maximum":1581.12,"gross_charge":1952,"discounted_cash":577.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1581.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1581.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1581.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":618.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":490.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":618.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":689.09,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":471.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC CSF IMG SHUNT EVAL","code_information":[{"code":"78645","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":825.39,"maximum":825.39,"gross_charge":1019,"discounted_cash":301.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":825.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":825.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":825.39,"methodology":"fee schedule"}]}]},{"description":"HC CSF IMG SHUNT EVAL","code_information":[{"code":"78645","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":152.85,"maximum":1178.45,"gross_charge":1019,"discounted_cash":301.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":825.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":825.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":825.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":601.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":476.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":603.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":672.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":452.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITH CC","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":4241,"maximum":18097,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9544,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9023,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5972,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18097,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16967,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16979.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11515,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13729,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11098,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17873.32,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15769,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9791,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9791,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4241,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9929.62,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10624.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10227.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10426.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10525.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10426.11,"methodology":"case rate"}]}]},{"description":"HC KIDNEY IMG SNG FLW/FUNC","code_information":[{"code":"78707","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1244.16,"maximum":1244.16,"gross_charge":1536,"discounted_cash":454.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1244.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1244.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1244.16,"methodology":"fee schedule"}]}]},{"description":"HC KIDNEY IMG SNG FLW/FUNC","code_information":[{"code":"78707","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":230.4,"maximum":1244.16,"gross_charge":1536,"discounted_cash":454.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1244.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1244.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1244.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":376.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":298.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":378.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":421.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":326.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"HC KIDNEY IMG SNG FLW/FUNC/PH","code_information":[{"code":"78708","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2487.51,"maximum":2487.51,"gross_charge":3071,"discounted_cash":909.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2487.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2487.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2487.51,"methodology":"fee schedule"}]}]},{"description":"HC KIDNEY IMG SNG FLW/FUNC/PH","code_information":[{"code":"78708","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":183.87,"maximum":2487.51,"gross_charge":3071,"discounted_cash":909.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2487.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2487.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2487.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1178.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":788.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":231.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":822.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":239.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":267.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":250.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":481.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":514.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":495.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":505.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":529.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":510.1,"methodology":"case rate"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":4607,"maximum":16056.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8132,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7688,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4858,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15077,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14136,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15253.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9430,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11243,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9027,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16056.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8342,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8342,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4607,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8920.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9544.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9188.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9366.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9455.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9366.42,"methodology":"case rate"}]}]},{"description":"HC LIMITED TUMOR LOCALIZ/RP DISTRIB","code_information":[{"code":"78800","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1163.16,"maximum":1163.16,"gross_charge":1436,"discounted_cash":425.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1163.16,"methodology":"fee schedule"}]}]},{"description":"HC LIMITED TUMOR LOCALIZ/RP DISTRIB","code_information":[{"code":"78800","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":215.4,"maximum":1163.16,"gross_charge":1436,"discounted_cash":425.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":879.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":601.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":319.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":253.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":614.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":461.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":513.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":361.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":359.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":384.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":370.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":377.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":395.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":380.81,"methodology":"case rate"}]}]},{"description":"HC INFLAMM LOCALIZE WHOLE BDY","code_information":[{"code":"78802","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":4131,"maximum":4131,"gross_charge":5100,"discounted_cash":1509.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4131,"methodology":"fee schedule"}]}]},{"description":"HC INFLAMM LOCALIZE WHOLE BDY","code_information":[{"code":"78802","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":436.41,"maximum":4131,"gross_charge":5100,"discounted_cash":1509.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":570.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":452.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":556.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":620.09,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":436.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":969,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":765,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC TRANSTHY-AMYLOISOSIS W/SPECT","code_information":[{"code":"78803","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":4010.31,"maximum":4010.31,"gross_charge":4951,"discounted_cash":1465.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4010.31,"methodology":"fee schedule"}]}]},{"description":"HC TRANSTHY-AMYLOISOSIS W/SPECT","code_information":[{"code":"78803","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":464.11,"maximum":4010.31,"gross_charge":4951,"discounted_cash":1465.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":585.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":464.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":684.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":762.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":543.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC TUMOR LOCALIZATION SPECT","code_information":[{"code":"78803","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":4010.31,"maximum":4010.31,"gross_charge":4951,"discounted_cash":1465.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4010.31,"methodology":"fee schedule"}]}]},{"description":"HC TUMOR LOCALIZATION SPECT","code_information":[{"code":"78803","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":464.11,"maximum":4010.31,"gross_charge":4951,"discounted_cash":1465.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4010.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":585.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":464.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":684.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":762.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":543.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":940.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC TUMOR LOCAL WB 2/MORE DAYS","code_information":[{"code":"78804","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":2326.32,"maximum":2326.32,"gross_charge":2872,"discounted_cash":850.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2326.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2326.32,"methodology":"fee schedule"}]}]},{"description":"HC TUMOR LOCAL WB 2/MORE DAYS","code_information":[{"code":"78804","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":430.8,"maximum":2858.12,"gross_charge":2872,"discounted_cash":850.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2326.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2326.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2326.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1048.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":831.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1241.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1382.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":918.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC PET IMG SKULL BASE TO MID-THG W/CT","code_information":[{"code":"78815","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":6168.15,"maximum":6168.15,"gross_charge":7615,"discounted_cash":2254.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6168.15,"methodology":"fee schedule"}]}]},{"description":"HC PET IMG SKULL BASE TO MID-THG W/CT","code_information":[{"code":"78815","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":1142.25,"maximum":6168.15,"gross_charge":7615,"discounted_cash":2254.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4527.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3589.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2442,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2836,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4569,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1446.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1523,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1523,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"HC PET IMG WHOLEBODY W/CT","code_information":[{"code":"78816","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":6168.15,"maximum":6168.15,"gross_charge":7615,"discounted_cash":2254.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6168.15,"methodology":"fee schedule"}]}]},{"description":"HC PET IMG WHOLEBODY W/CT","code_information":[{"code":"78816","type":"CPT"},{"code":"0404","type":"RC"}],"standard_charges":[{"minimum":1142.25,"maximum":6168.15,"gross_charge":7615,"discounted_cash":2254.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6168.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4527.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3589.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2442,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2836,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2466.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4569,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1313,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1446.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1523,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1142.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1523,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"HC CERETEC WB SCAN W/ SPECT CT","code_information":[{"code":"78830","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":4131,"maximum":4131,"gross_charge":5100,"discounted_cash":1509.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4131,"methodology":"fee schedule"}]}]},{"description":"HC CERETEC WB SCAN W/ SPECT CT","code_information":[{"code":"78830","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":684.18,"maximum":4131,"gross_charge":5100,"discounted_cash":1509.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":863,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":684.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":855.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":952.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":689.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":969,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":765,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC CERETEC WB SCAN W/ SPECT","code_information":[{"code":"78831","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":4131,"maximum":4131,"gross_charge":5100,"discounted_cash":1509.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4131,"methodology":"fee schedule"}]}]},{"description":"HC CERETEC WB SCAN W/ SPECT","code_information":[{"code":"78831","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":765,"maximum":4131,"gross_charge":5100,"discounted_cash":1509.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2858.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2071.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1280.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1015.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1995.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1269.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1413.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":994.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":969,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":765,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1167.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1248.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1202.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1225.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1283.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1237.18,"methodology":"case rate"}]}]},{"description":"HC CERETEC WB SCAN W/SPEC CT MULT","code_information":[{"code":"78832","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":4692.33,"maximum":4692.33,"gross_charge":5793,"discounted_cash":1714.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4692.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4692.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4692.33,"methodology":"fee schedule"}]}]},{"description":"HC CERETEC WB SCAN W/SPEC CT MULT","code_information":[{"code":"78832","type":"CPT"},{"code":"0341","type":"RC"}],"standard_charges":[{"minimum":868.95,"maximum":4692.33,"gross_charge":5793,"discounted_cash":1714.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4692.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4692.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4692.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3193.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2282.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1691.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1341.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2229.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1676.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1867.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1293.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1100.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1158.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":868.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1158.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1304.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1395.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1343.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1369.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1434.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1382.28,"methodology":"case rate"}]}]},{"description":"NEONATES DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":5575,"maximum":26771,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5946,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5575,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25117.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19735,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23529,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19209,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26439.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26771,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1547,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1547,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11885,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14688.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15716.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15129.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15422.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15569.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15422.98,"methodology":"case rate"}]}]},{"description":"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME NEONATE","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":4240,"maximum":88287,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53359,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50028,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70619.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65082,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":77594,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63349,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":74336.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88287,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3095,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3095,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4240,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41298.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44189.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42537.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43363.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":43776.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43363.13,"methodology":"case rate"}]}]},{"description":"HC ORAL RADIOPHARM RX","code_information":[{"code":"79005","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1470.96,"maximum":1470.96,"gross_charge":1816,"discounted_cash":537.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1470.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1470.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1470.96,"methodology":"fee schedule"}]}]},{"description":"HC ORAL RADIOPHARM RX","code_information":[{"code":"79005","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":76.77,"maximum":1470.96,"gross_charge":1816,"discounted_cash":537.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1470.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1470.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1470.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":490.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":490.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":362.99,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":96.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":76.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":342.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":100.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":198.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":345.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":200.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":206.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":210.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":220.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":212.4,"methodology":"case rate"}]}]},{"description":"PREMATURITY WITH MAJOR PROBLEMS","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":2231,"maximum":59584,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37656,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35305,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49914.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44448,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52993,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43264,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":52541.16,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59584,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2450,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2450,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2231,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29189.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31232.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30065.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30649.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30940.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30649.01,"methodology":"case rate"}]}]},{"description":"HC RADIOPHARM RX IV ADMIN","code_information":[{"code":"79101","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":1282.23,"maximum":1282.23,"gross_charge":1583,"discounted_cash":468.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1282.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1282.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1282.23,"methodology":"fee schedule"}]}]},{"description":"HC RADIOPHARM RX IV ADMIN","code_information":[{"code":"79101","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":77.9,"maximum":1282.23,"gross_charge":1583,"discounted_cash":468.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1282.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1282.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1282.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":490.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":490.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":362.99,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":98.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":77.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":342.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":101.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":113.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":214.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":200.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":206.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":210.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":220.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":212.4,"methodology":"case rate"}]}]},{"description":"PREMATURITY WITHOUT MAJOR PROBLEMS","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":1682,"maximum":36381,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6038,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5661,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32225.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26819,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31975,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26105,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33921.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36381,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1547,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1547,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1682,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18845.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20164.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19410.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19787.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19976.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19787.83,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7921","type":"APR-DRG"}],"standard_charges":[{"minimum":8773,"maximum":8773,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8773,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8773,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8773,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7922","type":"APR-DRG"}],"standard_charges":[{"minimum":11642,"maximum":11642,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11642,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11642,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11642,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7923","type":"APR-DRG"}],"standard_charges":[{"minimum":26400,"maximum":26400,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26400,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26400,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26400,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7924","type":"APR-DRG"}],"standard_charges":[{"minimum":34029,"maximum":34029,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34029,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34029,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34029,"methodology":"case rate"}]}]},{"description":"FULL TERM NEONATE WITH MAJOR PROBLEMS","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":9774,"maximum":61205,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10425,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9774,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":51129.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45657,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54435,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44442,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":53820.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61205,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2450,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2450,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10388,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29900.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31993.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30797.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31395.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31694.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31395.04,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7931","type":"APR-DRG"}],"standard_charges":[{"minimum":7899,"maximum":7899,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7899,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7899,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7899,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7932","type":"APR-DRG"}],"standard_charges":[{"minimum":12938,"maximum":12938,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12938,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12938,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12938,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7933","type":"APR-DRG"}],"standard_charges":[{"minimum":14877,"maximum":14877,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14877,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14877,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14877,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7934","type":"APR-DRG"}],"standard_charges":[{"minimum":28432,"maximum":28432,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28432,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28432,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28432,"methodology":"case rate"}]}]},{"description":"NEONATE WITH OTHER SIGNIFICANT PROBLEMS","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":2489,"maximum":25402,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2655,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2489,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21531.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16161,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19267,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15730,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22665.14,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1547,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1547,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25402,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12591.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13473.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12969.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13221.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13347.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13221.33,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7941","type":"APR-DRG"}],"standard_charges":[{"minimum":6574,"maximum":6574,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6574,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6574,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6574,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7942","type":"APR-DRG"}],"standard_charges":[{"minimum":8993,"maximum":8993,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8993,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8993,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8993,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7943","type":"APR-DRG"}],"standard_charges":[{"minimum":13231,"maximum":13231,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13231,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13231,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13231,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"7944","type":"APR-DRG"}],"standard_charges":[{"minimum":21273,"maximum":21273,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21273,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21273,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21273,"methodology":"case rate"}]}]},{"description":"HC RADIOPHRAM INTRA-ARTERIAL","code_information":[{"code":"79445","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":471.42,"maximum":471.42,"gross_charge":582,"discounted_cash":172.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":471.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":471.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":471.42,"methodology":"fee schedule"}]}]},{"description":"HC RADIOPHRAM INTRA-ARTERIAL","code_information":[{"code":"79445","type":"CPT"},{"code":"0340","type":"RC"}],"standard_charges":[{"minimum":87.3,"maximum":1067,"gross_charge":582,"discounted_cash":172.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":471.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":471.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":471.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":490.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":490.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":362.99,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":190.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":150.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":342.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":184.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":205.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1067,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":200.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":214.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":206.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":210.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":220.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":212.4,"methodology":"case rate"}]}]},{"description":"NORMAL NEWBORN","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1146,"maximum":7905.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1796,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1698,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1146,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1943,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1822,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7510.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2188,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2608,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2130,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":7905.78,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2967,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":967,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":967,"methodology":"per diem"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1297,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4392.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4699.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4523.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4611.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4655.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4611.71,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"minimum":6257,"maximum":24576,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11475,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10849,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8058,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24576,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23042,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19339.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14192,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16921,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14975,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20357.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18959,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11772,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11772,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6257,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11309.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12101.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11648.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11874.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11988.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11874.98,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"minimum":5658,"maximum":16791,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8703,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8228,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5658,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14176,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13291,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15951.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10030,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11958,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10515,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16791,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14379,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8928,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8928,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6257,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9328.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9981.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9608.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9794.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9888.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9794.75,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"minimum":4744,"maximum":16791,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8703,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8228,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4744,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14176,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13291,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15951.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10030,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11958,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8817,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16791,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14379,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8928,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8928,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9328.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9981.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9608.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9794.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9888.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9794.75,"methodology":"case rate"}]}]},{"description":"SPLENIC PROCEDURES WITH MCC","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"minimum":17030,"maximum":70614,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42741,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40406,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28149,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66141,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62012,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57547.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56290,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67112,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52311,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":60576.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70614,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":43844,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43844,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17030,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33653.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36009.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34663.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35336.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35672.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35336.28,"methodology":"case rate"}]}]},{"description":"SPLENIC PROCEDURES WITH CC","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"minimum":12705,"maximum":46228,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26192,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24761,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16008,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46228,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43342,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37324.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28736,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34260,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29749,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":39288.5,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43273,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26868,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26868,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12705,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21826.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23354.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22481.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22918.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23136.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22918.29,"methodology":"case rate"}]}]},{"description":"HC LAB BASIC METABOLIC PANEL","code_information":[{"code":"80048","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":288.36,"maximum":288.36,"gross_charge":356,"discounted_cash":105.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB BASIC METABOLIC PANEL","code_information":[{"code":"80048","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.46,"maximum":288.36,"gross_charge":356,"discounted_cash":105.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.47,"standard_charge_algorithm": "Lesser of $14.47 or 171 Percent of Billed Charges","median_amount":108.32,"10th_percentile":108.32,"90th_percentile":108.32,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.46,"standard_charge_algorithm": "Lesser of $8.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.05,"standard_charge_algorithm": "Lesser of $9.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.71,"standard_charge_algorithm": "Lesser of $8.71 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.88,"standard_charge_algorithm": "Lesser of $8.88 or 105 Percent of Billed Charges","median_amount":8.88,"10th_percentile":8.88,"90th_percentile":8.88,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.31,"standard_charge_algorithm": "Lesser of $9.31 or 110 Percent of Billed Charges","median_amount":8.46,"10th_percentile":8.46,"90th_percentile":8.46,"count":"14","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.97,"standard_charge_algorithm": "Lesser of $8.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GENERAL HEALTH PANEL","code_information":[{"code":"80050","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"GENERAL HEALTH PANEL","code_information":[{"code":"80050","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":103.9,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":93.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":103.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":47.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"}]}]},{"description":"HC LAB ELECTROLYTES PANEL","code_information":[{"code":"80051","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":439.02,"maximum":439.02,"gross_charge":542,"discounted_cash":160.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.02,"methodology":"fee schedule"}]}]},{"description":"HC LAB ELECTROLYTES PANEL","code_information":[{"code":"80051","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.01,"maximum":439.02,"gross_charge":542,"discounted_cash":160.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.99,"standard_charge_algorithm": "Lesser of $11.99 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.01,"standard_charge_algorithm": "Lesser of $7.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.5,"standard_charge_algorithm": "Lesser of $7.50 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.22,"standard_charge_algorithm": "Lesser of $7.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.36,"standard_charge_algorithm": "Lesser of $7.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.71,"standard_charge_algorithm": "Lesser of $7.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.43,"standard_charge_algorithm": "Lesser of $7.43 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COMP METABOLIC PANEL","code_information":[{"code":"80053","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":501.39,"maximum":501.39,"gross_charge":619,"discounted_cash":183.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":501.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":501.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":501.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB COMP METABOLIC PANEL","code_information":[{"code":"80053","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.56,"maximum":501.39,"gross_charge":619,"discounted_cash":183.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":501.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":501.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":501.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.06,"standard_charge_algorithm": "Lesser of $18.06 or 171 Percent of Billed Charges","median_amount":173.58,"10th_percentile":173.58,"90th_percentile":173.58,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.56,"standard_charge_algorithm": "Lesser of $10.56 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.3,"standard_charge_algorithm": "Lesser of $11.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.88,"standard_charge_algorithm": "Lesser of $10.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.09,"standard_charge_algorithm": "Lesser of $11.09 or 105 Percent of Billed Charges","median_amount":11.09,"10th_percentile":11.09,"90th_percentile":11.09,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.62,"standard_charge_algorithm": "Lesser of $11.62 or 110 Percent of Billed Charges","median_amount":10.56,"10th_percentile":10.56,"90th_percentile":33.67,"count":"39","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.19,"standard_charge_algorithm": "Lesser of $11.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LIPID PANEL","code_information":[{"code":"80061","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB LIPID PANEL","code_information":[{"code":"80061","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.39,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.9,"standard_charge_algorithm": "Lesser of $22.90 or 171 Percent of Billed Charges","median_amount":22.9,"10th_percentile":21.56,"90th_percentile":22.9,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"standard_charge_algorithm": "Lesser of $13.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 103 Percent of Billed Charges","median_amount":13.79,"10th_percentile":13.79,"90th_percentile":13.79,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.06,"standard_charge_algorithm": "Lesser of $14.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.73,"standard_charge_algorithm": "Lesser of $14.73 or 110 Percent of Billed Charges","median_amount":14.73,"10th_percentile":14.73,"90th_percentile":14.73,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 106 Percent of Billed Charges","median_amount":14.19,"10th_percentile":14.19,"90th_percentile":14.19,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"HC LAB LIPID PANEL","code_information":[{"code":"80061","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB LIPID PANEL","code_information":[{"code":"80061","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.39,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.9,"standard_charge_algorithm": "Lesser of $22.90 or 171 Percent of Billed Charges","median_amount":22.9,"10th_percentile":21.56,"90th_percentile":22.9,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"standard_charge_algorithm": "Lesser of $13.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 103 Percent of Billed Charges","median_amount":13.79,"10th_percentile":13.79,"90th_percentile":13.79,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.06,"standard_charge_algorithm": "Lesser of $14.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.73,"standard_charge_algorithm": "Lesser of $14.73 or 110 Percent of Billed Charges","median_amount":14.73,"10th_percentile":14.73,"90th_percentile":14.73,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 106 Percent of Billed Charges","median_amount":14.19,"10th_percentile":14.19,"90th_percentile":14.19,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"HC RENAL PROFILE","code_information":[{"code":"80069","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":396.9,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"}]}]},{"description":"HC RENAL PROFILE","code_information":[{"code":"80069","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.68,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.84,"standard_charge_algorithm": "Lesser of $14.84 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.68,"standard_charge_algorithm": "Lesser of $8.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.29,"standard_charge_algorithm": "Lesser of $9.29 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.94,"standard_charge_algorithm": "Lesser of $8.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.11,"standard_charge_algorithm": "Lesser of $9.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.55,"standard_charge_algorithm": "Lesser of $9.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.2,"standard_charge_algorithm": "Lesser of $9.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ACUTE HEPATITIS PANEL","code_information":[{"code":"80074","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":398.52,"maximum":398.52,"gross_charge":492,"discounted_cash":145.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":398.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":398.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":398.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB ACUTE HEPATITIS PANEL","code_information":[{"code":"80074","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":47.63,"maximum":398.52,"gross_charge":492,"discounted_cash":145.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":398.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":398.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":398.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":139.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.45,"standard_charge_algorithm": "Lesser of $81.45 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":116.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":71.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.63,"standard_charge_algorithm": "Lesser of $47.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":50.96,"standard_charge_algorithm": "Lesser of $50.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.06,"standard_charge_algorithm": "Lesser of $49.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.01,"standard_charge_algorithm": "Lesser of $50.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.39,"standard_charge_algorithm": "Lesser of $52.39 or 110 Percent of Billed Charges","median_amount":47.63,"10th_percentile":47.63,"90th_percentile":47.63,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.49,"standard_charge_algorithm": "Lesser of $50.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEPATIC FUNCTION PANEL","code_information":[{"code":"80076","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":410.67,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEPATIC FUNCTION PANEL","code_information":[{"code":"80076","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.17,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.97,"standard_charge_algorithm": "Lesser of $13.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"standard_charge_algorithm": "Lesser of $8.74 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.42,"standard_charge_algorithm": "Lesser of $8.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.58,"standard_charge_algorithm": "Lesser of $8.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.99,"standard_charge_algorithm": "Lesser of $8.99 or 110 Percent of Billed Charges","median_amount":8.17,"10th_percentile":8.17,"90th_percentile":8.17,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.66,"standard_charge_algorithm": "Lesser of $8.66 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPLENIC PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"minimum":8350,"maximum":38922,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14757,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13951,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10168,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38922,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36492,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23349.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19413,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23145,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18896,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24578.86,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24381,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15138,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15138,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8350,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13654.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14610.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14064.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14337.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14474.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14337.67,"methodology":"case rate"}]}]},{"description":"HC LAB AMIKACIN","code_information":[{"code":"80150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMIKACIN","code_information":[{"code":"80150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.08,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.79,"standard_charge_algorithm": "Lesser of $25.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"standard_charge_algorithm": "Lesser of $15.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.98,"standard_charge_algorithm": "Lesser of $15.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMIKACIN TROUGH","code_information":[{"code":"80150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMIKACIN TROUGH","code_information":[{"code":"80150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.08,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.79,"standard_charge_algorithm": "Lesser of $25.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"standard_charge_algorithm": "Lesser of $15.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.98,"standard_charge_algorithm": "Lesser of $15.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMIODARONE (CORDARONE)","code_information":[{"code":"80151","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE (CORDARONE)","code_information":[{"code":"80151","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.68,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.87,"standard_charge_algorithm": "Lesser of $31.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"standard_charge_algorithm": "Lesser of $18.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"standard_charge_algorithm": "Lesser of $19.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.2,"standard_charge_algorithm": "Lesser of $19.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.57,"standard_charge_algorithm": "Lesser of $19.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.5,"standard_charge_algorithm": "Lesser of $20.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.76,"standard_charge_algorithm": "Lesser of $19.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CARBEMAZEPINE EPOXIDE AND TOT","code_information":[{"code":"80156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":157.95,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"}]}]},{"description":"HC LAB CARBEMAZEPINE EPOXIDE AND TOT","code_information":[{"code":"80156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.57,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.91,"standard_charge_algorithm": "Lesser of $24.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"standard_charge_algorithm": "Lesser of $15.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.01,"standard_charge_algorithm": "Lesser of $15.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.03,"standard_charge_algorithm": "Lesser of $16.03 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TEGRETOL/CARBAMAZEPINE","code_information":[{"code":"80156","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":157.95,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"}]}]},{"description":"HC LAB TEGRETOL/CARBAMAZEPINE","code_information":[{"code":"80156","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.57,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.91,"standard_charge_algorithm": "Lesser of $24.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"standard_charge_algorithm": "Lesser of $15.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.01,"standard_charge_algorithm": "Lesser of $15.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.03,"standard_charge_algorithm": "Lesser of $16.03 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CARBAMAZEPINE FREE","code_information":[{"code":"80157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE FREE","code_information":[{"code":"80157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CYCLOSPORINE MONOCL","code_information":[{"code":"80158","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":119.88,"maximum":119.88,"gross_charge":148,"discounted_cash":43.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.88,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYCLOSPORINE MONOCL","code_information":[{"code":"80158","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.39,"maximum":119.88,"gross_charge":148,"discounted_cash":43.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.87,"standard_charge_algorithm": "Lesser of $30.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.59,"standard_charge_algorithm": "Lesser of $18.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.95,"standard_charge_algorithm": "Lesser of $18.95 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.86,"standard_charge_algorithm": "Lesser of $19.86 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.13,"standard_charge_algorithm": "Lesser of $19.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CLOZAPINE (CLOZARIL) SERUM","code_information":[{"code":"80159","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":70.47,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE (CLOZARIL) SERUM","code_information":[{"code":"80159","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.15,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.46,"standard_charge_algorithm": "Lesser of $34.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.15,"standard_charge_algorithm": "Lesser of $20.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.56,"standard_charge_algorithm": "Lesser of $21.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.75,"standard_charge_algorithm": "Lesser of $20.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.16,"standard_charge_algorithm": "Lesser of $21.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.16,"standard_charge_algorithm": "Lesser of $22.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.36,"standard_charge_algorithm": "Lesser of $21.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ASY CARBAMAZEPIN 1011-EPXIDE","code_information":[{"code":"80161","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"ASY CARBAMAZEPIN 1011-EPXIDE","code_information":[{"code":"80161","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.68,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.87,"standard_charge_algorithm": "Lesser of $31.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"standard_charge_algorithm": "Lesser of $18.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"standard_charge_algorithm": "Lesser of $19.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.2,"standard_charge_algorithm": "Lesser of $19.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.57,"standard_charge_algorithm": "Lesser of $19.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.5,"standard_charge_algorithm": "Lesser of $20.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.76,"standard_charge_algorithm": "Lesser of $19.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DIGOXIN","code_information":[{"code":"80162","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":303.75,"maximum":303.75,"gross_charge":375,"discounted_cash":111,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.75,"methodology":"fee schedule"}]}]},{"description":"HC LAB DIGOXIN","code_information":[{"code":"80162","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.28,"maximum":303.75,"gross_charge":375,"discounted_cash":111,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.71,"standard_charge_algorithm": "Lesser of $22.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"standard_charge_algorithm": "Lesser of $13.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.21,"standard_charge_algorithm": "Lesser of $14.21 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.68,"standard_charge_algorithm": "Lesser of $13.68 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.94,"standard_charge_algorithm": "Lesser of $13.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.08,"standard_charge_algorithm": "Lesser of $14.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VALPROIC ACID","code_information":[{"code":"80164","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":431.73,"maximum":431.73,"gross_charge":533,"discounted_cash":157.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":431.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":431.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":431.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB VALPROIC ACID","code_information":[{"code":"80164","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.54,"maximum":431.73,"gross_charge":533,"discounted_cash":157.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":431.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":431.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":431.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.15,"standard_charge_algorithm": "Lesser of $23.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.49,"standard_charge_algorithm": "Lesser of $14.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.95,"standard_charge_algorithm": "Lesser of $13.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.22,"standard_charge_algorithm": "Lesser of $14.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.35,"standard_charge_algorithm": "Lesser of $14.35 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VALPROIC ACID FREE","code_information":[{"code":"80165","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":168.48,"maximum":168.48,"gross_charge":208,"discounted_cash":61.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.48,"methodology":"fee schedule"}]}]},{"description":"HC VALPROIC ACID FREE","code_information":[{"code":"80165","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.54,"maximum":168.48,"gross_charge":208,"discounted_cash":61.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.15,"standard_charge_algorithm": "Lesser of $23.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.49,"standard_charge_algorithm": "Lesser of $14.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.95,"standard_charge_algorithm": "Lesser of $13.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.22,"standard_charge_algorithm": "Lesser of $14.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.35,"standard_charge_algorithm": "Lesser of $14.35 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ETHOSUXIMIDE","code_information":[{"code":"80168","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB ETHOSUXIMIDE","code_information":[{"code":"80168","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.34,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.94,"standard_charge_algorithm": "Lesser of $27.94 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.34,"standard_charge_algorithm": "Lesser of $16.34 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.48,"standard_charge_algorithm": "Lesser of $17.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.83,"standard_charge_algorithm": "Lesser of $16.83 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.16,"standard_charge_algorithm": "Lesser of $17.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.97,"standard_charge_algorithm": "Lesser of $17.97 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.32,"standard_charge_algorithm": "Lesser of $17.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EVEROLIMUS","code_information":[{"code":"80169","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"EVEROLIMUS","code_information":[{"code":"80169","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.73,"maximum":263.58,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":263.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":208.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.48,"standard_charge_algorithm": "Lesser of $23.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.69,"standard_charge_algorithm": "Lesser of $14.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.14,"standard_charge_algorithm": "Lesser of $14.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.42,"standard_charge_algorithm": "Lesser of $14.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.1,"standard_charge_algorithm": "Lesser of $15.10 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GENTAMICIN","code_information":[{"code":"80170","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":368.55,"maximum":368.55,"gross_charge":455,"discounted_cash":134.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":368.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":368.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":368.55,"methodology":"fee schedule"}]}]},{"description":"HC LAB GENTAMICIN","code_information":[{"code":"80170","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.38,"maximum":368.55,"gross_charge":455,"discounted_cash":134.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":368.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":368.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":368.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.01,"standard_charge_algorithm": "Lesser of $28.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.38,"standard_charge_algorithm": "Lesser of $16.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.53,"standard_charge_algorithm": "Lesser of $17.53 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.87,"standard_charge_algorithm": "Lesser of $16.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.2,"standard_charge_algorithm": "Lesser of $17.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.02,"standard_charge_algorithm": "Lesser of $18.02 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DRUG SCREEN QUANT GABAPENTIN","code_information":[{"code":"80171","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB DRUG SCREEN QUANT GABAPENTIN","code_information":[{"code":"80171","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.19,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.06,"standard_charge_algorithm": "Lesser of $37.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.67,"standard_charge_algorithm": "Lesser of $21.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.19,"standard_charge_algorithm": "Lesser of $23.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.32,"standard_charge_algorithm": "Lesser of $22.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.75,"standard_charge_algorithm": "Lesser of $22.75 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.84,"standard_charge_algorithm": "Lesser of $23.84 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.97,"standard_charge_algorithm": "Lesser of $22.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DRUG SCREEN QUAN LAMOTRIGINE","code_information":[{"code":"80175","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB DRUG SCREEN QUAN LAMOTRIGINE","code_information":[{"code":"80175","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","median_amount":13.25,"10th_percentile":13.25,"90th_percentile":13.25,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LIDOCAINE","code_information":[{"code":"80176","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":194.4,"maximum":194.4,"gross_charge":240,"discounted_cash":71.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":194.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB LIDOCAINE","code_information":[{"code":"80176","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.69,"maximum":194.4,"gross_charge":240,"discounted_cash":71.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.12,"standard_charge_algorithm": "Lesser of $25.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.69,"standard_charge_algorithm": "Lesser of $14.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.72,"standard_charge_algorithm": "Lesser of $15.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.13,"standard_charge_algorithm": "Lesser of $15.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.42,"standard_charge_algorithm": "Lesser of $15.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.16,"standard_charge_algorithm": "Lesser of $16.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.57,"standard_charge_algorithm": "Lesser of $15.57 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"80177","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB DRUG SCRN QUAN LEVETIRACETAM","code_information":[{"code":"80177","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LITHIUM","code_information":[{"code":"80178","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":162,"maximum":162,"gross_charge":200,"discounted_cash":59.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162,"methodology":"fee schedule"}]}]},{"description":"HC LAB LITHIUM","code_information":[{"code":"80178","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.61,"maximum":162,"gross_charge":200,"discounted_cash":59.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.3,"standard_charge_algorithm": "Lesser of $11.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"standard_charge_algorithm": "Lesser of $6.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.07,"standard_charge_algorithm": "Lesser of $7.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.81,"standard_charge_algorithm": "Lesser of $6.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.94,"standard_charge_algorithm": "Lesser of $6.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.27,"standard_charge_algorithm": "Lesser of $7.27 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.01,"standard_charge_algorithm": "Lesser of $7.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CELLSEPT (MYCOPHENOHO)","code_information":[{"code":"80180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC CELLSEPT (MYCOPHENOHO)","code_information":[{"code":"80180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.27,"maximum":54.68,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.87,"standard_charge_algorithm": "Lesser of $30.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.59,"standard_charge_algorithm": "Lesser of $18.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.95,"standard_charge_algorithm": "Lesser of $18.95 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.86,"standard_charge_algorithm": "Lesser of $19.86 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.13,"standard_charge_algorithm": "Lesser of $19.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OXCARBAZEPINE METAB","code_information":[{"code":"80183","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC OXCARBAZEPINE METAB","code_information":[{"code":"80183","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":40.16,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PHENOBARB LEVEL","code_information":[{"code":"80184","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB PHENOBARB LEVEL","code_information":[{"code":"80184","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.16,"standard_charge_algorithm": "Lesser of $26.16 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.37,"standard_charge_algorithm": "Lesser of $16.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.76,"standard_charge_algorithm": "Lesser of $15.76 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.83,"standard_charge_algorithm": "Lesser of $16.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.22,"standard_charge_algorithm": "Lesser of $16.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PHENOBARBITAL","code_information":[{"code":"80184","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB PHENOBARBITAL","code_information":[{"code":"80184","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.16,"standard_charge_algorithm": "Lesser of $26.16 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.37,"standard_charge_algorithm": "Lesser of $16.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.76,"standard_charge_algorithm": "Lesser of $15.76 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.83,"standard_charge_algorithm": "Lesser of $16.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.22,"standard_charge_algorithm": "Lesser of $16.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DILANTINTOTAL","code_information":[{"code":"80185","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB DILANTINTOTAL","code_information":[{"code":"80185","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FREE PHENYTOIN","code_information":[{"code":"80185","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB FREE PHENYTOIN","code_information":[{"code":"80185","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DILANTINFREE","code_information":[{"code":"80186","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"HC LAB DILANTINFREE","code_information":[{"code":"80186","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.76,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.53,"standard_charge_algorithm": "Lesser of $23.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.76,"standard_charge_algorithm": "Lesser of $13.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.72,"standard_charge_algorithm": "Lesser of $14.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.45,"standard_charge_algorithm": "Lesser of $14.45 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.14,"standard_charge_algorithm": "Lesser of $15.14 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.59,"standard_charge_algorithm": "Lesser of $14.59 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POSACONAZOLESERUM/PLASMA","code_information":[{"code":"80187","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":89.1,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLESERUM/PLASMA","code_information":[{"code":"80187","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":24.27,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.36,"standard_charge_algorithm": "Lesser of $46.36 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"standard_charge_algorithm": "Lesser of $27.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.01,"standard_charge_algorithm": "Lesser of $29.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.92,"standard_charge_algorithm": "Lesser of $27.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.47,"standard_charge_algorithm": "Lesser of $28.47 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.82,"standard_charge_algorithm": "Lesser of $29.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.74,"standard_charge_algorithm": "Lesser of $28.74 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PRIMIDONE","code_information":[{"code":"80188","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC PRIMIDONE","code_information":[{"code":"80188","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.59,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.37,"standard_charge_algorithm": "Lesser of $28.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.75,"standard_charge_algorithm": "Lesser of $17.75 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.09,"standard_charge_algorithm": "Lesser of $17.09 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.42,"standard_charge_algorithm": "Lesser of $17.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.25,"standard_charge_algorithm": "Lesser of $18.25 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.59,"standard_charge_algorithm": "Lesser of $17.59 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRUG ASSAY ITRACONAZOLE","code_information":[{"code":"80189","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":89.1,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"}]}]},{"description":"DRUG ASSAY ITRACONAZOLE","code_information":[{"code":"80189","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":24.27,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.36,"standard_charge_algorithm": "Lesser of $46.36 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"standard_charge_algorithm": "Lesser of $27.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.01,"standard_charge_algorithm": "Lesser of $29.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.92,"standard_charge_algorithm": "Lesser of $27.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.47,"standard_charge_algorithm": "Lesser of $28.47 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.82,"standard_charge_algorithm": "Lesser of $29.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.74,"standard_charge_algorithm": "Lesser of $28.74 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB NAPA+PROCAINAMIDE","code_information":[{"code":"80192","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC LAB NAPA+PROCAINAMIDE","code_information":[{"code":"80192","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.75,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.64,"standard_charge_algorithm": "Lesser of $28.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.75,"standard_charge_algorithm": "Lesser of $16.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.25,"standard_charge_algorithm": "Lesser of $17.25 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.59,"standard_charge_algorithm": "Lesser of $17.59 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.43,"standard_charge_algorithm": "Lesser of $18.43 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.75,"standard_charge_algorithm": "Lesser of $17.75 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC QUINIDINE SERUM","code_information":[{"code":"80194","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":249.48,"maximum":249.48,"gross_charge":308,"discounted_cash":91.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":249.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.48,"methodology":"fee schedule"}]}]},{"description":"HC QUINIDINE SERUM","code_information":[{"code":"80194","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.6,"maximum":249.48,"gross_charge":308,"discounted_cash":91.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":249.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":249.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":249.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.97,"standard_charge_algorithm": "Lesser of $24.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"standard_charge_algorithm": "Lesser of $14.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.62,"standard_charge_algorithm": "Lesser of $15.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.04,"standard_charge_algorithm": "Lesser of $15.04 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.33,"standard_charge_algorithm": "Lesser of $15.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.06,"standard_charge_algorithm": "Lesser of $16.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.48,"standard_charge_algorithm": "Lesser of $15.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RAPAMYCIN TROUGH","code_information":[{"code":"80195","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":227.61,"maximum":227.61,"gross_charge":281,"discounted_cash":83.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.61,"methodology":"fee schedule"}]}]},{"description":"HC LAB RAPAMYCIN TROUGH","code_information":[{"code":"80195","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.73,"maximum":227.61,"gross_charge":281,"discounted_cash":83.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.48,"standard_charge_algorithm": "Lesser of $23.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.69,"standard_charge_algorithm": "Lesser of $14.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.14,"standard_charge_algorithm": "Lesser of $14.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.42,"standard_charge_algorithm": "Lesser of $14.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.1,"standard_charge_algorithm": "Lesser of $15.10 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TACROLIMUS","code_information":[{"code":"80197","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":564.57,"maximum":564.57,"gross_charge":697,"discounted_cash":206.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":564.57,"methodology":"fee schedule"}]}]},{"description":"HC LAB TACROLIMUS","code_information":[{"code":"80197","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.73,"maximum":564.57,"gross_charge":697,"discounted_cash":206.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.48,"standard_charge_algorithm": "Lesser of $23.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.69,"standard_charge_algorithm": "Lesser of $14.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.14,"standard_charge_algorithm": "Lesser of $14.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.42,"standard_charge_algorithm": "Lesser of $14.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.1,"standard_charge_algorithm": "Lesser of $15.10 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THEOPHYLLINE","code_information":[{"code":"80198","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":315.9,"maximum":315.9,"gross_charge":390,"discounted_cash":115.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB THEOPHYLLINE","code_information":[{"code":"80198","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":315.9,"gross_charge":390,"discounted_cash":115.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.18,"standard_charge_algorithm": "Lesser of $24.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"standard_charge_algorithm": "Lesser of $14.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.13,"standard_charge_algorithm": "Lesser of $15.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.85,"standard_charge_algorithm": "Lesser of $14.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.55,"standard_charge_algorithm": "Lesser of $15.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"minimum":16432,"maximum":53238,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32224,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30464,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19492,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46769,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43849,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44695.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41204,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49125,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36222,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":47047.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53238,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33055,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33055,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16432,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26137.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27967.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26921.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27444.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27705.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27444.35,"methodology":"case rate"}]}]},{"description":"HC LAB TOBRAMYCIN","code_information":[{"code":"80200","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":283.5,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOBRAMYCIN","code_information":[{"code":"80200","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.13,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.58,"standard_charge_algorithm": "Lesser of $27.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.13,"standard_charge_algorithm": "Lesser of $16.13 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.26,"standard_charge_algorithm": "Lesser of $17.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.61,"standard_charge_algorithm": "Lesser of $16.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.74,"standard_charge_algorithm": "Lesser of $17.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.1,"standard_charge_algorithm": "Lesser of $17.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC TOPIRAMATE","code_information":[{"code":"80201","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC TOPIRAMATE","code_information":[{"code":"80201","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.92,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.38,"standard_charge_algorithm": "Lesser of $20.38 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.92,"standard_charge_algorithm": "Lesser of $11.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.75,"standard_charge_algorithm": "Lesser of $12.75 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.28,"standard_charge_algorithm": "Lesser of $12.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.52,"standard_charge_algorithm": "Lesser of $12.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.11,"standard_charge_algorithm": "Lesser of $13.11 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.64,"standard_charge_algorithm": "Lesser of $12.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VANCOMYCIN","code_information":[{"code":"80202","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB VANCOMYCIN","code_information":[{"code":"80202","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.54,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.15,"standard_charge_algorithm": "Lesser of $23.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.49,"standard_charge_algorithm": "Lesser of $14.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.95,"standard_charge_algorithm": "Lesser of $13.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.22,"standard_charge_algorithm": "Lesser of $14.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.35,"standard_charge_algorithm": "Lesser of $14.35 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VANCOMYCIN RANDOM","code_information":[{"code":"80202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB VANCOMYCIN RANDOM","code_information":[{"code":"80202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.54,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.15,"standard_charge_algorithm": "Lesser of $23.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.49,"standard_charge_algorithm": "Lesser of $14.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.95,"standard_charge_algorithm": "Lesser of $13.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.22,"standard_charge_algorithm": "Lesser of $14.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.35,"standard_charge_algorithm": "Lesser of $14.35 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ZONISAMIDE (ZONEGRAN)","code_information":[{"code":"80203","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC ZONISAMIDE (ZONEGRAN)","code_information":[{"code":"80203","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRUG ASSAY METHOTREXATE","code_information":[{"code":"80204","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":125.55,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"}]}]},{"description":"DRUG ASSAY METHOTREXATE","code_information":[{"code":"80204","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":34.53,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":85.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65.95,"standard_charge_algorithm": "Lesser of $65.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"standard_charge_algorithm": "Lesser of $38.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.27,"standard_charge_algorithm": "Lesser of $41.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.73,"standard_charge_algorithm": "Lesser of $39.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.5,"standard_charge_algorithm": "Lesser of $40.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.43,"standard_charge_algorithm": "Lesser of $42.43 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40.88,"standard_charge_algorithm": "Lesser of $40.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DRUG ASSAY INFLIXIMAB","code_information":[{"code":"80230","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":142.56,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"}]}]},{"description":"DRUG ASSAY INFLIXIMAB","code_information":[{"code":"80230","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.53,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":85.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65.95,"standard_charge_algorithm": "Lesser of $65.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"standard_charge_algorithm": "Lesser of $38.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.27,"standard_charge_algorithm": "Lesser of $41.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.73,"standard_charge_algorithm": "Lesser of $39.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.5,"standard_charge_algorithm": "Lesser of $40.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.43,"standard_charge_algorithm": "Lesser of $42.43 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40.88,"standard_charge_algorithm": "Lesser of $40.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LACOSAMIDE (VIMPAT)","code_information":[{"code":"80235","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE (VIMPAT)","code_information":[{"code":"80235","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.27,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.36,"standard_charge_algorithm": "Lesser of $46.36 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"standard_charge_algorithm": "Lesser of $27.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.01,"standard_charge_algorithm": "Lesser of $29.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.92,"standard_charge_algorithm": "Lesser of $27.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.47,"standard_charge_algorithm": "Lesser of $28.47 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.82,"standard_charge_algorithm": "Lesser of $29.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.74,"standard_charge_algorithm": "Lesser of $28.74 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VEDOLIZUMAB","code_information":[{"code":"80280","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":136.08,"maximum":136.08,"gross_charge":168,"discounted_cash":49.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.08,"methodology":"fee schedule"}]}]},{"description":"VEDOLIZUMAB","code_information":[{"code":"80280","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.53,"maximum":136.08,"gross_charge":168,"discounted_cash":49.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":85.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65.95,"standard_charge_algorithm": "Lesser of $65.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.57,"standard_charge_algorithm": "Lesser of $38.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.27,"standard_charge_algorithm": "Lesser of $41.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.73,"standard_charge_algorithm": "Lesser of $39.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.5,"standard_charge_algorithm": "Lesser of $40.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.43,"standard_charge_algorithm": "Lesser of $42.43 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40.88,"standard_charge_algorithm": "Lesser of $40.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VORICONAZOLE SERUM/PLASMA","code_information":[{"code":"80285","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE SERUM/PLASMA","code_information":[{"code":"80285","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.27,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.36,"standard_charge_algorithm": "Lesser of $46.36 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.11,"standard_charge_algorithm": "Lesser of $27.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.01,"standard_charge_algorithm": "Lesser of $29.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.92,"standard_charge_algorithm": "Lesser of $27.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.47,"standard_charge_algorithm": "Lesser of $28.47 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.82,"standard_charge_algorithm": "Lesser of $29.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.74,"standard_charge_algorithm": "Lesser of $28.74 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTI-USTEKINUMAB ABY","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":291.6,"maximum":291.6,"gross_charge":360,"discounted_cash":106.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.6,"methodology":"fee schedule"}]}]},{"description":"ANTI-USTEKINUMAB ABY","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":291.6,"gross_charge":360,"discounted_cash":106.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.87,"standard_charge_algorithm": "Lesser of $31.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"standard_charge_algorithm": "Lesser of $18.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"standard_charge_algorithm": "Lesser of $19.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.2,"standard_charge_algorithm": "Lesser of $19.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.57,"standard_charge_algorithm": "Lesser of $19.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.5,"standard_charge_algorithm": "Lesser of $20.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.76,"standard_charge_algorithm": "Lesser of $19.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CITALOPRAM (CELEXA)","code_information":[{"code":"80299","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"CITALOPRAM (CELEXA)","code_information":[{"code":"80299","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.87,"standard_charge_algorithm": "Lesser of $31.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"standard_charge_algorithm": "Lesser of $18.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"standard_charge_algorithm": "Lesser of $19.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.2,"standard_charge_algorithm": "Lesser of $19.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.57,"standard_charge_algorithm": "Lesser of $19.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.5,"standard_charge_algorithm": "Lesser of $20.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.76,"standard_charge_algorithm": "Lesser of $19.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMIODARONE","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMIODARONE","code_information":[{"code":"80299","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.87,"standard_charge_algorithm": "Lesser of $31.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"standard_charge_algorithm": "Lesser of $18.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"standard_charge_algorithm": "Lesser of $19.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.2,"standard_charge_algorithm": "Lesser of $19.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.57,"standard_charge_algorithm": "Lesser of $19.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.5,"standard_charge_algorithm": "Lesser of $20.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.76,"standard_charge_algorithm": "Lesser of $19.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DRUG QUANT NES","code_information":[{"code":"80299","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB DRUG QUANT NES","code_information":[{"code":"80299","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.87,"standard_charge_algorithm": "Lesser of $31.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.64,"standard_charge_algorithm": "Lesser of $18.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.94,"standard_charge_algorithm": "Lesser of $19.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.2,"standard_charge_algorithm": "Lesser of $19.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.57,"standard_charge_algorithm": "Lesser of $19.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.5,"standard_charge_algorithm": "Lesser of $20.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.76,"standard_charge_algorithm": "Lesser of $19.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"minimum":7925,"maximum":26461,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16000,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15126,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10557,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20706,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19413,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24869.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22194,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26461,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19619,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26178.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26435,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16413,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16413,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7925,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14543.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15561.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14979.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15270.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15415.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15270.54,"methodology":"case rate"}]}]},{"description":"HC LAB COTININE SCREEN URINE","code_information":[{"code":"80305","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB COTININE SCREEN URINE","code_information":[{"code":"80305","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.55,"standard_charge_algorithm": "Lesser of $21.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.6,"standard_charge_algorithm": "Lesser of $12.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.48,"standard_charge_algorithm": "Lesser of $13.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.98,"standard_charge_algorithm": "Lesser of $12.98 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.23,"standard_charge_algorithm": "Lesser of $13.23 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.86,"standard_charge_algorithm": "Lesser of $13.86 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.36,"standard_charge_algorithm": "Lesser of $13.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DRUG SCREEN LATERAL FLOW","code_information":[{"code":"80305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB DRUG SCREEN LATERAL FLOW","code_information":[{"code":"80305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.55,"standard_charge_algorithm": "Lesser of $21.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.6,"standard_charge_algorithm": "Lesser of $12.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.48,"standard_charge_algorithm": "Lesser of $13.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.98,"standard_charge_algorithm": "Lesser of $12.98 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.23,"standard_charge_algorithm": "Lesser of $13.23 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.86,"standard_charge_algorithm": "Lesser of $13.86 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.36,"standard_charge_algorithm": "Lesser of $13.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ACETOMINOPHEN","code_information":[{"code":"80307","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":283.5,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB ACETOMINOPHEN","code_information":[{"code":"80307","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":62.14,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":140.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":106.26,"standard_charge_algorithm": "Lesser of $106.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":127.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"standard_charge_algorithm": "Lesser of $62.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":66.49,"standard_charge_algorithm": "Lesser of $66.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":64,"standard_charge_algorithm": "Lesser of $64.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":65.25,"standard_charge_algorithm": "Lesser of $65.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":68.35,"standard_charge_algorithm": "Lesser of $68.35 or 110 Percent of Billed Charges","median_amount":62.14,"10th_percentile":28.13,"90th_percentile":62.14,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":65.87,"standard_charge_algorithm": "Lesser of $65.87 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BARBITURATES SCREEN URINE","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":283.5,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB BARBITURATES SCREEN URINE","code_information":[{"code":"80307","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.14,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":140.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":106.26,"standard_charge_algorithm": "Lesser of $106.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":127.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":62.14,"standard_charge_algorithm": "Lesser of $62.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":66.49,"standard_charge_algorithm": "Lesser of $66.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":64,"standard_charge_algorithm": "Lesser of $64.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":65.25,"standard_charge_algorithm": "Lesser of $65.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":68.35,"standard_charge_algorithm": "Lesser of $68.35 or 110 Percent of Billed Charges","median_amount":62.14,"10th_percentile":28.13,"90th_percentile":62.14,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":65.87,"standard_charge_algorithm": "Lesser of $65.87 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMPHETAMINES; 1 0R 2","code_information":[{"code":"80324","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":410.67,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"}]}]},{"description":"AMPHETAMINES; 1 0R 2","code_information":[{"code":"80324","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC AMITRIPTYLINE (ELAVIL) SERUM","code_information":[{"code":"80335","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":110.16,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"}]}]},{"description":"HC AMITRIPTYLINE (ELAVIL) SERUM","code_information":[{"code":"80335","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.18,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.18,"methodology":"fee schedule"}]}]},{"description":"HC CLONAZEPAM","code_information":[{"code":"80346","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"HC CLONAZEPAM","code_information":[{"code":"80346","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.02,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.02,"methodology":"fee schedule"}]}]},{"description":"HC CANNABINOID CONFIRMATION","code_information":[{"code":"80349","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.17,"maximum":46.17,"gross_charge":57,"discounted_cash":16.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"}]}]},{"description":"HC CANNABINOID CONFIRMATION","code_information":[{"code":"80349","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.55,"maximum":46.17,"gross_charge":57,"discounted_cash":16.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"}]}]},{"description":"HC PREGABALIN (LYRICA)","code_information":[{"code":"80366","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":186.3,"maximum":186.3,"gross_charge":230,"discounted_cash":68.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"}]}]},{"description":"HC PREGABALIN (LYRICA)","code_information":[{"code":"80366","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.5,"maximum":186.3,"gross_charge":230,"discounted_cash":68.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46,"methodology":"fee schedule"}]}]},{"description":"ISOMER ANALYSIS SINGLE DRUG CLS","code_information":[{"code":"80374","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":410.67,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"}]}]},{"description":"ISOMER ANALYSIS SINGLE DRUG CLS","code_information":[{"code":"80374","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":76.05,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.4,"methodology":"fee schedule"}]}]},{"description":"HC LEFLUNOMIDE (ARAVA)","code_information":[{"code":"80375","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":286.74,"maximum":286.74,"gross_charge":354,"discounted_cash":104.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.74,"methodology":"fee schedule"}]}]},{"description":"HC LEFLUNOMIDE (ARAVA)","code_information":[{"code":"80375","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.42,"maximum":286.74,"gross_charge":354,"discounted_cash":104.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"minimum":6522,"maximum":18379.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9938,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9395,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6877,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17554,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16458,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17460.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13639,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16261,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12779,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18379.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16419,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10195,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10195,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10210.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10925.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10517.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10721.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10823.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10721.54,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":5728,"maximum":17135.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8481,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5728,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17127,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16058,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16278.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10870,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12959,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10645,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17135.59,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14821,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9203,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9203,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9519.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10186.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9805.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9995.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10090.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9995.76,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":4242,"maximum":13962.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6504,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6149,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4242,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11841,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11102,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13264.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7543,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8993,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7884,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13962.62,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10746,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6672,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6672,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7757.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8300.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7989.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8144.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8222.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8144.87,"methodology":"case rate"}]}]},{"description":"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":3717,"maximum":12964.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5729,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5416,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3717,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10278,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9636,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12316.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6825,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8137,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6908,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12964.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9465,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5877,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5877,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7202.62,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7706.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7418.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7562.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7634.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7562.76,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"minimum":12443,"maximum":34013,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20587,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19463,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12443,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24283,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22767,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30474.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23142,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27591,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23123,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32078.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34013,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21119,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21119,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17048,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17821.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19069.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18356.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18712.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18890.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18712.63,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":6843,"maximum":19916.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11133,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10525,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6843,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14791,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13867,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18920.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13140,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15667,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12716,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19916.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18393,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11420,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11420,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8066,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11064.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11839.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11396.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11617.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11728.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11617.99,"methodology":"case rate"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"minimum":4107,"maximum":16601.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8556,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8088,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5707,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10927,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10245,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15771.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10147,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12098,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10606,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16601.37,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8777,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8777,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4107,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9222.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9868.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9499.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9684.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9776.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9684.13,"methodology":"case rate"}]}]},{"description":"HC URINALYSIS NON AUTOMATED (BO)","code_information":[{"code":"81000","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":25.92,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"}]}]},{"description":"HC URINALYSIS NON AUTOMATED (BO)","code_information":[{"code":"81000","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":4.02,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.87,"standard_charge_algorithm": "Lesser of $6.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.02,"standard_charge_algorithm": "Lesser of $4.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.3,"standard_charge_algorithm": "Lesser of $4.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.14,"standard_charge_algorithm": "Lesser of $4.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.22,"standard_charge_algorithm": "Lesser of $4.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.42,"standard_charge_algorithm": "Lesser of $4.42 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.26,"standard_charge_algorithm": "Lesser of $4.26 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AUTO URINALYS W/ MICRO","code_information":[{"code":"81001","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC LAB AUTO URINALYS W/ MICRO","code_information":[{"code":"81001","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.17,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.42,"standard_charge_algorithm": "Lesser of $5.42 or 171 Percent of Billed Charges","median_amount":28,"10th_percentile":28,"90th_percentile":28,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"standard_charge_algorithm": "Lesser of $3.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.39,"standard_charge_algorithm": "Lesser of $3.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.27,"standard_charge_algorithm": "Lesser of $3.27 or 103 Percent of Billed Charges","median_amount":3.27,"10th_percentile":3.27,"90th_percentile":3.27,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.33,"standard_charge_algorithm": "Lesser of $3.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.49,"standard_charge_algorithm": "Lesser of $3.49 or 110 Percent of Billed Charges","median_amount":3.17,"10th_percentile":2.25,"90th_percentile":3.17,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URINALYSIS W/REFLEX TO URINE","code_information":[{"code":"81001","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINALYSIS W/REFLEX TO URINE","code_information":[{"code":"81001","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":3.17,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.42,"standard_charge_algorithm": "Lesser of $5.42 or 171 Percent of Billed Charges","median_amount":28,"10th_percentile":28,"90th_percentile":28,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.17,"standard_charge_algorithm": "Lesser of $3.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.39,"standard_charge_algorithm": "Lesser of $3.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.27,"standard_charge_algorithm": "Lesser of $3.27 or 103 Percent of Billed Charges","median_amount":3.27,"10th_percentile":3.27,"90th_percentile":3.27,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.33,"standard_charge_algorithm": "Lesser of $3.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.49,"standard_charge_algorithm": "Lesser of $3.49 or 110 Percent of Billed Charges","median_amount":3.17,"10th_percentile":2.25,"90th_percentile":3.17,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB NON AUTO URINALYSIS","code_information":[{"code":"81002","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"HC LAB NON AUTO URINALYSIS","code_information":[{"code":"81002","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.48,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"standard_charge_algorithm": "Lesser of $3.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.72,"standard_charge_algorithm": "Lesser of $3.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.58,"standard_charge_algorithm": "Lesser of $3.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.65,"standard_charge_algorithm": "Lesser of $3.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.83,"standard_charge_algorithm": "Lesser of $3.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.69,"standard_charge_algorithm": "Lesser of $3.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPECIFIC GRAVITY URINE - MANUAL","code_information":[{"code":"81002","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"SPECIFIC GRAVITY URINE - MANUAL","code_information":[{"code":"81002","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":3.48,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.48,"standard_charge_algorithm": "Lesser of $3.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.72,"standard_charge_algorithm": "Lesser of $3.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.58,"standard_charge_algorithm": "Lesser of $3.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.65,"standard_charge_algorithm": "Lesser of $3.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.83,"standard_charge_algorithm": "Lesser of $3.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.69,"standard_charge_algorithm": "Lesser of $3.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AUTO URINALYS WO MICRO","code_information":[{"code":"81003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.06,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB AUTO URINALYS WO MICRO","code_information":[{"code":"81003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.25,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"standard_charge_algorithm": "Lesser of $2.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.41,"standard_charge_algorithm": "Lesser of $2.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.32,"standard_charge_algorithm": "Lesser of $2.32 or 103 Percent of Billed Charges","median_amount":2.32,"10th_percentile":2.32,"90th_percentile":2.32,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.36,"standard_charge_algorithm": "Lesser of $2.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.48,"standard_charge_algorithm": "Lesser of $2.48 or 110 Percent of Billed Charges","median_amount":2.25,"10th_percentile":2.25,"90th_percentile":2.25,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.38,"standard_charge_algorithm": "Lesser of $2.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB KETONES","code_information":[{"code":"81003","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":21.06,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB KETONES","code_information":[{"code":"81003","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":2.25,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"standard_charge_algorithm": "Lesser of $2.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.41,"standard_charge_algorithm": "Lesser of $2.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.32,"standard_charge_algorithm": "Lesser of $2.32 or 103 Percent of Billed Charges","median_amount":2.32,"10th_percentile":2.32,"90th_percentile":2.32,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.36,"standard_charge_algorithm": "Lesser of $2.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.48,"standard_charge_algorithm": "Lesser of $2.48 or 110 Percent of Billed Charges","median_amount":2.25,"10th_percentile":2.25,"90th_percentile":2.25,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.38,"standard_charge_algorithm": "Lesser of $2.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SPECIFIC GRAVITY URINE - AUTO","code_information":[{"code":"81003","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"SPECIFIC GRAVITY URINE - AUTO","code_information":[{"code":"81003","type":"CPT"},{"code":"0307","type":"RC"}],"standard_charges":[{"minimum":2.25,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.25,"standard_charge_algorithm": "Lesser of $2.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.41,"standard_charge_algorithm": "Lesser of $2.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.32,"standard_charge_algorithm": "Lesser of $2.32 or 103 Percent of Billed Charges","median_amount":2.32,"10th_percentile":2.32,"90th_percentile":2.32,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.36,"standard_charge_algorithm": "Lesser of $2.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.48,"standard_charge_algorithm": "Lesser of $2.48 or 110 Percent of Billed Charges","median_amount":2.25,"10th_percentile":2.25,"90th_percentile":2.25,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.38,"standard_charge_algorithm": "Lesser of $2.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8101","type":"APR-DRG"}],"standard_charges":[{"minimum":3347,"maximum":3347,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3347,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3347,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3347,"methodology":"case rate"}]}]},{"description":"HC LAB URINALYSIS MICROSCOPE","code_information":[{"code":"81015","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINALYSIS MICROSCOPE","code_information":[{"code":"81015","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.05,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.05,"standard_charge_algorithm": "Lesser of $3.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.26,"standard_charge_algorithm": "Lesser of $3.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.14,"standard_charge_algorithm": "Lesser of $3.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.2,"standard_charge_algorithm": "Lesser of $3.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.35,"standard_charge_algorithm": "Lesser of $3.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.23,"standard_charge_algorithm": "Lesser of $3.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8102","type":"APR-DRG"}],"standard_charges":[{"minimum":4446,"maximum":4446,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4446,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4446,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4446,"methodology":"case rate"}]}]},{"description":"HC LAB PREG URINE VIS CLR-WAIV","code_information":[{"code":"81025","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB PREG URINE VIS CLR-WAIV","code_information":[{"code":"81025","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.61,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.72,"standard_charge_algorithm": "Lesser of $14.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.61,"standard_charge_algorithm": "Lesser of $8.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.21,"standard_charge_algorithm": "Lesser of $9.21 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.87,"standard_charge_algorithm": "Lesser of $8.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.04,"standard_charge_algorithm": "Lesser of $9.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.47,"standard_charge_algorithm": "Lesser of $9.47 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.13,"standard_charge_algorithm": "Lesser of $9.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8103","type":"APR-DRG"}],"standard_charges":[{"minimum":7460,"maximum":7460,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7460,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7460,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7460,"methodology":"case rate"}]}]},{"description":"HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION","code_information":[{"code":"8104","type":"APR-DRG"}],"standard_charges":[{"minimum":14239,"maximum":14239,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14239,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14239,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14239,"methodology":"case rate"}]}]},{"description":"HC LAB VOLUME TOTAL","code_information":[{"code":"81050","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.06,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB VOLUME TOTAL","code_information":[{"code":"81050","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.64,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.22,"standard_charge_algorithm": "Lesser of $6.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.64,"standard_charge_algorithm": "Lesser of $3.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.89,"standard_charge_algorithm": "Lesser of $3.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.75,"standard_charge_algorithm": "Lesser of $3.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.82,"standard_charge_algorithm": "Lesser of $3.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4,"standard_charge_algorithm": "Lesser of $4.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.86,"standard_charge_algorithm": "Lesser of $3.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RED BLOOD CELL DISORDERS WITH MCC","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":7974,"maximum":21863.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12647,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11956,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7974,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13194,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12370,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20770.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15028,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17917,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14819,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21863.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20894,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12973,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12973,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8904,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12146.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12996.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12510.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12753.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12875.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12753.89,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8111","type":"APR-DRG"}],"standard_charges":[{"minimum":2262,"maximum":2262,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2262,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2262,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2262,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8112","type":"APR-DRG"}],"standard_charges":[{"minimum":4348,"maximum":4348,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4348,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4348,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4348,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8113","type":"APR-DRG"}],"standard_charges":[{"minimum":5838,"maximum":5838,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5838,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5838,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5838,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS","code_information":[{"code":"8114","type":"APR-DRG"}],"standard_charges":[{"minimum":11998,"maximum":11998,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11998,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11998,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11998,"methodology":"case rate"}]}]},{"description":"BRCA1 AND BRCA2 COMP. ANALYSIS","code_information":[{"code":"81162","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5913,"maximum":5913,"gross_charge":7300,"discounted_cash":2160.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5913,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5913,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5913,"methodology":"fee schedule"}]}]},{"description":"BRCA1 AND BRCA2 COMP. ANALYSIS","code_information":[{"code":"81162","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1824.88,"maximum":5913,"gross_charge":7300,"discounted_cash":2160.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5913,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5913,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5913,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5518.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4375.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3120.54,"standard_charge_algorithm": "Lesser of $3120.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4001.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4455.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2737.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1824.88,"standard_charge_algorithm": "Lesser of $1824.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1952.62,"standard_charge_algorithm": "Lesser of $1952.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1879.63,"standard_charge_algorithm": "Lesser of $1879.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1916.12,"standard_charge_algorithm": "Lesser of $1916.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2007.37,"standard_charge_algorithm": "Lesser of $2007.37 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1934.37,"standard_charge_algorithm": "Lesser of $1934.37 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RED BLOOD CELL DISORDERS WITHOUT MCC","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":5044,"maximum":16267.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8296,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7843,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5117,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9161,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8589,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15453.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9706,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11573,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9510,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16267.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13706,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8510,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8510,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5044,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9037.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9669.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9308.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9489.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9579.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9489.19,"methodology":"case rate"}]}]},{"description":"BCR-ABL1 CML/ALL PCR-MAJ BKP","code_information":[{"code":"81206","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":574.29,"maximum":574.29,"gross_charge":709,"discounted_cash":209.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.29,"methodology":"fee schedule"}]}]},{"description":"BCR-ABL1 CML/ALL PCR-MAJ BKP","code_information":[{"code":"81206","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":574.29,"gross_charge":709,"discounted_cash":209.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":496.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":393.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":280.37,"standard_charge_algorithm": "Lesser of $280.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":359.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":400.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":245.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":163.96,"standard_charge_algorithm": "Lesser of $163.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":175.44,"standard_charge_algorithm": "Lesser of $175.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":168.88,"standard_charge_algorithm": "Lesser of $168.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":172.16,"standard_charge_algorithm": "Lesser of $172.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":180.36,"standard_charge_algorithm": "Lesser of $180.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":173.8,"standard_charge_algorithm": "Lesser of $173.80 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BCR-ABL1 CML/ALL PCR-MIN BKP","code_information":[{"code":"81207","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":924.21,"maximum":924.21,"gross_charge":1141,"discounted_cash":337.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.21,"methodology":"fee schedule"}]}]},{"description":"BCR-ABL1 CML/ALL PCR-MIN BKP","code_information":[{"code":"81207","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":924.21,"gross_charge":1141,"discounted_cash":337.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":438.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":347.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":247.68,"standard_charge_algorithm": "Lesser of $247.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":317.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":353.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":217.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"standard_charge_algorithm": "Lesser of $144.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":154.98,"standard_charge_algorithm": "Lesser of $154.98 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":149.19,"standard_charge_algorithm": "Lesser of $149.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":152.08,"standard_charge_algorithm": "Lesser of $152.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":159.32,"standard_charge_algorithm": "Lesser of $159.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":153.53,"standard_charge_algorithm": "Lesser of $153.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BCR/ABL1 GENE MINOR BP","code_information":[{"code":"81207","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":924.21,"maximum":924.21,"gross_charge":1141,"discounted_cash":337.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB BCR/ABL1 GENE MINOR BP","code_information":[{"code":"81207","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":924.21,"gross_charge":1141,"discounted_cash":337.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":438.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":347.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":247.68,"standard_charge_algorithm": "Lesser of $247.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":317.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":353.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":217.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":144.84,"standard_charge_algorithm": "Lesser of $144.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":154.98,"standard_charge_algorithm": "Lesser of $154.98 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":149.19,"standard_charge_algorithm": "Lesser of $149.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":152.08,"standard_charge_algorithm": "Lesser of $152.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":159.32,"standard_charge_algorithm": "Lesser of $159.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":153.53,"standard_charge_algorithm": "Lesser of $153.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8121","type":"APR-DRG"}],"standard_charges":[{"minimum":2427,"maximum":2427,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427,"methodology":"case rate"}]}]},{"description":"HC LAB BRAF GENE ANALYSIS","code_information":[{"code":"81210","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":829.44,"maximum":829.44,"gross_charge":1024,"discounted_cash":303.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":829.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":829.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":829.44,"methodology":"fee schedule"}]}]},{"description":"HC LAB BRAF GENE ANALYSIS","code_information":[{"code":"81210","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":829.44,"gross_charge":1024,"discounted_cash":303.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":829.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":829.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":829.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":397.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":315.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":299.93,"standard_charge_algorithm": "Lesser of $299.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":346.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":385.46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":263.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":175.4,"standard_charge_algorithm": "Lesser of $175.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":187.68,"standard_charge_algorithm": "Lesser of $187.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":180.66,"standard_charge_algorithm": "Lesser of $180.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":184.17,"standard_charge_algorithm": "Lesser of $184.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":192.94,"standard_charge_algorithm": "Lesser of $192.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":185.92,"standard_charge_algorithm": "Lesser of $185.92 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALR GENE MUTATION","code_information":[{"code":"81219","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":585.63,"maximum":585.63,"gross_charge":723,"discounted_cash":214.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":585.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":585.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":585.63,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALR GENE MUTATION","code_information":[{"code":"81219","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":121.63,"maximum":585.63,"gross_charge":723,"discounted_cash":214.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":585.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":585.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":585.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":367.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":207.99,"standard_charge_algorithm": "Lesser of $207.99 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":266.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":296.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":182.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":121.63,"standard_charge_algorithm": "Lesser of $121.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":130.14,"standard_charge_algorithm": "Lesser of $130.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":125.28,"standard_charge_algorithm": "Lesser of $125.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":127.71,"standard_charge_algorithm": "Lesser of $127.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":133.79,"standard_charge_algorithm": "Lesser of $133.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":128.93,"standard_charge_algorithm": "Lesser of $128.93 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8122","type":"APR-DRG"}],"standard_charges":[{"minimum":4224,"maximum":4224,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224,"methodology":"case rate"}]}]},{"description":"HC CYSTIC FIBROSIS CARR SCR REFL","code_information":[{"code":"81220","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":219.51,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"}]}]},{"description":"HC CYSTIC FIBROSIS CARR SCR REFL","code_information":[{"code":"81220","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":219.51,"maximum":2664,"gross_charge":271,"discounted_cash":80.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2664,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2112,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":463.41,"standard_charge_algorithm": "Lesser of $951.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1098.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1223,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":834.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":556.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1074.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":271,"standard_charge_algorithm": "Lesser of $556.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":289.97,"standard_charge_algorithm": "Lesser of $595.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":279.13,"standard_charge_algorithm": "Lesser of $573.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":284.55,"standard_charge_algorithm": "Lesser of $584.43 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":298.1,"standard_charge_algorithm": "Lesser of $612.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":287.26,"standard_charge_algorithm": "Lesser of $590.00 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CYTOCHROME P450 CYP2D6","code_information":[{"code":"81226","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":724.14,"maximum":724.14,"gross_charge":894,"discounted_cash":264.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":724.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":724.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":724.14,"methodology":"fee schedule"}]}]},{"description":"HC CYTOCHROME P450 CYP2D6","code_information":[{"code":"81226","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":1002.53,"gross_charge":894,"discounted_cash":264.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":724.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":724.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":724.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1002.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":794.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":771.06,"standard_charge_algorithm": "Lesser of $771.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":889.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":990.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":676.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":450.91,"standard_charge_algorithm": "Lesser of $450.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":482.47,"standard_charge_algorithm": "Lesser of $482.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":464.44,"standard_charge_algorithm": "Lesser of $464.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":473.46,"standard_charge_algorithm": "Lesser of $473.46 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":496,"standard_charge_algorithm": "Lesser of $496.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":477.96,"standard_charge_algorithm": "Lesser of $477.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8123","type":"APR-DRG"}],"standard_charges":[{"minimum":6132,"maximum":6132,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132,"methodology":"case rate"}]}]},{"description":"DMPK GENE ANALYSIS (DM1)","code_information":[{"code":"81234","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":459.27,"maximum":459.27,"gross_charge":567,"discounted_cash":167.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":459.27,"methodology":"fee schedule"}]}]},{"description":"DMPK GENE ANALYSIS (DM1)","code_information":[{"code":"81234","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":122.62,"maximum":459.27,"gross_charge":567,"discounted_cash":167.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":304.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":241.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":234.27,"standard_charge_algorithm": "Lesser of $234.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":270.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":301.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":205.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"standard_charge_algorithm": "Lesser of $137.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":146.59,"standard_charge_algorithm": "Lesser of $146.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":141.11,"standard_charge_algorithm": "Lesser of $141.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":143.85,"standard_charge_algorithm": "Lesser of $143.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":150.7,"standard_charge_algorithm": "Lesser of $150.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":145.22,"standard_charge_algorithm": "Lesser of $145.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB EGFR GENE COM ANALYSIS","code_information":[{"code":"81235","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":425.25,"maximum":425.25,"gross_charge":525,"discounted_cash":155.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":425.25,"methodology":"fee schedule"}]}]},{"description":"HC LAB EGFR GENE COM ANALYSIS","code_information":[{"code":"81235","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":732.62,"gross_charge":525,"discounted_cash":155.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":425.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":732.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":580.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":555.03,"standard_charge_algorithm": "Lesser of $555.03 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":640.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":713.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":486.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"standard_charge_algorithm": "Lesser of $324.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":347.3,"standard_charge_algorithm": "Lesser of $347.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":334.32,"standard_charge_algorithm": "Lesser of $334.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":340.81,"standard_charge_algorithm": "Lesser of $340.81 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":357.04,"standard_charge_algorithm": "Lesser of $357.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":344.05,"standard_charge_algorithm": "Lesser of $344.05 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POISONING OF MEDICINAL AGENTS","code_information":[{"code":"8124","type":"APR-DRG"}],"standard_charges":[{"minimum":13538,"maximum":13538,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13538,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13538,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13538,"methodology":"case rate"}]}]},{"description":"HC LAB PROTHROMBIN FACTOR II","code_information":[{"code":"81240","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":217.89,"maximum":217.89,"gross_charge":269,"discounted_cash":79.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.89,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTHROMBIN FACTOR II","code_information":[{"code":"81240","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":217.89,"gross_charge":269,"discounted_cash":79.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":149.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":118.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":112.33,"standard_charge_algorithm": "Lesser of $112.33 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":129.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":144.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":98.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.69,"standard_charge_algorithm": "Lesser of $65.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"standard_charge_algorithm": "Lesser of $70.29 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":67.66,"standard_charge_algorithm": "Lesser of $67.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.97,"standard_charge_algorithm": "Lesser of $68.97 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":72.26,"standard_charge_algorithm": "Lesser of $72.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":69.63,"standard_charge_algorithm": "Lesser of $69.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR V LEIDEN GENE","code_information":[{"code":"81241","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":191.16,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR V LEIDEN GENE","code_information":[{"code":"81241","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":185.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":146.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":125.46,"standard_charge_algorithm": "Lesser of $125.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":144.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":161,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":110.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":73.37,"standard_charge_algorithm": "Lesser of $73.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":78.51,"standard_charge_algorithm": "Lesser of $78.51 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":75.57,"standard_charge_algorithm": "Lesser of $75.57 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":77.04,"standard_charge_algorithm": "Lesser of $77.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":80.71,"standard_charge_algorithm": "Lesser of $80.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":77.77,"standard_charge_algorithm": "Lesser of $77.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FRAGILE X SYNDROME CARRIER","code_information":[{"code":"81243","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":186.3,"maximum":186.3,"gross_charge":230,"discounted_cash":68.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"}]}]},{"description":"FRAGILE X SYNDROME CARRIER","code_information":[{"code":"81243","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":57.04,"maximum":391.59,"gross_charge":230,"discounted_cash":68.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":273.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":216.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":97.54,"standard_charge_algorithm": "Lesser of $97.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":112.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":57.04,"standard_charge_algorithm": "Lesser of $57.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":61.03,"standard_charge_algorithm": "Lesser of $61.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":58.75,"standard_charge_algorithm": "Lesser of $58.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":59.89,"standard_charge_algorithm": "Lesser of $59.89 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":62.74,"standard_charge_algorithm": "Lesser of $62.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":60.46,"standard_charge_algorithm": "Lesser of $60.46 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FRAGILE X METHYLAT ANALYSIS","code_information":[{"code":"81244","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":145.8,"maximum":145.8,"gross_charge":180,"discounted_cash":53.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"}]}]},{"description":"FRAGILE X METHYLAT ANALYSIS","code_information":[{"code":"81244","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.89,"maximum":273.06,"gross_charge":180,"discounted_cash":53.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":273.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":216.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":76.76,"standard_charge_algorithm": "Lesser of $76.76 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":88.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":98.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":44.89,"standard_charge_algorithm": "Lesser of $44.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":48.03,"standard_charge_algorithm": "Lesser of $48.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":46.24,"standard_charge_algorithm": "Lesser of $46.24 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":47.13,"standard_charge_algorithm": "Lesser of $47.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":49.38,"standard_charge_algorithm": "Lesser of $49.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":47.58,"standard_charge_algorithm": "Lesser of $47.58 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEREDITARY HEMOCHROMDNA","code_information":[{"code":"81256","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEREDITARY HEMOCHROMDNA","code_information":[{"code":"81256","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":197.96,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":197.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":111.77,"standard_charge_algorithm": "Lesser of $111.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":143.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":159.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":98.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.36,"standard_charge_algorithm": "Lesser of $65.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":69.94,"standard_charge_algorithm": "Lesser of $69.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":67.32,"standard_charge_algorithm": "Lesser of $67.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.63,"standard_charge_algorithm": "Lesser of $68.63 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":71.9,"standard_charge_algorithm": "Lesser of $71.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":69.28,"standard_charge_algorithm": "Lesser of $69.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ALPHA GLOBIN GENE ANALYSIS","code_information":[{"code":"81257","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":830.25,"maximum":830.25,"gross_charge":1025,"discounted_cash":303.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":830.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":830.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":830.25,"methodology":"fee schedule"}]}]},{"description":"HC ALPHA GLOBIN GENE ANALYSIS","code_information":[{"code":"81257","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.26,"maximum":830.25,"gross_charge":1025,"discounted_cash":303.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":830.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":830.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":830.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":521.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":413.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":174.86,"standard_charge_algorithm": "Lesser of $174.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":201.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":224.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":102.26,"standard_charge_algorithm": "Lesser of $102.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":109.42,"standard_charge_algorithm": "Lesser of $109.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":105.33,"standard_charge_algorithm": "Lesser of $105.33 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":107.37,"standard_charge_algorithm": "Lesser of $107.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":112.49,"standard_charge_algorithm": "Lesser of $112.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":108.4,"standard_charge_algorithm": "Lesser of $108.40 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC JAK2 V617F MUTATION ANALYSIS","code_information":[{"code":"81270","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":352.35,"maximum":352.35,"gross_charge":435,"discounted_cash":128.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.35,"methodology":"fee schedule"}]}]},{"description":"HC JAK2 V617F MUTATION ANALYSIS","code_information":[{"code":"81270","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.55,"maximum":352.35,"gross_charge":435,"discounted_cash":128.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":277.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":220.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":156.74,"standard_charge_algorithm": "Lesser of $156.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":200.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":223.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":91.66,"standard_charge_algorithm": "Lesser of $91.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":98.08,"standard_charge_algorithm": "Lesser of $98.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":94.41,"standard_charge_algorithm": "Lesser of $94.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":96.24,"standard_charge_algorithm": "Lesser of $96.24 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":100.83,"standard_charge_algorithm": "Lesser of $100.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":97.16,"standard_charge_algorithm": "Lesser of $97.16 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HUNTINGTON DISEASE GENE ANALYSIS","code_information":[{"code":"81271","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":445.5,"maximum":445.5,"gross_charge":550,"discounted_cash":162.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.5,"methodology":"fee schedule"}]}]},{"description":"HUNTINGTON DISEASE GENE ANALYSIS","code_information":[{"code":"81271","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":122.62,"maximum":445.5,"gross_charge":550,"discounted_cash":162.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":304.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":241.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":234.27,"standard_charge_algorithm": "Lesser of $234.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":270.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":301.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":205.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"standard_charge_algorithm": "Lesser of $137.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":146.59,"standard_charge_algorithm": "Lesser of $146.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":141.11,"standard_charge_algorithm": "Lesser of $141.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":143.85,"standard_charge_algorithm": "Lesser of $143.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":150.7,"standard_charge_algorithm": "Lesser of $150.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":145.22,"standard_charge_algorithm": "Lesser of $145.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB METHYL FOLATE-MTHFR GENE","code_information":[{"code":"81291","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":197.64,"maximum":197.64,"gross_charge":244,"discounted_cash":72.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB METHYL FOLATE-MTHFR GENE","code_information":[{"code":"81291","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":197.64,"gross_charge":244,"discounted_cash":72.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":132.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":104.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":111.73,"standard_charge_algorithm": "Lesser of $111.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":128.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":143.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.34,"standard_charge_algorithm": "Lesser of $65.34 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":69.91,"standard_charge_algorithm": "Lesser of $69.91 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":67.3,"standard_charge_algorithm": "Lesser of $67.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.61,"standard_charge_algorithm": "Lesser of $68.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":71.87,"standard_charge_algorithm": "Lesser of $71.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":69.26,"standard_charge_algorithm": "Lesser of $69.26 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"COAGULATION DISORDERS","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":7254,"maximum":23495.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13915,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13155,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8863,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14136,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13254,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22320.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16917,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20169,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16470,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23495.39,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22989,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14274,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14274,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7254,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13052.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13966.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13444.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13705.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13836.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13705.64,"methodology":"case rate"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8131","type":"APR-DRG"}],"standard_charges":[{"minimum":4824,"maximum":4824,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4824,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4824,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4824,"methodology":"case rate"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8132","type":"APR-DRG"}],"standard_charges":[{"minimum":6695,"maximum":6695,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6695,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6695,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6695,"methodology":"case rate"}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8133","type":"APR-DRG"}],"standard_charges":[{"minimum":10631,"maximum":10631,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10631,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10631,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10631,"methodology":"case rate"}]}]},{"description":"ALPHA 1 ANTITRIPSIN GENOTYPE","code_information":[{"code":"81332","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":204.12,"maximum":204.12,"gross_charge":252,"discounted_cash":74.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.12,"methodology":"fee schedule"}]}]},{"description":"ALPHA 1 ANTITRIPSIN GENOTYPE","code_information":[{"code":"81332","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":43.65,"maximum":204.12,"gross_charge":252,"discounted_cash":74.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":132.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":104.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":74.64,"standard_charge_algorithm": "Lesser of $74.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":106.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.65,"standard_charge_algorithm": "Lesser of $43.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":46.71,"standard_charge_algorithm": "Lesser of $46.71 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.96,"standard_charge_algorithm": "Lesser of $44.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.83,"standard_charge_algorithm": "Lesser of $45.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48.02,"standard_charge_algorithm": "Lesser of $48.02 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46.27,"standard_charge_algorithm": "Lesser of $46.27 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER COMPLICATIONS OF TREATMENT","code_information":[{"code":"8134","type":"APR-DRG"}],"standard_charges":[{"minimum":12008,"maximum":12008,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12008,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12008,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12008,"methodology":"case rate"}]}]},{"description":"BETA THALASSEMIA: HBB","code_information":[{"code":"81364","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1053,"maximum":1053,"gross_charge":1300,"discounted_cash":384.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1053,"methodology":"fee schedule"}]}]},{"description":"BETA THALASSEMIA: HBB","code_information":[{"code":"81364","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":290.51,"maximum":1053,"gross_charge":1300,"discounted_cash":384.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":720.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":571.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":555.03,"standard_charge_algorithm": "Lesser of $555.03 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":640.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":713.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":486.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":324.58,"standard_charge_algorithm": "Lesser of $324.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":347.3,"standard_charge_algorithm": "Lesser of $347.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":334.32,"standard_charge_algorithm": "Lesser of $334.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":340.81,"standard_charge_algorithm": "Lesser of $340.81 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":357.04,"standard_charge_algorithm": "Lesser of $357.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":344.05,"standard_charge_algorithm": "Lesser of $344.05 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HLA ABC (IR)","code_information":[{"code":"81372","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1568.97,"maximum":1568.97,"gross_charge":1937,"discounted_cash":573.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1568.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1568.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1568.97,"methodology":"fee schedule"}]}]},{"description":"HLA ABC (IR)","code_information":[{"code":"81372","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":1568.97,"gross_charge":1937,"discounted_cash":573.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1568.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1568.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1568.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":403.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":669.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":530.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":690.14,"standard_charge_algorithm": "Lesser of $690.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":796.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":886.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":605.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":403.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":403.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":403.59,"standard_charge_algorithm": "Lesser of $403.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":431.84,"standard_charge_algorithm": "Lesser of $431.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":415.7,"standard_charge_algorithm": "Lesser of $415.70 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":423.77,"standard_charge_algorithm": "Lesser of $423.77 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":443.95,"standard_charge_algorithm": "Lesser of $443.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":427.81,"standard_charge_algorithm": "Lesser of $427.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HLA-A TYPING","code_information":[{"code":"81373","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2481.03,"maximum":2481.03,"gross_charge":3063,"discounted_cash":906.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2481.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2481.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2481.03,"methodology":"fee schedule"}]}]},{"description":"HC HLA-A TYPING","code_information":[{"code":"81373","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.09,"maximum":2481.03,"gross_charge":3063,"discounted_cash":906.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2481.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2481.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2481.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":337.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":267.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":217.91,"standard_charge_algorithm": "Lesser of $217.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":251.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":279.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":191.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":127.43,"standard_charge_algorithm": "Lesser of $127.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":136.35,"standard_charge_algorithm": "Lesser of $136.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":131.25,"standard_charge_algorithm": "Lesser of $131.25 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":133.8,"standard_charge_algorithm": "Lesser of $133.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":140.17,"standard_charge_algorithm": "Lesser of $140.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":135.08,"standard_charge_algorithm": "Lesser of $135.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HLA B 27 DISEASE ASSOCIATION","code_information":[{"code":"81374","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":310.23,"maximum":310.23,"gross_charge":383,"discounted_cash":113.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":310.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":310.23,"methodology":"fee schedule"}]}]},{"description":"HLA B 27 DISEASE ASSOCIATION","code_information":[{"code":"81374","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":74.33,"maximum":310.23,"gross_charge":383,"discounted_cash":113.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":310.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":310.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":220.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":174.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":127.1,"standard_charge_algorithm": "Lesser of $127.10 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":159.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":111.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":74.33,"standard_charge_algorithm": "Lesser of $74.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":79.53,"standard_charge_algorithm": "Lesser of $79.53 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":76.56,"standard_charge_algorithm": "Lesser of $76.56 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":78.05,"standard_charge_algorithm": "Lesser of $78.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":81.76,"standard_charge_algorithm": "Lesser of $81.76 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":78.79,"standard_charge_algorithm": "Lesser of $78.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HLA II TYPING LOW RES ONE ANTIGEN","code_information":[{"code":"81377","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":333.72,"maximum":333.72,"gross_charge":412,"discounted_cash":121.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":333.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":333.72,"methodology":"fee schedule"}]}]},{"description":"HLA II TYPING LOW RES ONE ANTIGEN","code_information":[{"code":"81377","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":333.72,"gross_charge":412,"discounted_cash":121.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":333.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":333.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":94.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":278.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":220.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.01,"standard_charge_algorithm": "Lesser of $162.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":201.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":224.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":142.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":94.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":94.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":94.74,"standard_charge_algorithm": "Lesser of $94.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.37,"standard_charge_algorithm": "Lesser of $101.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.58,"standard_charge_algorithm": "Lesser of $97.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.48,"standard_charge_algorithm": "Lesser of $99.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.21,"standard_charge_algorithm": "Lesser of $104.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.42,"standard_charge_algorithm": "Lesser of $100.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HLAB*5701 TYPING","code_information":[{"code":"81381","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":340.2,"maximum":340.2,"gross_charge":420,"discounted_cash":124.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.2,"methodology":"fee schedule"}]}]},{"description":"HC HLAB*5701 TYPING","code_information":[{"code":"81381","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.75,"maximum":373.56,"gross_charge":420,"discounted_cash":124.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":286.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":290.53,"standard_charge_algorithm": "Lesser of $290.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":335.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":373.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":254.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":169.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":169.9,"standard_charge_algorithm": "Lesser of $169.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":181.79,"standard_charge_algorithm": "Lesser of $181.79 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":175,"standard_charge_algorithm": "Lesser of $175.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":178.4,"standard_charge_algorithm": "Lesser of $178.40 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":186.89,"standard_charge_algorithm": "Lesser of $186.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":180.09,"standard_charge_algorithm": "Lesser of $180.09 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HLA DQ GENOTYPING","code_information":[{"code":"81382","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":630.99,"maximum":630.99,"gross_charge":779,"discounted_cash":230.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":630.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":630.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":630.99,"methodology":"fee schedule"}]}]},{"description":"HC HLA DQ GENOTYPING","code_information":[{"code":"81382","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":123.68,"maximum":630.99,"gross_charge":779,"discounted_cash":230.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":630.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":630.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":630.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":374.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":296.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":211.49,"standard_charge_algorithm": "Lesser of $211.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":271.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":302.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":185.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":123.68,"standard_charge_algorithm": "Lesser of $123.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":132.34,"standard_charge_algorithm": "Lesser of $132.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":127.39,"standard_charge_algorithm": "Lesser of $127.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":129.86,"standard_charge_algorithm": "Lesser of $129.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":136.05,"standard_charge_algorithm": "Lesser of $136.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":131.1,"standard_charge_algorithm": "Lesser of $131.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HLA II HI RES 1 ALLELE OR ALLELE GRP","code_information":[{"code":"81383","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":383.94,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"}]}]},{"description":"HLA II HI RES 1 ALLELE OR ALLELE GRP","code_information":[{"code":"81383","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":109.13,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":330.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":262.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":186.61,"standard_charge_algorithm": "Lesser of $186.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":239.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":266.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":163.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":109.13,"standard_charge_algorithm": "Lesser of $109.13 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":116.77,"standard_charge_algorithm": "Lesser of $116.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":112.4,"standard_charge_algorithm": "Lesser of $112.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":114.59,"standard_charge_algorithm": "Lesser of $114.59 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":120.04,"standard_charge_algorithm": "Lesser of $120.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":115.68,"standard_charge_algorithm": "Lesser of $115.68 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"minimum":6682,"maximum":31046,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18791,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17765,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12090,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21572,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20225,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28280.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20311,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24216,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22468,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29768.46,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31046,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19277,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19277,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6682,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16538.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17695.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17034.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17364.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17530.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17364.94,"methodology":"case rate"}]}]},{"description":"APOE ALZHEIMERS RISK","code_information":[{"code":"81401","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":643.14,"maximum":643.14,"gross_charge":794,"discounted_cash":235.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.14,"methodology":"fee schedule"}]}]},{"description":"APOE ALZHEIMERS RISK","code_information":[{"code":"81401","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":125.31,"maximum":643.14,"gross_charge":794,"discounted_cash":235.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":246.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":234.27,"standard_charge_algorithm": "Lesser of $234.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":270.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":301.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":205.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"standard_charge_algorithm": "Lesser of $137.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":146.59,"standard_charge_algorithm": "Lesser of $146.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":141.11,"standard_charge_algorithm": "Lesser of $141.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":143.85,"standard_charge_algorithm": "Lesser of $143.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":150.7,"standard_charge_algorithm": "Lesser of $150.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":145.22,"standard_charge_algorithm": "Lesser of $145.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MOPATH PROCEDURE LEVEL 2","code_information":[{"code":"81401","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":662.58,"maximum":662.58,"gross_charge":818,"discounted_cash":242.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":662.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":662.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":662.58,"methodology":"fee schedule"}]}]},{"description":"HC LAB MOPATH PROCEDURE LEVEL 2","code_information":[{"code":"81401","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":125.31,"maximum":662.58,"gross_charge":818,"discounted_cash":242.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":662.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":662.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":662.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":246.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":234.27,"standard_charge_algorithm": "Lesser of $234.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":270.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":301.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":205.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"standard_charge_algorithm": "Lesser of $137.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":146.59,"standard_charge_algorithm": "Lesser of $146.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":141.11,"standard_charge_algorithm": "Lesser of $141.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":143.85,"standard_charge_algorithm": "Lesser of $143.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":150.7,"standard_charge_algorithm": "Lesser of $150.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":145.22,"standard_charge_algorithm": "Lesser of $145.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC GENOTYPE RBC BLOOD GROUP","code_information":[{"code":"81403","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":479.52,"maximum":479.52,"gross_charge":592,"discounted_cash":175.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.52,"methodology":"fee schedule"}]}]},{"description":"HC GENOTYPE RBC BLOOD GROUP","code_information":[{"code":"81403","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":185.2,"maximum":521.7,"gross_charge":592,"discounted_cash":175.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":521.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":413.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":316.69,"standard_charge_algorithm": "Lesser of $316.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":365.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":277.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":185.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":185.2,"standard_charge_algorithm": "Lesser of $185.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":198.16,"standard_charge_algorithm": "Lesser of $198.16 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":190.76,"standard_charge_algorithm": "Lesser of $190.76 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":194.46,"standard_charge_algorithm": "Lesser of $194.46 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":203.72,"standard_charge_algorithm": "Lesser of $203.72 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":196.31,"standard_charge_algorithm": "Lesser of $196.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOLECULAR PATHOLOGY LEVEL 5","code_information":[{"code":"81404","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":917.73,"maximum":917.73,"gross_charge":1133,"discounted_cash":335.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":917.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":917.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":917.73,"methodology":"fee schedule"}]}]},{"description":"MOLECULAR PATHOLOGY LEVEL 5","code_information":[{"code":"81404","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":272.99,"maximum":917.73,"gross_charge":1133,"discounted_cash":335.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":917.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":917.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":917.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":677.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":536.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":469.96,"standard_charge_algorithm": "Lesser of $469.96 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":542.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":604.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":412.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":274.83,"standard_charge_algorithm": "Lesser of $274.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":294.07,"standard_charge_algorithm": "Lesser of $294.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":283.07,"standard_charge_algorithm": "Lesser of $283.07 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":288.57,"standard_charge_algorithm": "Lesser of $288.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":302.31,"standard_charge_algorithm": "Lesser of $302.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":291.32,"standard_charge_algorithm": "Lesser of $291.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOLECULAR PATHOLOGY LEVEL 7","code_information":[{"code":"81406","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":942.84,"maximum":942.84,"gross_charge":1164,"discounted_cash":344.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":942.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":942.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":942.84,"methodology":"fee schedule"}]}]},{"description":"MOLECULAR PATHOLOGY LEVEL 7","code_information":[{"code":"81406","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":282.88,"maximum":1443,"gross_charge":1164,"discounted_cash":344.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":942.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":942.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":942.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1443,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1144,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":483.72,"standard_charge_algorithm": "Lesser of $483.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":558.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":621.81,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":424.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":282.88,"standard_charge_algorithm": "Lesser of $282.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":302.68,"standard_charge_algorithm": "Lesser of $302.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":291.37,"standard_charge_algorithm": "Lesser of $291.37 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":297.02,"standard_charge_algorithm": "Lesser of $297.02 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":311.17,"standard_charge_algorithm": "Lesser of $311.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":299.85,"standard_charge_algorithm": "Lesser of $299.85 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MOLECULAR PATHOLOGY LEVEL 9","code_information":[{"code":"81408","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":6674.4,"maximum":6674.4,"gross_charge":8240,"discounted_cash":2439.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6674.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6674.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6674.4,"methodology":"fee schedule"}]}]},{"description":"MOLECULAR PATHOLOGY LEVEL 9","code_information":[{"code":"81408","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":2000,"maximum":6674.4,"gross_charge":8240,"discounted_cash":2439.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6674.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6674.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6674.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2000,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3663,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2904,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3420,"standard_charge_algorithm": "Lesser of $3420.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3946.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4395.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3000,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2000,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2000,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2595.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2595.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2595.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2595.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2000,"standard_charge_algorithm": "Lesser of $2000.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2140,"standard_charge_algorithm": "Lesser of $2140.00 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2060,"standard_charge_algorithm": "Lesser of $2060.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2100,"standard_charge_algorithm": "Lesser of $2100.00 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2200,"standard_charge_algorithm": "Lesser of $2200.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2120,"standard_charge_algorithm": "Lesser of $2120.00 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AORTIC DYSFUN/DILGENOMIC SEQ","code_information":[{"code":"81410","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1681.56,"maximum":1681.56,"gross_charge":2076,"discounted_cash":614.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1681.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1681.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1681.56,"methodology":"fee schedule"}]}]},{"description":"AORTIC DYSFUN/DILGENOMIC SEQ","code_information":[{"code":"81410","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":394.44,"maximum":1681.56,"gross_charge":2076,"discounted_cash":614.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1681.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1681.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1681.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":504,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1118.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":887.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":861.84,"standard_charge_algorithm": "Lesser of $861.84 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":994.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1107.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":756,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":504,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":504,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":504,"standard_charge_algorithm": "Lesser of $504.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":539.28,"standard_charge_algorithm": "Lesser of $539.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":519.12,"standard_charge_algorithm": "Lesser of $519.12 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":529.2,"standard_charge_algorithm": "Lesser of $529.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":554.4,"standard_charge_algorithm": "Lesser of $554.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":534.24,"standard_charge_algorithm": "Lesser of $534.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AORTIC DYSFUN/DILDUP/DELETE","code_information":[{"code":"81411","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":4505.22,"maximum":4505.22,"gross_charge":5562,"discounted_cash":1646.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4505.22,"methodology":"fee schedule"}]}]},{"description":"AORTIC DYSFUN/DILDUP/DELETE","code_information":[{"code":"81411","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":834.3,"maximum":4505.22,"gross_charge":5562,"discounted_cash":1646.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4505.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2997.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2376.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2308.82,"standard_charge_algorithm": "Lesser of $2308.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2664.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2967.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2025.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1056.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1350.19,"standard_charge_algorithm": "Lesser of $1350.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1444.7,"standard_charge_algorithm": "Lesser of $1444.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1390.7,"standard_charge_algorithm": "Lesser of $1390.70 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1417.7,"standard_charge_algorithm": "Lesser of $1417.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1485.21,"standard_charge_algorithm": "Lesser of $1485.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1431.2,"standard_charge_algorithm": "Lesser of $1431.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GENOMIC SEQUENCE","code_information":[{"code":"81460","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":4297.05,"maximum":4297.05,"gross_charge":5305,"discounted_cash":1570.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4297.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4297.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4297.05,"methodology":"fee schedule"}]}]},{"description":"GENOMIC SEQUENCE","code_information":[{"code":"81460","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":795.75,"maximum":4297.05,"gross_charge":5305,"discounted_cash":1570.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4297.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4297.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4297.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1287,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2857.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2265.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2200.77,"standard_charge_algorithm": "Lesser of $2200.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2539.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2828.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1930.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1287,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1287,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1007.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":795.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1061,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1287,"standard_charge_algorithm": "Lesser of $1287.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1377.09,"standard_charge_algorithm": "Lesser of $1377.09 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1325.61,"standard_charge_algorithm": "Lesser of $1325.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1351.35,"standard_charge_algorithm": "Lesser of $1351.35 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1415.7,"standard_charge_algorithm": "Lesser of $1415.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1364.22,"standard_charge_algorithm": "Lesser of $1364.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"WHOLE MITOCHONDRIAL GENOME","code_information":[{"code":"81465","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":3124.17,"maximum":3124.17,"gross_charge":3857,"discounted_cash":1141.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3124.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3124.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3124.17,"methodology":"fee schedule"}]}]},{"description":"WHOLE MITOCHONDRIAL GENOME","code_information":[{"code":"81465","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":578.55,"maximum":3124.17,"gross_charge":3857,"discounted_cash":1141.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3124.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3124.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3124.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":936,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2077.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1647.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1600.56,"standard_charge_algorithm": "Lesser of $1600.56 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1847.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2057.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":936,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":936,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":732.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":936,"standard_charge_algorithm": "Lesser of $936.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1001.52,"standard_charge_algorithm": "Lesser of $1001.52 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":964.08,"standard_charge_algorithm": "Lesser of $964.08 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":982.8,"standard_charge_algorithm": "Lesser of $982.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1029.6,"standard_charge_algorithm": "Lesser of $1029.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":992.16,"standard_charge_algorithm": "Lesser of $992.16 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB UNLISTED MOLECULAR PRCED","code_information":[{"code":"81479","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1777.14,"maximum":1777.14,"gross_charge":2194,"discounted_cash":649.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1777.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB UNLISTED MOLECULAR PRCED","code_information":[{"code":"81479","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":240.31,"maximum":1777.14,"gross_charge":2194,"discounted_cash":649.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":240.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":267.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1097,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1097,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"}]}]},{"description":"NOTCH3 GENE - MAYO","code_information":[{"code":"81479","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1725.3,"maximum":1725.3,"gross_charge":2130,"discounted_cash":630.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1725.3,"methodology":"fee schedule"}]}]},{"description":"NOTCH3 GENE - MAYO","code_information":[{"code":"81479","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":240.31,"maximum":1725.3,"gross_charge":2130,"discounted_cash":630.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":240.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":267.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1065,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1065,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"}]}]},{"description":"UNLISTED MOLECULAR C9ORF","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1777.14,"maximum":1777.14,"gross_charge":2194,"discounted_cash":649.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1777.14,"methodology":"fee schedule"}]}]},{"description":"UNLISTED MOLECULAR C9ORF","code_information":[{"code":"81479","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":240.31,"maximum":1777.14,"gross_charge":2194,"discounted_cash":649.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1777.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":240.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":267.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1097,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1097,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":995.82,"methodology":"fee schedule"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"minimum":5241,"maximum":17344.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9134,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8635,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5648,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13840,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12976,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16477.63,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11145,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13288,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10497,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17344.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15090,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9369,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9369,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5241,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9636.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10310.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9925.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10117.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10214.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10117.85,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8151","type":"APR-DRG"}],"standard_charges":[{"minimum":3024,"maximum":3024,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3024,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3024,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3024,"methodology":"case rate"}]}]},{"description":"NFCT DS BV&VAGINITIS DNA ALG","code_information":[{"code":"81515","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":876.42,"maximum":876.42,"gross_charge":1082,"discounted_cash":320.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":876.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":876.42,"methodology":"fee schedule"}]}]},{"description":"NFCT DS BV&VAGINITIS DNA ALG","code_information":[{"code":"81515","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":162.3,"maximum":876.42,"gross_charge":1082,"discounted_cash":320.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":876.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":876.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":876.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.4,"methodology":"fee schedule"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8152","type":"APR-DRG"}],"standard_charges":[{"minimum":5614,"maximum":5614,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5614,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5614,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5614,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8153","type":"APR-DRG"}],"standard_charges":[{"minimum":11569,"maximum":11569,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11569,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11569,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11569,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES","code_information":[{"code":"8154","type":"APR-DRG"}],"standard_charges":[{"minimum":12598,"maximum":12598,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12598,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12598,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12598,"methodology":"case rate"}]}]},{"description":"HEP C (HCV) FIBROSURE","code_information":[{"code":"81596","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":254.34,"maximum":254.34,"gross_charge":314,"discounted_cash":92.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"}]}]},{"description":"HEP C (HCV) FIBROSURE","code_information":[{"code":"81596","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":64.61,"maximum":254.34,"gross_charge":314,"discounted_cash":92.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":160.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":127.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":123.44,"standard_charge_algorithm": "Lesser of $123.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":142.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":158.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":108.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":72.19,"standard_charge_algorithm": "Lesser of $72.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":77.24,"standard_charge_algorithm": "Lesser of $77.24 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":74.36,"standard_charge_algorithm": "Lesser of $74.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":75.8,"standard_charge_algorithm": "Lesser of $75.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":79.41,"standard_charge_algorithm": "Lesser of $79.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":76.52,"standard_charge_algorithm": "Lesser of $76.52 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"minimum":3445,"maximum":13220.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5927,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5604,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4035,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10549,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9890,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12559.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7880,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9395,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7498,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13220.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9793,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6080,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6080,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3445,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7344.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7858.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7564.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7711.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7785.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7711.82,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8161","type":"APR-DRG"}],"standard_charges":[{"minimum":5836,"maximum":5836,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5836,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5836,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5836,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8162","type":"APR-DRG"}],"standard_charges":[{"minimum":5856,"maximum":5856,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5856,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8163","type":"APR-DRG"}],"standard_charges":[{"minimum":6774,"maximum":6774,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6774,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6774,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6774,"methodology":"case rate"}]}]},{"description":"TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES","code_information":[{"code":"8164","type":"APR-DRG"}],"standard_charges":[{"minimum":11490,"maximum":11490,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11490,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11490,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11490,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"minimum":16003,"maximum":42378,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22788,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21543,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16003,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42378,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39732,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33164.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33830,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40334,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29740,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":34909.49,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37649,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23376,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23376,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19394.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20751.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19975.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20363.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20557.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20363.87,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8171","type":"APR-DRG"}],"standard_charges":[{"minimum":4106,"maximum":4106,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4106,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4106,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4106,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8172","type":"APR-DRG"}],"standard_charges":[{"minimum":4892,"maximum":4892,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4892,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4892,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4892,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8173","type":"APR-DRG"}],"standard_charges":[{"minimum":7568,"maximum":7568,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7568,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7568,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7568,"methodology":"case rate"}]}]},{"description":"INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE","code_information":[{"code":"8174","type":"APR-DRG"}],"standard_charges":[{"minimum":13580,"maximum":13580,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13580,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13580,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13580,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"minimum":8131,"maximum":22740,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11578,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10945,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8131,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22740,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21320,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19464.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17187,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20492,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15110,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20488.94,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19128,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11877,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11877,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11382.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12179.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11724.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11951.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12065.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11951.88,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"minimum":5154,"maximum":15036.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7340,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6939,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5154,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14044,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14285,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9604,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11450,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9578,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15036.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7529,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7529,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8353.8,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8938.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8604.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8771.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8855.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8771.49,"methodology":"case rate"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"minimum":28015,"maximum":86467,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52337,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49478,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34353,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":75275,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70576,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":69274.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57478,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68528,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63841,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":72920.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86467,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":53687,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":53687,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28015,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":40511.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":43347.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":41726.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":42536.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42941.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":42536.83,"methodology":"case rate"}]}]},{"description":"HC LAB KETONES SERUM","code_information":[{"code":"82009","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"}]}]},{"description":"HC LAB KETONES SERUM","code_information":[{"code":"82009","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.52,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.73,"standard_charge_algorithm": "Lesser of $7.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"standard_charge_algorithm": "Lesser of $4.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.84,"standard_charge_algorithm": "Lesser of $4.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.66,"standard_charge_algorithm": "Lesser of $4.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.97,"standard_charge_algorithm": "Lesser of $4.97 or 110 Percent of Billed Charges","median_amount":4.52,"10th_percentile":4.52,"90th_percentile":4.52,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.79,"standard_charge_algorithm": "Lesser of $4.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB KETONES BLOOD","code_information":[{"code":"82010","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":47.79,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB KETONES BLOOD","code_information":[{"code":"82010","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.17,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.97,"standard_charge_algorithm": "Lesser of $13.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"standard_charge_algorithm": "Lesser of $8.74 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.42,"standard_charge_algorithm": "Lesser of $8.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.58,"standard_charge_algorithm": "Lesser of $8.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.99,"standard_charge_algorithm": "Lesser of $8.99 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.66,"standard_charge_algorithm": "Lesser of $8.66 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ACTH","code_information":[{"code":"82024","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":179.82,"maximum":179.82,"gross_charge":222,"discounted_cash":65.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB ACTH","code_information":[{"code":"82024","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":38.62,"maximum":179.82,"gross_charge":222,"discounted_cash":65.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":116.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":66.04,"standard_charge_algorithm": "Lesser of $66.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":94.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.62,"standard_charge_algorithm": "Lesser of $38.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.32,"standard_charge_algorithm": "Lesser of $41.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.78,"standard_charge_algorithm": "Lesser of $39.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.55,"standard_charge_algorithm": "Lesser of $40.55 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.48,"standard_charge_algorithm": "Lesser of $42.48 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40.94,"standard_charge_algorithm": "Lesser of $40.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALBUMIN","code_information":[{"code":"82040","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":169.29,"maximum":169.29,"gross_charge":209,"discounted_cash":61.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALBUMIN","code_information":[{"code":"82040","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":169.29,"gross_charge":209,"discounted_cash":61.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.46,"standard_charge_algorithm": "Lesser of $8.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"standard_charge_algorithm": "Lesser of $4.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"standard_charge_algorithm": "Lesser of $5.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.2,"standard_charge_algorithm": "Lesser of $5.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.45,"standard_charge_algorithm": "Lesser of $5.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.25,"standard_charge_algorithm": "Lesser of $5.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALBUMIN SERUM","code_information":[{"code":"82040","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":169.29,"maximum":169.29,"gross_charge":209,"discounted_cash":61.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALBUMIN SERUM","code_information":[{"code":"82040","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":169.29,"gross_charge":209,"discounted_cash":61.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.46,"standard_charge_algorithm": "Lesser of $8.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.95,"standard_charge_algorithm": "Lesser of $4.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"standard_charge_algorithm": "Lesser of $5.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.2,"standard_charge_algorithm": "Lesser of $5.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.45,"standard_charge_algorithm": "Lesser of $5.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.25,"standard_charge_algorithm": "Lesser of $5.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALBUMIN CSF","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":163.62,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALBUMIN CSF","code_information":[{"code":"82042","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.63,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.3,"standard_charge_algorithm": "Lesser of $13.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"standard_charge_algorithm": "Lesser of $7.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.32,"standard_charge_algorithm": "Lesser of $8.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.01,"standard_charge_algorithm": "Lesser of $8.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.56,"standard_charge_algorithm": "Lesser of $8.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.25,"standard_charge_algorithm": "Lesser of $8.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALBUMIN QUAN","code_information":[{"code":"82042","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":163.62,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALBUMIN QUAN","code_information":[{"code":"82042","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.63,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.3,"standard_charge_algorithm": "Lesser of $13.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.78,"standard_charge_algorithm": "Lesser of $7.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.32,"standard_charge_algorithm": "Lesser of $8.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.01,"standard_charge_algorithm": "Lesser of $8.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.56,"standard_charge_algorithm": "Lesser of $8.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.25,"standard_charge_algorithm": "Lesser of $8.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MICROALBUMIN 24 HR URINE","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB MICROALBUMIN 24 HR URINE","code_information":[{"code":"82043","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.63,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.88,"standard_charge_algorithm": "Lesser of $9.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"standard_charge_algorithm": "Lesser of $5.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.18,"standard_charge_algorithm": "Lesser of $6.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.07,"standard_charge_algorithm": "Lesser of $6.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.36,"standard_charge_algorithm": "Lesser of $6.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.13,"standard_charge_algorithm": "Lesser of $6.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MICROALBUMIN URINE","code_information":[{"code":"82043","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB MICROALBUMIN URINE","code_information":[{"code":"82043","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.63,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.88,"standard_charge_algorithm": "Lesser of $9.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"standard_charge_algorithm": "Lesser of $5.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.18,"standard_charge_algorithm": "Lesser of $6.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.07,"standard_charge_algorithm": "Lesser of $6.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.36,"standard_charge_algorithm": "Lesser of $6.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.13,"standard_charge_algorithm": "Lesser of $6.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALDOLASE","code_information":[{"code":"82085","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":71.28,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALDOLASE","code_information":[{"code":"82085","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.71,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.6,"standard_charge_algorithm": "Lesser of $16.60 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"standard_charge_algorithm": "Lesser of $9.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.39,"standard_charge_algorithm": "Lesser of $10.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10,"standard_charge_algorithm": "Lesser of $10.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.2,"standard_charge_algorithm": "Lesser of $10.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.68,"standard_charge_algorithm": "Lesser of $10.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.29,"standard_charge_algorithm": "Lesser of $10.29 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALDOSTERONE","code_information":[{"code":"82088","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":202.5,"maximum":202.5,"gross_charge":250,"discounted_cash":74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALDOSTERONE","code_information":[{"code":"82088","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.75,"maximum":202.5,"gross_charge":250,"discounted_cash":74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":69.68,"standard_charge_algorithm": "Lesser of $69.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":89.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"standard_charge_algorithm": "Lesser of $40.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":43.6,"standard_charge_algorithm": "Lesser of $43.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":41.97,"standard_charge_algorithm": "Lesser of $41.97 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":42.79,"standard_charge_algorithm": "Lesser of $42.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44.83,"standard_charge_algorithm": "Lesser of $44.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.2,"standard_charge_algorithm": "Lesser of $43.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALDOSTERONE","code_information":[{"code":"82088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":202.5,"maximum":202.5,"gross_charge":250,"discounted_cash":74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALDOSTERONE","code_information":[{"code":"82088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":40.75,"maximum":202.5,"gross_charge":250,"discounted_cash":74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":69.68,"standard_charge_algorithm": "Lesser of $69.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":89.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":40.75,"standard_charge_algorithm": "Lesser of $40.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":43.6,"standard_charge_algorithm": "Lesser of $43.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":41.97,"standard_charge_algorithm": "Lesser of $41.97 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":42.79,"standard_charge_algorithm": "Lesser of $42.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44.83,"standard_charge_algorithm": "Lesser of $44.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.2,"standard_charge_algorithm": "Lesser of $43.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"minimum":11831,"maximum":36632,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20067,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12681,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36632,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34345,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29838.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23373,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27867,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23567,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31409.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33154,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20585,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20585,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11831,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17449.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18671.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17973.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18322.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18496.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18322.08,"methodology":"case rate"}]}]},{"description":"HC LAB A-1-ANTITRYPSIN TOTAL","code_information":[{"code":"82103","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":188.73,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB A-1-ANTITRYPSIN TOTAL","code_information":[{"code":"82103","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.44,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.98,"standard_charge_algorithm": "Lesser of $22.98 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"standard_charge_algorithm": "Lesser of $14.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.84,"standard_charge_algorithm": "Lesser of $13.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.25,"standard_charge_algorithm": "Lesser of $14.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALPHA-1-ANTITRYPSIN","code_information":[{"code":"82103","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":188.73,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALPHA-1-ANTITRYPSIN","code_information":[{"code":"82103","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.44,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.98,"standard_charge_algorithm": "Lesser of $22.98 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"standard_charge_algorithm": "Lesser of $14.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.84,"standard_charge_algorithm": "Lesser of $13.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.25,"standard_charge_algorithm": "Lesser of $14.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALPHA1 ANTITRYPSIN PHNTYP1","code_information":[{"code":"82104","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":177.39,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALPHA1 ANTITRYPSIN PHNTYP1","code_information":[{"code":"82104","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.46,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.73,"standard_charge_algorithm": "Lesser of $24.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.46,"standard_charge_algorithm": "Lesser of $14.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.47,"standard_charge_algorithm": "Lesser of $15.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.18,"standard_charge_algorithm": "Lesser of $15.18 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.91,"standard_charge_algorithm": "Lesser of $15.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.33,"standard_charge_algorithm": "Lesser of $15.33 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AFP SERUM MATERNAL ONTD","code_information":[{"code":"82105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB AFP SERUM MATERNAL ONTD","code_information":[{"code":"82105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.77,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.68,"standard_charge_algorithm": "Lesser of $28.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"standard_charge_algorithm": "Lesser of $16.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.94,"standard_charge_algorithm": "Lesser of $17.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.61,"standard_charge_algorithm": "Lesser of $17.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.45,"standard_charge_algorithm": "Lesser of $18.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.78,"standard_charge_algorithm": "Lesser of $17.78 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AFP TUMOR MARKER","code_information":[{"code":"82105","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB AFP TUMOR MARKER","code_information":[{"code":"82105","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.77,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.68,"standard_charge_algorithm": "Lesser of $28.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.77,"standard_charge_algorithm": "Lesser of $16.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.94,"standard_charge_algorithm": "Lesser of $17.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.61,"standard_charge_algorithm": "Lesser of $17.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.45,"standard_charge_algorithm": "Lesser of $18.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.78,"standard_charge_algorithm": "Lesser of $17.78 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALUMINUM SERUM","code_information":[{"code":"82108","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.87,"maximum":102.87,"gross_charge":127,"discounted_cash":37.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALUMINUM SERUM","code_information":[{"code":"82108","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.72,"maximum":102.87,"gross_charge":127,"discounted_cash":37.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.57,"standard_charge_algorithm": "Lesser of $43.57 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.48,"standard_charge_algorithm": "Lesser of $25.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.26,"standard_charge_algorithm": "Lesser of $27.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.24,"standard_charge_algorithm": "Lesser of $26.24 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.75,"standard_charge_algorithm": "Lesser of $26.75 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.03,"standard_charge_algorithm": "Lesser of $28.03 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.01,"standard_charge_algorithm": "Lesser of $27.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CYSTINE URINE 24 HOUR","code_information":[{"code":"82131","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC CYSTINE URINE 24 HOUR","code_information":[{"code":"82131","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":22.98,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.3,"standard_charge_algorithm": "Lesser of $39.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.98,"standard_charge_algorithm": "Lesser of $22.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.59,"standard_charge_algorithm": "Lesser of $24.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.67,"standard_charge_algorithm": "Lesser of $23.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.13,"standard_charge_algorithm": "Lesser of $24.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.28,"standard_charge_algorithm": "Lesser of $25.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.36,"standard_charge_algorithm": "Lesser of $24.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AMINOLEVULINIC ACID (ALA)","code_information":[{"code":"82135","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"AMINOLEVULINIC ACID (ALA)","code_information":[{"code":"82135","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.45,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.13,"standard_charge_algorithm": "Lesser of $28.13 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"standard_charge_algorithm": "Lesser of $16.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.6,"standard_charge_algorithm": "Lesser of $17.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.09,"standard_charge_algorithm": "Lesser of $18.09 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.44,"standard_charge_algorithm": "Lesser of $17.44 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC AMINO ACIDS QUANT PLASMA","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC AMINO ACIDS QUANT PLASMA","code_information":[{"code":"82139","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.08,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.85,"standard_charge_algorithm": "Lesser of $28.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"standard_charge_algorithm": "Lesser of $16.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.38,"standard_charge_algorithm": "Lesser of $17.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.56,"standard_charge_algorithm": "Lesser of $18.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.88,"standard_charge_algorithm": "Lesser of $17.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMMONIA (NH3)","code_information":[{"code":"82140","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":410.67,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMMONIA (NH3)","code_information":[{"code":"82140","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.92,"maximum":410.67,"gross_charge":507,"discounted_cash":150.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.91,"standard_charge_algorithm": "Lesser of $24.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"standard_charge_algorithm": "Lesser of $15.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.01,"standard_charge_algorithm": "Lesser of $15.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.03,"standard_charge_algorithm": "Lesser of $16.03 or 110 Percent of Billed Charges","median_amount":42.98,"10th_percentile":13.92,"90th_percentile":42.98,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMYLASE","code_information":[{"code":"82150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMYLASE","code_information":[{"code":"82150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.08,"standard_charge_algorithm": "Lesser of $11.08 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"standard_charge_algorithm": "Lesser of $6.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"standard_charge_algorithm": "Lesser of $6.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.67,"standard_charge_algorithm": "Lesser of $6.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.8,"standard_charge_algorithm": "Lesser of $6.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.13,"standard_charge_algorithm": "Lesser of $7.13 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.87,"standard_charge_algorithm": "Lesser of $6.87 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMYLASE ISOENZYMES","code_information":[{"code":"82150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMYLASE ISOENZYMES","code_information":[{"code":"82150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.08,"standard_charge_algorithm": "Lesser of $11.08 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.48,"standard_charge_algorithm": "Lesser of $6.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.93,"standard_charge_algorithm": "Lesser of $6.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.67,"standard_charge_algorithm": "Lesser of $6.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.8,"standard_charge_algorithm": "Lesser of $6.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.13,"standard_charge_algorithm": "Lesser of $7.13 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.87,"standard_charge_algorithm": "Lesser of $6.87 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANDROSTENEDIONE","code_information":[{"code":"82157","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":133.65,"maximum":133.65,"gross_charge":165,"discounted_cash":48.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANDROSTENEDIONE","code_information":[{"code":"82157","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":29.28,"maximum":133.65,"gross_charge":165,"discounted_cash":48.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.07,"standard_charge_algorithm": "Lesser of $50.07 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.33,"standard_charge_algorithm": "Lesser of $31.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.16,"standard_charge_algorithm": "Lesser of $30.16 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.74,"standard_charge_algorithm": "Lesser of $30.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.21,"standard_charge_algorithm": "Lesser of $32.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.04,"standard_charge_algorithm": "Lesser of $31.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANDROSTENEDIONE","code_information":[{"code":"82157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":133.65,"maximum":133.65,"gross_charge":165,"discounted_cash":48.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANDROSTENEDIONE","code_information":[{"code":"82157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.28,"maximum":133.65,"gross_charge":165,"discounted_cash":48.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.07,"standard_charge_algorithm": "Lesser of $50.07 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.33,"standard_charge_algorithm": "Lesser of $31.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.16,"standard_charge_algorithm": "Lesser of $30.16 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.74,"standard_charge_algorithm": "Lesser of $30.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.21,"standard_charge_algorithm": "Lesser of $32.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.04,"standard_charge_algorithm": "Lesser of $31.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANGIOTENSIN CONV ENZY","code_information":[{"code":"82164","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":428.49,"maximum":428.49,"gross_charge":529,"discounted_cash":156.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":428.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":428.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":428.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANGIOTENSIN CONV ENZY","code_information":[{"code":"82164","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.6,"maximum":428.49,"gross_charge":529,"discounted_cash":156.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":428.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":428.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":428.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.97,"standard_charge_algorithm": "Lesser of $24.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.6,"standard_charge_algorithm": "Lesser of $14.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.62,"standard_charge_algorithm": "Lesser of $15.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.04,"standard_charge_algorithm": "Lesser of $15.04 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.33,"standard_charge_algorithm": "Lesser of $15.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.06,"standard_charge_algorithm": "Lesser of $16.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.48,"standard_charge_algorithm": "Lesser of $15.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ASSAY ANTI-MULLERIAN HORM","code_information":[{"code":"82166","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":125.55,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"}]}]},{"description":"ASSAY ANTI-MULLERIAN HORM","code_information":[{"code":"82166","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.25,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTI-MULLERIAN HORMONE","code_information":[{"code":"82166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTI-MULLERIAN HORMONE","code_information":[{"code":"82166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.2,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"}]}]},{"description":"HC LAB APOLIPOPROTEIN A1","code_information":[{"code":"82172","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":88.29,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB APOLIPOPROTEIN A1","code_information":[{"code":"82172","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.09,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.06,"standard_charge_algorithm": "Lesser of $36.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"standard_charge_algorithm": "Lesser of $21.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.57,"standard_charge_algorithm": "Lesser of $22.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.72,"standard_charge_algorithm": "Lesser of $21.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.14,"standard_charge_algorithm": "Lesser of $22.14 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.2,"standard_charge_algorithm": "Lesser of $23.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.36,"standard_charge_algorithm": "Lesser of $22.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB APOLIPOPROTEIN A-1","code_information":[{"code":"82172","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":88.29,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB APOLIPOPROTEIN A-1","code_information":[{"code":"82172","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.09,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.06,"standard_charge_algorithm": "Lesser of $36.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.09,"standard_charge_algorithm": "Lesser of $21.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.57,"standard_charge_algorithm": "Lesser of $22.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.72,"standard_charge_algorithm": "Lesser of $21.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.14,"standard_charge_algorithm": "Lesser of $22.14 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.2,"standard_charge_algorithm": "Lesser of $23.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.36,"standard_charge_algorithm": "Lesser of $22.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ARSENIC","code_information":[{"code":"82175","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":106.92,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"}]}]},{"description":"HC LAB ARSENIC","code_information":[{"code":"82175","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.97,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.44,"standard_charge_algorithm": "Lesser of $32.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.3,"standard_charge_algorithm": "Lesser of $20.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.54,"standard_charge_algorithm": "Lesser of $19.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.92,"standard_charge_algorithm": "Lesser of $19.92 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.87,"standard_charge_algorithm": "Lesser of $20.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.11,"standard_charge_algorithm": "Lesser of $20.11 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ARSENIC WHOLE BLOOD","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":106.92,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"}]}]},{"description":"HC LAB ARSENIC WHOLE BLOOD","code_information":[{"code":"82175","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.97,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.44,"standard_charge_algorithm": "Lesser of $32.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.3,"standard_charge_algorithm": "Lesser of $20.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.54,"standard_charge_algorithm": "Lesser of $19.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.92,"standard_charge_algorithm": "Lesser of $19.92 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.87,"standard_charge_algorithm": "Lesser of $20.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.11,"standard_charge_algorithm": "Lesser of $20.11 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VITAMIN C","code_information":[{"code":"82180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC VITAMIN C","code_information":[{"code":"82180","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.89,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.91,"standard_charge_algorithm": "Lesser of $16.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"standard_charge_algorithm": "Lesser of $9.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.58,"standard_charge_algorithm": "Lesser of $10.58 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.19,"standard_charge_algorithm": "Lesser of $10.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.38,"standard_charge_algorithm": "Lesser of $10.38 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.88,"standard_charge_algorithm": "Lesser of $10.88 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.48,"standard_charge_algorithm": "Lesser of $10.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"minimum":6700,"maximum":26764,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10281,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9719,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7038,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26764,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25093,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17879.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13025,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15529,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13079,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18820.35,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16985,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10546,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10546,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6700,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10455.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11187.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10769.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10978.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11083.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10978.54,"methodology":"case rate"}]}]},{"description":"HC LAB BETA-2-MICROGLOBULIN","code_information":[{"code":"82232","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":187.11,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB BETA-2-MICROGLOBULIN","code_information":[{"code":"82232","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.18,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.67,"standard_charge_algorithm": "Lesser of $27.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.18,"standard_charge_algorithm": "Lesser of $16.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.31,"standard_charge_algorithm": "Lesser of $17.31 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.67,"standard_charge_algorithm": "Lesser of $16.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.99,"standard_charge_algorithm": "Lesser of $16.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.8,"standard_charge_algorithm": "Lesser of $17.80 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.15,"standard_charge_algorithm": "Lesser of $17.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BETA-AMYLOID 1-40 (ABETA 40)","code_information":[{"code":"82233","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"BETA-AMYLOID 1-40 (ABETA 40)","code_information":[{"code":"82233","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.4,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"}]}]},{"description":"BETA-AMYLOID 1-42 (ABETA 42)","code_information":[{"code":"82234","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"BETA-AMYLOID 1-42 (ABETA 42)","code_information":[{"code":"82234","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.4,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"}]}]},{"description":"HC LAB BILIRUBIN TOTAL","code_information":[{"code":"82247","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":152.28,"maximum":152.28,"gross_charge":188,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.28,"methodology":"fee schedule"}]}]},{"description":"HC LAB BILIRUBIN TOTAL","code_information":[{"code":"82247","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.02,"maximum":152.28,"gross_charge":188,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.58,"standard_charge_algorithm": "Lesser of $8.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"standard_charge_algorithm": "Lesser of $5.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.37,"standard_charge_algorithm": "Lesser of $5.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.17,"standard_charge_algorithm": "Lesser of $5.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.27,"standard_charge_algorithm": "Lesser of $5.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.52,"standard_charge_algorithm": "Lesser of $5.52 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.32,"standard_charge_algorithm": "Lesser of $5.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BILIRUBIN DIRECT","code_information":[{"code":"82248","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":206.55,"maximum":206.55,"gross_charge":255,"discounted_cash":75.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":206.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":206.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":206.55,"methodology":"fee schedule"}]}]},{"description":"HC LAB BILIRUBIN DIRECT","code_information":[{"code":"82248","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.02,"maximum":206.55,"gross_charge":255,"discounted_cash":75.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":206.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":206.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":206.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.58,"standard_charge_algorithm": "Lesser of $8.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.02,"standard_charge_algorithm": "Lesser of $5.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.37,"standard_charge_algorithm": "Lesser of $5.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.17,"standard_charge_algorithm": "Lesser of $5.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.27,"standard_charge_algorithm": "Lesser of $5.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.52,"standard_charge_algorithm": "Lesser of $5.52 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.32,"standard_charge_algorithm": "Lesser of $5.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OCCULT BLOOD GUAIAC","code_information":[{"code":"82270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC OCCULT BLOOD GUAIAC","code_information":[{"code":"82270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.38,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.49,"standard_charge_algorithm": "Lesser of $7.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.38,"standard_charge_algorithm": "Lesser of $4.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.69,"standard_charge_algorithm": "Lesser of $4.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.51,"standard_charge_algorithm": "Lesser of $4.51 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.6,"standard_charge_algorithm": "Lesser of $4.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.82,"standard_charge_algorithm": "Lesser of $4.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.64,"standard_charge_algorithm": "Lesser of $4.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OCCULT BLOOD QL OTH SRC","code_information":[{"code":"82271","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.86,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB OCCULT BLOOD QL OTH SRC","code_information":[{"code":"82271","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.52,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.1,"standard_charge_algorithm": "Lesser of $9.10 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.32,"standard_charge_algorithm": "Lesser of $5.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.69,"standard_charge_algorithm": "Lesser of $5.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.85,"standard_charge_algorithm": "Lesser of $5.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.64,"standard_charge_algorithm": "Lesser of $5.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OCCULT BLOOD QUAL FECES","code_information":[{"code":"82272","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.19,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB OCCULT BLOOD QUAL FECES","code_information":[{"code":"82272","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.23,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.23,"standard_charge_algorithm": "Lesser of $7.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"standard_charge_algorithm": "Lesser of $4.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.36,"standard_charge_algorithm": "Lesser of $4.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.44,"standard_charge_algorithm": "Lesser of $4.44 or 105 Percent of Billed Charges","median_amount":4.44,"10th_percentile":4.44,"90th_percentile":4.44,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.65,"standard_charge_algorithm": "Lesser of $4.65 or 110 Percent of Billed Charges","median_amount":4.23,"10th_percentile":4.23,"90th_percentile":4.23,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OCCULT BLOOD IFOBT","code_information":[{"code":"82274","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC OCCULT BLOOD IFOBT","code_information":[{"code":"82274","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.92,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.22,"standard_charge_algorithm": "Lesser of $27.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.92,"standard_charge_algorithm": "Lesser of $15.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.4,"standard_charge_algorithm": "Lesser of $16.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.72,"standard_charge_algorithm": "Lesser of $16.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.51,"standard_charge_algorithm": "Lesser of $17.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.88,"standard_charge_algorithm": "Lesser of $16.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"minimum":22116,"maximum":93372,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42064,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39766,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25577,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93372,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":87543,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":56720.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46764,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55754,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47531,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":59705.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69496,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":43150,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43150,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22116,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33169.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35491.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34164.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34828.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35160.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34828.37,"methodology":"case rate"}]}]},{"description":"CADMIUM URINE","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":110.97,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"}]}]},{"description":"CADMIUM URINE","code_information":[{"code":"82300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.64,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40.42,"standard_charge_algorithm": "Lesser of $40.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23.64,"standard_charge_algorithm": "Lesser of $23.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.29,"standard_charge_algorithm": "Lesser of $25.29 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.35,"standard_charge_algorithm": "Lesser of $24.35 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.82,"standard_charge_algorithm": "Lesser of $24.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26,"standard_charge_algorithm": "Lesser of $26.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.06,"standard_charge_algorithm": "Lesser of $25.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN D 25-OH","code_information":[{"code":"82306","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":255.15,"maximum":255.15,"gross_charge":315,"discounted_cash":93.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.15,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN D 25-OH","code_information":[{"code":"82306","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":29.6,"maximum":255.15,"gross_charge":315,"discounted_cash":93.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":89.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.62,"standard_charge_algorithm": "Lesser of $50.62 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.6,"standard_charge_algorithm": "Lesser of $29.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.67,"standard_charge_algorithm": "Lesser of $31.67 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.49,"standard_charge_algorithm": "Lesser of $30.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31.08,"standard_charge_algorithm": "Lesser of $31.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.56,"standard_charge_algorithm": "Lesser of $32.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.38,"standard_charge_algorithm": "Lesser of $31.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALCITONIN","code_information":[{"code":"82308","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALCITONIN","code_information":[{"code":"82308","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.79,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.81,"standard_charge_algorithm": "Lesser of $45.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.79,"standard_charge_algorithm": "Lesser of $26.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.67,"standard_charge_algorithm": "Lesser of $28.67 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.59,"standard_charge_algorithm": "Lesser of $27.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.13,"standard_charge_algorithm": "Lesser of $28.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.47,"standard_charge_algorithm": "Lesser of $29.47 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.4,"standard_charge_algorithm": "Lesser of $28.40 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALCIUM","code_information":[{"code":"82310","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":197.64,"maximum":197.64,"gross_charge":244,"discounted_cash":72.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALCIUM","code_information":[{"code":"82310","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.16,"maximum":197.64,"gross_charge":244,"discounted_cash":72.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.82,"standard_charge_algorithm": "Lesser of $8.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.16,"standard_charge_algorithm": "Lesser of $5.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.52,"standard_charge_algorithm": "Lesser of $5.52 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.31,"standard_charge_algorithm": "Lesser of $5.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.42,"standard_charge_algorithm": "Lesser of $5.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.68,"standard_charge_algorithm": "Lesser of $5.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.47,"standard_charge_algorithm": "Lesser of $5.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALCIUM IONIZED","code_information":[{"code":"82330","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":281.07,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALCIUM IONIZED","code_information":[{"code":"82330","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.68,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.39,"standard_charge_algorithm": "Lesser of $23.39 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"standard_charge_algorithm": "Lesser of $13.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.64,"standard_charge_algorithm": "Lesser of $14.64 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.09,"standard_charge_algorithm": "Lesser of $14.09 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.36,"standard_charge_algorithm": "Lesser of $14.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.5,"standard_charge_algorithm": "Lesser of $14.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALCIUM IONIZED POST FILTER","code_information":[{"code":"82330","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":281.07,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALCIUM IONIZED POST FILTER","code_information":[{"code":"82330","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.68,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.39,"standard_charge_algorithm": "Lesser of $23.39 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.68,"standard_charge_algorithm": "Lesser of $13.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.64,"standard_charge_algorithm": "Lesser of $14.64 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.09,"standard_charge_algorithm": "Lesser of $14.09 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.36,"standard_charge_algorithm": "Lesser of $14.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.5,"standard_charge_algorithm": "Lesser of $14.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALCIUM 24 HR URINE","code_information":[{"code":"82340","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALCIUM 24 HR URINE","code_information":[{"code":"82340","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.03,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.31,"standard_charge_algorithm": "Lesser of $10.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"standard_charge_algorithm": "Lesser of $6.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.45,"standard_charge_algorithm": "Lesser of $6.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.21,"standard_charge_algorithm": "Lesser of $6.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.33,"standard_charge_algorithm": "Lesser of $6.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.63,"standard_charge_algorithm": "Lesser of $6.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.39,"standard_charge_algorithm": "Lesser of $6.39 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CALCIUM URINE QUAN","code_information":[{"code":"82340","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB CALCIUM URINE QUAN","code_information":[{"code":"82340","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.03,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.31,"standard_charge_algorithm": "Lesser of $10.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.03,"standard_charge_algorithm": "Lesser of $6.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.45,"standard_charge_algorithm": "Lesser of $6.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.21,"standard_charge_algorithm": "Lesser of $6.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.33,"standard_charge_algorithm": "Lesser of $6.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.63,"standard_charge_algorithm": "Lesser of $6.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.39,"standard_charge_algorithm": "Lesser of $6.39 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB STONE IR SPECTROSCOPY","code_information":[{"code":"82365","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB STONE IR SPECTROSCOPY","code_information":[{"code":"82365","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.9,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"standard_charge_algorithm": "Lesser of $12.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"standard_charge_algorithm": "Lesser of $13.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.29,"standard_charge_algorithm": "Lesser of $13.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.67,"standard_charge_algorithm": "Lesser of $13.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CO2 CONT","code_information":[{"code":"82374","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"HC LAB CO2 CONT","code_information":[{"code":"82374","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.88,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.34,"standard_charge_algorithm": "Lesser of $8.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.88,"standard_charge_algorithm": "Lesser of $4.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.03,"standard_charge_algorithm": "Lesser of $5.03 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.12,"standard_charge_algorithm": "Lesser of $5.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.37,"standard_charge_algorithm": "Lesser of $5.37 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.17,"standard_charge_algorithm": "Lesser of $5.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CARBOXYHEMOGLOBIN","code_information":[{"code":"82375","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":41.31,"maximum":41.31,"gross_charge":51,"discounted_cash":15.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"}]}]},{"description":"HC LAB CARBOXYHEMOGLOBIN","code_information":[{"code":"82375","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":41.31,"gross_charge":51,"discounted_cash":15.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.07,"standard_charge_algorithm": "Lesser of $21.07 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.32,"standard_charge_algorithm": "Lesser of $12.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.69,"standard_charge_algorithm": "Lesser of $12.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.94,"standard_charge_algorithm": "Lesser of $12.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.55,"standard_charge_algorithm": "Lesser of $13.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.06,"standard_charge_algorithm": "Lesser of $13.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CEA","code_information":[{"code":"82378","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":404.19,"maximum":404.19,"gross_charge":499,"discounted_cash":147.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":404.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB CEA","code_information":[{"code":"82378","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.96,"maximum":404.19,"gross_charge":499,"discounted_cash":147.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":404.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.42,"standard_charge_algorithm": "Lesser of $32.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.96,"standard_charge_algorithm": "Lesser of $18.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.53,"standard_charge_algorithm": "Lesser of $19.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.91,"standard_charge_algorithm": "Lesser of $19.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.86,"standard_charge_algorithm": "Lesser of $20.86 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.1,"standard_charge_algorithm": "Lesser of $20.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CARNITINE FREE AND TOTAL PLAS","code_information":[{"code":"82379","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC CARNITINE FREE AND TOTAL PLAS","code_information":[{"code":"82379","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.08,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.85,"standard_charge_algorithm": "Lesser of $28.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.87,"standard_charge_algorithm": "Lesser of $16.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.38,"standard_charge_algorithm": "Lesser of $17.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.56,"standard_charge_algorithm": "Lesser of $18.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.88,"standard_charge_algorithm": "Lesser of $17.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CAROTENE","code_information":[{"code":"82380","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB CAROTENE","code_information":[{"code":"82380","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.22,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.77,"standard_charge_algorithm": "Lesser of $15.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"standard_charge_algorithm": "Lesser of $9.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.87,"standard_charge_algorithm": "Lesser of $9.87 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.5,"standard_charge_algorithm": "Lesser of $9.50 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.68,"standard_charge_algorithm": "Lesser of $9.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.14,"standard_charge_algorithm": "Lesser of $10.14 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.77,"standard_charge_algorithm": "Lesser of $9.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CATECHOLAMINES FRAC","code_information":[{"code":"82384","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":118.26,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"}]}]},{"description":"HC LAB CATECHOLAMINES FRAC","code_information":[{"code":"82384","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.25,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.18,"standard_charge_algorithm": "Lesser of $43.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"standard_charge_algorithm": "Lesser of $25.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.02,"standard_charge_algorithm": "Lesser of $27.02 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.01,"standard_charge_algorithm": "Lesser of $26.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.51,"standard_charge_algorithm": "Lesser of $26.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.77,"standard_charge_algorithm": "Lesser of $27.77 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.77,"standard_charge_algorithm": "Lesser of $26.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CATECHOLAMINES URINE FRACT 24","code_information":[{"code":"82384","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":118.26,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"}]}]},{"description":"HC LAB CATECHOLAMINES URINE FRACT 24","code_information":[{"code":"82384","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.25,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.18,"standard_charge_algorithm": "Lesser of $43.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"standard_charge_algorithm": "Lesser of $25.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.02,"standard_charge_algorithm": "Lesser of $27.02 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.01,"standard_charge_algorithm": "Lesser of $26.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.51,"standard_charge_algorithm": "Lesser of $26.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.77,"standard_charge_algorithm": "Lesser of $27.77 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.77,"standard_charge_algorithm": "Lesser of $26.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CERULOPLASMIN","code_information":[{"code":"82390","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB CERULOPLASMIN","code_information":[{"code":"82390","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.37,"standard_charge_algorithm": "Lesser of $18.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"standard_charge_algorithm": "Lesser of $10.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"standard_charge_algorithm": "Lesser of $11.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.28,"standard_charge_algorithm": "Lesser of $11.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.81,"standard_charge_algorithm": "Lesser of $11.81 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.38,"standard_charge_algorithm": "Lesser of $11.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHEMILUMINESCENT ASSAY","code_information":[{"code":"82397","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHEMILUMINESCENT ASSAY","code_information":[{"code":"82397","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.12,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.15,"standard_charge_algorithm": "Lesser of $24.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"standard_charge_algorithm": "Lesser of $14.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.54,"standard_charge_algorithm": "Lesser of $14.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.83,"standard_charge_algorithm": "Lesser of $14.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.97,"standard_charge_algorithm": "Lesser of $14.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INHIBIN B","code_information":[{"code":"82397","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB INHIBIN B","code_information":[{"code":"82397","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.12,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.15,"standard_charge_algorithm": "Lesser of $24.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"standard_charge_algorithm": "Lesser of $14.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.54,"standard_charge_algorithm": "Lesser of $14.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.83,"standard_charge_algorithm": "Lesser of $14.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.97,"standard_charge_algorithm": "Lesser of $14.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"USTEKINUMAB","code_information":[{"code":"82397","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":185.49,"maximum":185.49,"gross_charge":229,"discounted_cash":67.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":185.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":185.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":185.49,"methodology":"fee schedule"}]}]},{"description":"USTEKINUMAB","code_information":[{"code":"82397","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.12,"maximum":185.49,"gross_charge":229,"discounted_cash":67.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":185.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":185.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":185.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.15,"standard_charge_algorithm": "Lesser of $24.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.12,"standard_charge_algorithm": "Lesser of $14.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.54,"standard_charge_algorithm": "Lesser of $14.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.83,"standard_charge_algorithm": "Lesser of $14.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.97,"standard_charge_algorithm": "Lesser of $14.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"minimum":11928,"maximum":32663,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19770,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18690,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12686,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28870,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27067,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29476.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24756,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29515,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23575,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":31027.7,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32663,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20281,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20281,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11928,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17237.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18444.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17754.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18099.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18271.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18099.5,"methodology":"case rate"}]}]},{"description":"HC LAB CHLORIDE","code_information":[{"code":"82435","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHLORIDE","code_information":[{"code":"82435","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.6,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.87,"standard_charge_algorithm": "Lesser of $7.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.6,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.92,"standard_charge_algorithm": "Lesser of $4.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.74,"standard_charge_algorithm": "Lesser of $4.74 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.83,"standard_charge_algorithm": "Lesser of $4.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.06,"standard_charge_algorithm": "Lesser of $5.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.88,"standard_charge_algorithm": "Lesser of $4.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHLORIDE URINE","code_information":[{"code":"82436","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":114.21,"maximum":114.21,"gross_charge":141,"discounted_cash":41.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHLORIDE URINE","code_information":[{"code":"82436","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.75,"maximum":114.21,"gross_charge":141,"discounted_cash":41.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.83,"standard_charge_algorithm": "Lesser of $9.83 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.75,"standard_charge_algorithm": "Lesser of $5.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.15,"standard_charge_algorithm": "Lesser of $6.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.92,"standard_charge_algorithm": "Lesser of $5.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.04,"standard_charge_algorithm": "Lesser of $6.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.33,"standard_charge_algorithm": "Lesser of $6.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.09,"standard_charge_algorithm": "Lesser of $6.09 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHLORIDE BODY FLUID","code_information":[{"code":"82438","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":98.82,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHLORIDE BODY FLUID","code_information":[{"code":"82438","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.55,"standard_charge_algorithm": "Lesser of $8.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"standard_charge_algorithm": "Lesser of $5.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.35,"standard_charge_algorithm": "Lesser of $5.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.15,"standard_charge_algorithm": "Lesser of $5.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.25,"standard_charge_algorithm": "Lesser of $5.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.5,"standard_charge_algorithm": "Lesser of $5.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.3,"standard_charge_algorithm": "Lesser of $5.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHLORIDE OTHER","code_information":[{"code":"82438","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHLORIDE OTHER","code_information":[{"code":"82438","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.55,"standard_charge_algorithm": "Lesser of $8.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5,"standard_charge_algorithm": "Lesser of $5.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.35,"standard_charge_algorithm": "Lesser of $5.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.15,"standard_charge_algorithm": "Lesser of $5.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.25,"standard_charge_algorithm": "Lesser of $5.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.5,"standard_charge_algorithm": "Lesser of $5.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.3,"standard_charge_algorithm": "Lesser of $5.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHOLESTEROL","code_information":[{"code":"82465","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHOLESTEROL","code_information":[{"code":"82465","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.35,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"standard_charge_algorithm": "Lesser of $4.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.65,"standard_charge_algorithm": "Lesser of $4.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.78,"standard_charge_algorithm": "Lesser of $4.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FHP CHOLESTEROL","code_information":[{"code":"82465","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB FHP CHOLESTEROL","code_information":[{"code":"82465","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.35,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.35,"standard_charge_algorithm": "Lesser of $4.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.65,"standard_charge_algorithm": "Lesser of $4.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.78,"standard_charge_algorithm": "Lesser of $4.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHOLINESTERASE SERUM","code_information":[{"code":"82480","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHOLINESTERASE SERUM","code_information":[{"code":"82480","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.87,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.46,"standard_charge_algorithm": "Lesser of $13.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.87,"standard_charge_algorithm": "Lesser of $7.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.42,"standard_charge_algorithm": "Lesser of $8.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.11,"standard_charge_algorithm": "Lesser of $8.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.26,"standard_charge_algorithm": "Lesser of $8.26 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.66,"standard_charge_algorithm": "Lesser of $8.66 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.34,"standard_charge_algorithm": "Lesser of $8.34 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHROMIUM RBC","code_information":[{"code":"82495","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":73.71,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"}]}]},{"description":"CHROMIUM RBC","code_information":[{"code":"82495","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.28,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.68,"standard_charge_algorithm": "Lesser of $34.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.28,"standard_charge_algorithm": "Lesser of $20.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.7,"standard_charge_algorithm": "Lesser of $21.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.89,"standard_charge_algorithm": "Lesser of $20.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.31,"standard_charge_algorithm": "Lesser of $22.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.5,"standard_charge_algorithm": "Lesser of $21.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"minimum":7337,"maximum":19827.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11064,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10459,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7337,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18107,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16976,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18836.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14231,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16967,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13635,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19827.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18279,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11349,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11349,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7817,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11015.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11786.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11345.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11566.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11676.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11566.05,"methodology":"case rate"}]}]},{"description":"HC CITRIC ACID (CITRATE) URINE","code_information":[{"code":"82507","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"HC CITRIC ACID (CITRATE) URINE","code_information":[{"code":"82507","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.8,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47.54,"standard_charge_algorithm": "Lesser of $47.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.8,"standard_charge_algorithm": "Lesser of $27.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.75,"standard_charge_algorithm": "Lesser of $29.75 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.63,"standard_charge_algorithm": "Lesser of $28.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29.19,"standard_charge_algorithm": "Lesser of $29.19 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.58,"standard_charge_algorithm": "Lesser of $30.58 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.47,"standard_charge_algorithm": "Lesser of $29.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC N-TELOPEPTIDE","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"HC N-TELOPEPTIDE","code_information":[{"code":"82523","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.68,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.94,"standard_charge_algorithm": "Lesser of $31.94 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.99,"standard_charge_algorithm": "Lesser of $19.99 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.24,"standard_charge_algorithm": "Lesser of $19.24 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.61,"standard_charge_algorithm": "Lesser of $19.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.55,"standard_charge_algorithm": "Lesser of $20.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.8,"standard_charge_algorithm": "Lesser of $19.80 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COPPER","code_information":[{"code":"82525","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.19,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB COPPER","code_information":[{"code":"82525","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.41,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.22,"standard_charge_algorithm": "Lesser of $21.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"standard_charge_algorithm": "Lesser of $13.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.78,"standard_charge_algorithm": "Lesser of $12.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.03,"standard_charge_algorithm": "Lesser of $13.03 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.15,"standard_charge_algorithm": "Lesser of $13.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COPPER TISSUE","code_information":[{"code":"82525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":80.19,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB COPPER TISSUE","code_information":[{"code":"82525","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.41,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.22,"standard_charge_algorithm": "Lesser of $21.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.28,"standard_charge_algorithm": "Lesser of $13.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.78,"standard_charge_algorithm": "Lesser of $12.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.03,"standard_charge_algorithm": "Lesser of $13.03 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.15,"standard_charge_algorithm": "Lesser of $13.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CORTISOL URINARY FREE","code_information":[{"code":"82530","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"HC LAB CORTISOL URINARY FREE","code_information":[{"code":"82530","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.71,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.57,"standard_charge_algorithm": "Lesser of $28.57 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"standard_charge_algorithm": "Lesser of $16.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.88,"standard_charge_algorithm": "Lesser of $17.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.21,"standard_charge_algorithm": "Lesser of $17.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.55,"standard_charge_algorithm": "Lesser of $17.55 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.38,"standard_charge_algorithm": "Lesser of $18.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CORTISOL URINE FREE","code_information":[{"code":"82530","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"HC LAB CORTISOL URINE FREE","code_information":[{"code":"82530","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.71,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.57,"standard_charge_algorithm": "Lesser of $28.57 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.71,"standard_charge_algorithm": "Lesser of $16.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.88,"standard_charge_algorithm": "Lesser of $17.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.21,"standard_charge_algorithm": "Lesser of $17.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.55,"standard_charge_algorithm": "Lesser of $17.55 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.38,"standard_charge_algorithm": "Lesser of $18.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CORTISOL TOTAL","code_information":[{"code":"82533","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":268.92,"maximum":268.92,"gross_charge":332,"discounted_cash":98.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.92,"methodology":"fee schedule"}]}]},{"description":"HC LAB CORTISOL TOTAL","code_information":[{"code":"82533","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.3,"maximum":268.92,"gross_charge":332,"discounted_cash":98.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.87,"standard_charge_algorithm": "Lesser of $27.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.3,"standard_charge_algorithm": "Lesser of $16.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.44,"standard_charge_algorithm": "Lesser of $17.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.79,"standard_charge_algorithm": "Lesser of $16.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.11,"standard_charge_algorithm": "Lesser of $17.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.93,"standard_charge_algorithm": "Lesser of $17.93 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.28,"standard_charge_algorithm": "Lesser of $17.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CREATINE","code_information":[{"code":"82540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB CREATINE","code_information":[{"code":"82540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.64,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.93,"standard_charge_algorithm": "Lesser of $7.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.64,"standard_charge_algorithm": "Lesser of $4.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.96,"standard_charge_algorithm": "Lesser of $4.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.78,"standard_charge_algorithm": "Lesser of $4.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.87,"standard_charge_algorithm": "Lesser of $4.87 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.92,"standard_charge_algorithm": "Lesser of $4.92 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANTI-DEPRESSANT PANEL","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTI-DEPRESSANT PANEL","code_information":[{"code":"82542","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.19,"standard_charge_algorithm": "Lesser of $41.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"standard_charge_algorithm": "Lesser of $24.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.78,"standard_charge_algorithm": "Lesser of $25.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.81,"standard_charge_algorithm": "Lesser of $24.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.29,"standard_charge_algorithm": "Lesser of $25.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.5,"standard_charge_algorithm": "Lesser of $26.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.54,"standard_charge_algorithm": "Lesser of $25.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COL CHROMOTOGRAPHY GUANT","code_information":[{"code":"82542","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB COL CHROMOTOGRAPHY GUANT","code_information":[{"code":"82542","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.19,"standard_charge_algorithm": "Lesser of $41.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"standard_charge_algorithm": "Lesser of $24.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.78,"standard_charge_algorithm": "Lesser of $25.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.81,"standard_charge_algorithm": "Lesser of $24.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.29,"standard_charge_algorithm": "Lesser of $25.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.5,"standard_charge_algorithm": "Lesser of $26.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.54,"standard_charge_algorithm": "Lesser of $25.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CK (CPK)","code_information":[{"code":"82550","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB CK (CPK)","code_information":[{"code":"82550","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.51,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.13,"standard_charge_algorithm": "Lesser of $11.13 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.51,"standard_charge_algorithm": "Lesser of $6.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.97,"standard_charge_algorithm": "Lesser of $6.97 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.71,"standard_charge_algorithm": "Lesser of $6.71 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.84,"standard_charge_algorithm": "Lesser of $6.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.16,"standard_charge_algorithm": "Lesser of $7.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.9,"standard_charge_algorithm": "Lesser of $6.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CK ISOENZYME PROFILE","code_information":[{"code":"82552","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":65.61,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"HC LAB CK ISOENZYME PROFILE","code_information":[{"code":"82552","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.39,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.9,"standard_charge_algorithm": "Lesser of $22.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.39,"standard_charge_algorithm": "Lesser of $13.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.06,"standard_charge_algorithm": "Lesser of $14.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.73,"standard_charge_algorithm": "Lesser of $14.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CK-MB (CPK-MB)","code_information":[{"code":"82553","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"HC LAB CK-MB (CPK-MB)","code_information":[{"code":"82553","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.75,"standard_charge_algorithm": "Lesser of $19.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.55,"standard_charge_algorithm": "Lesser of $11.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.36,"standard_charge_algorithm": "Lesser of $12.36 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.9,"standard_charge_algorithm": "Lesser of $11.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.13,"standard_charge_algorithm": "Lesser of $12.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.71,"standard_charge_algorithm": "Lesser of $12.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.24,"standard_charge_algorithm": "Lesser of $12.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CREATININE","code_information":[{"code":"82565","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.11,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB CREATININE","code_information":[{"code":"82565","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.12,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.76,"standard_charge_algorithm": "Lesser of $8.76 or 171 Percent of Billed Charges","median_amount":8.76,"10th_percentile":8.76,"90th_percentile":8.76,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"standard_charge_algorithm": "Lesser of $5.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.27,"standard_charge_algorithm": "Lesser of $5.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 105 Percent of Billed Charges","median_amount":5.38,"10th_percentile":5.38,"90th_percentile":5.38,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.63,"standard_charge_algorithm": "Lesser of $5.63 or 110 Percent of Billed Charges","median_amount":5.63,"10th_percentile":5.12,"90th_percentile":11.14,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.43,"standard_charge_algorithm": "Lesser of $5.43 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB I-STAT CREATININE","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.11,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB I-STAT CREATININE","code_information":[{"code":"82565","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.12,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.76,"standard_charge_algorithm": "Lesser of $8.76 or 171 Percent of Billed Charges","median_amount":8.76,"10th_percentile":8.76,"90th_percentile":8.76,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.12,"standard_charge_algorithm": "Lesser of $5.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.27,"standard_charge_algorithm": "Lesser of $5.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 105 Percent of Billed Charges","median_amount":5.38,"10th_percentile":5.38,"90th_percentile":5.38,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.63,"standard_charge_algorithm": "Lesser of $5.63 or 110 Percent of Billed Charges","median_amount":5.63,"10th_percentile":5.12,"90th_percentile":11.14,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.43,"standard_charge_algorithm": "Lesser of $5.43 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CREATININE 24HR URINE","code_information":[{"code":"82570","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB CREATININE 24HR URINE","code_information":[{"code":"82570","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CREATININE OTHER","code_information":[{"code":"82570","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB CREATININE OTHER","code_information":[{"code":"82570","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CREATININE CLEARANCE","code_information":[{"code":"82575","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":323.19,"maximum":323.19,"gross_charge":399,"discounted_cash":118.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB CREATININE CLEARANCE","code_information":[{"code":"82575","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":323.19,"gross_charge":399,"discounted_cash":118.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.18,"standard_charge_algorithm": "Lesser of $16.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.12,"standard_charge_algorithm": "Lesser of $10.12 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.74,"standard_charge_algorithm": "Lesser of $9.74 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.93,"standard_charge_algorithm": "Lesser of $9.93 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.41,"standard_charge_algorithm": "Lesser of $10.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.03,"standard_charge_algorithm": "Lesser of $10.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CRYOFIBRINOGEN","code_information":[{"code":"82585","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":109.35,"maximum":109.35,"gross_charge":135,"discounted_cash":39.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.35,"methodology":"fee schedule"}]}]},{"description":"HC LAB CRYOFIBRINOGEN","code_information":[{"code":"82585","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.06,"maximum":109.35,"gross_charge":135,"discounted_cash":39.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.18,"standard_charge_algorithm": "Lesser of $24.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.14,"standard_charge_algorithm": "Lesser of $14.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.13,"standard_charge_algorithm": "Lesser of $15.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.85,"standard_charge_algorithm": "Lesser of $14.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.55,"standard_charge_algorithm": "Lesser of $15.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CRYOGLOBULIN","code_information":[{"code":"82595","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB CRYOGLOBULIN","code_information":[{"code":"82595","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"minimum":23423,"maximum":117126,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42927,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40582,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26292,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":117126,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":109814,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57775.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55579,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66264,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48859,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":60815.85,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70921,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":44035,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":44035,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23423,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33786.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36151.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34800.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35475.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35813.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35475.91,"methodology":"case rate"}]}]},{"description":"HC LAB CYANIDE","code_information":[{"code":"82600","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":88.29,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYANIDE","code_information":[{"code":"82600","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.4,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.17,"standard_charge_algorithm": "Lesser of $33.17 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.4,"standard_charge_algorithm": "Lesser of $19.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.76,"standard_charge_algorithm": "Lesser of $20.76 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.98,"standard_charge_algorithm": "Lesser of $19.98 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.37,"standard_charge_algorithm": "Lesser of $20.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.34,"standard_charge_algorithm": "Lesser of $21.34 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.56,"standard_charge_algorithm": "Lesser of $20.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ASSAY VITAMIN B-12","code_information":[{"code":"82607","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":94.77,"maximum":94.77,"gross_charge":117,"discounted_cash":34.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB ASSAY VITAMIN B-12","code_information":[{"code":"82607","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.08,"maximum":94.77,"gross_charge":117,"discounted_cash":34.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.79,"standard_charge_algorithm": "Lesser of $25.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"standard_charge_algorithm": "Lesser of $15.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.98,"standard_charge_algorithm": "Lesser of $15.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN B12","code_information":[{"code":"82607","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":94.77,"maximum":94.77,"gross_charge":117,"discounted_cash":34.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN B12","code_information":[{"code":"82607","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.08,"maximum":94.77,"gross_charge":117,"discounted_cash":34.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.79,"standard_charge_algorithm": "Lesser of $25.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"standard_charge_algorithm": "Lesser of $15.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.98,"standard_charge_algorithm": "Lesser of $15.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CYSTATIN C","code_information":[{"code":"82610","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC CYSTATIN C","code_information":[{"code":"82610","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.52,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.67,"standard_charge_algorithm": "Lesser of $31.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"standard_charge_algorithm": "Lesser of $18.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.82,"standard_charge_algorithm": "Lesser of $19.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.08,"standard_charge_algorithm": "Lesser of $19.08 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.45,"standard_charge_algorithm": "Lesser of $19.45 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.37,"standard_charge_algorithm": "Lesser of $20.37 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.63,"standard_charge_algorithm": "Lesser of $19.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DHEA","code_information":[{"code":"82626","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":120.69,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB DHEA","code_information":[{"code":"82626","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.27,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.21,"standard_charge_algorithm": "Lesser of $43.21 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.27,"standard_charge_algorithm": "Lesser of $25.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.04,"standard_charge_algorithm": "Lesser of $27.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.03,"standard_charge_algorithm": "Lesser of $26.03 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.53,"standard_charge_algorithm": "Lesser of $26.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.8,"standard_charge_algorithm": "Lesser of $27.80 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.79,"standard_charge_algorithm": "Lesser of $26.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DHEA SULFATE","code_information":[{"code":"82627","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":98.01,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"}]}]},{"description":"HC LAB DHEA SULFATE","code_information":[{"code":"82627","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.23,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":53.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.01,"standard_charge_algorithm": "Lesser of $38.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.23,"standard_charge_algorithm": "Lesser of $22.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.79,"standard_charge_algorithm": "Lesser of $23.79 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.9,"standard_charge_algorithm": "Lesser of $22.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.34,"standard_charge_algorithm": "Lesser of $23.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.45,"standard_charge_algorithm": "Lesser of $24.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.56,"standard_charge_algorithm": "Lesser of $23.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DEOXYCORTICOSTERONE","code_information":[{"code":"82633","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":591.3,"maximum":591.3,"gross_charge":730,"discounted_cash":216.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":591.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":591.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":591.3,"methodology":"fee schedule"}]}]},{"description":"HC DEOXYCORTICOSTERONE","code_information":[{"code":"82633","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":30.98,"maximum":591.3,"gross_charge":730,"discounted_cash":216.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":591.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":591.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":591.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":74.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52.98,"standard_charge_algorithm": "Lesser of $52.98 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"standard_charge_algorithm": "Lesser of $30.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33.15,"standard_charge_algorithm": "Lesser of $33.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31.91,"standard_charge_algorithm": "Lesser of $31.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32.53,"standard_charge_algorithm": "Lesser of $32.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34.08,"standard_charge_algorithm": "Lesser of $34.08 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32.84,"standard_charge_algorithm": "Lesser of $32.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DIHYDROTESTOSTERONE","code_information":[{"code":"82642","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":93.96,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB DIHYDROTESTOSTERONE","code_information":[{"code":"82642","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.11,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.07,"standard_charge_algorithm": "Lesser of $50.07 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.33,"standard_charge_algorithm": "Lesser of $31.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.16,"standard_charge_algorithm": "Lesser of $30.16 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.74,"standard_charge_algorithm": "Lesser of $30.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.21,"standard_charge_algorithm": "Lesser of $32.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.04,"standard_charge_algorithm": "Lesser of $31.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN D 125-DIHYDROX","code_information":[{"code":"82652","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":76.14,"maximum":76.14,"gross_charge":94,"discounted_cash":27.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN D 125-DIHYDROX","code_information":[{"code":"82652","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":38.5,"maximum":116.62,"gross_charge":94,"discounted_cash":27.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":116.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":92.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65.83,"standard_charge_algorithm": "Lesser of $65.83 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":94.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.5,"standard_charge_algorithm": "Lesser of $38.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.2,"standard_charge_algorithm": "Lesser of $41.20 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.66,"standard_charge_algorithm": "Lesser of $39.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.42,"standard_charge_algorithm": "Lesser of $40.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.35,"standard_charge_algorithm": "Lesser of $42.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40.81,"standard_charge_algorithm": "Lesser of $40.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PANCREATIC ELASTASE FECAL","code_information":[{"code":"82656","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":123.93,"maximum":123.93,"gross_charge":153,"discounted_cash":45.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.93,"methodology":"fee schedule"}]}]},{"description":"HC LAB PANCREATIC ELASTASE FECAL","code_information":[{"code":"82656","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.53,"maximum":123.93,"gross_charge":153,"discounted_cash":45.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"standard_charge_algorithm": "Lesser of $11.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.22,"standard_charge_algorithm": "Lesser of $12.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC NEUTROPHIL OXIDATIVE BURST","code_information":[{"code":"82657","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC NEUTROPHIL OXIDATIVE BURST","code_information":[{"code":"82657","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.91,"standard_charge_algorithm": "Lesser of $37.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"standard_charge_algorithm": "Lesser of $22.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.72,"standard_charge_algorithm": "Lesser of $23.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.84,"standard_charge_algorithm": "Lesser of $22.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.28,"standard_charge_algorithm": "Lesser of $23.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.39,"standard_charge_algorithm": "Lesser of $24.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.5,"standard_charge_algorithm": "Lesser of $23.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TPMT(THIPURINE METHYLTRANSFER)","code_information":[{"code":"82657","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"TPMT(THIPURINE METHYLTRANSFER)","code_information":[{"code":"82657","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.91,"standard_charge_algorithm": "Lesser of $37.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.17,"standard_charge_algorithm": "Lesser of $22.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.72,"standard_charge_algorithm": "Lesser of $23.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.84,"standard_charge_algorithm": "Lesser of $22.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.28,"standard_charge_algorithm": "Lesser of $23.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.39,"standard_charge_algorithm": "Lesser of $24.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.5,"standard_charge_algorithm": "Lesser of $23.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CHYLOMICRON SCREEN BODY FLUID","code_information":[{"code":"82664","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":329.67,"maximum":329.67,"gross_charge":407,"discounted_cash":120.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":329.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":329.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":329.67,"methodology":"fee schedule"}]}]},{"description":"HC CHYLOMICRON SCREEN BODY FLUID","code_information":[{"code":"82664","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":48.33,"maximum":329.67,"gross_charge":407,"discounted_cash":120.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":329.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":329.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":329.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":61.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":104.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":82.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":105.17,"standard_charge_algorithm": "Lesser of $105.17 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":134.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":61.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":61.5,"standard_charge_algorithm": "Lesser of $61.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":65.81,"standard_charge_algorithm": "Lesser of $65.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":63.34,"standard_charge_algorithm": "Lesser of $63.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":64.58,"standard_charge_algorithm": "Lesser of $64.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":67.65,"standard_charge_algorithm": "Lesser of $67.65 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":65.19,"standard_charge_algorithm": "Lesser of $65.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ERYTHROPOIETIN","code_information":[{"code":"82668","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":81,"maximum":81,"gross_charge":100,"discounted_cash":29.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81,"methodology":"fee schedule"}]}]},{"description":"HC LAB ERYTHROPOIETIN","code_information":[{"code":"82668","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.79,"maximum":81,"gross_charge":100,"discounted_cash":29.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.13,"standard_charge_algorithm": "Lesser of $32.13 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.79,"standard_charge_algorithm": "Lesser of $18.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.11,"standard_charge_algorithm": "Lesser of $20.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.73,"standard_charge_algorithm": "Lesser of $19.73 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.67,"standard_charge_algorithm": "Lesser of $20.67 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.92,"standard_charge_algorithm": "Lesser of $19.92 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ESTRADIOL (E2)","code_information":[{"code":"82670","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB ESTRADIOL (E2)","code_information":[{"code":"82670","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.94,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47.78,"standard_charge_algorithm": "Lesser of $47.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"standard_charge_algorithm": "Lesser of $27.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.9,"standard_charge_algorithm": "Lesser of $29.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.78,"standard_charge_algorithm": "Lesser of $28.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29.34,"standard_charge_algorithm": "Lesser of $29.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.73,"standard_charge_algorithm": "Lesser of $30.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.62,"standard_charge_algorithm": "Lesser of $29.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ESTRADIOL ULTRASENSITIVE","code_information":[{"code":"82670","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB ESTRADIOL ULTRASENSITIVE","code_information":[{"code":"82670","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.94,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47.78,"standard_charge_algorithm": "Lesser of $47.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.94,"standard_charge_algorithm": "Lesser of $27.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.9,"standard_charge_algorithm": "Lesser of $29.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.78,"standard_charge_algorithm": "Lesser of $28.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29.34,"standard_charge_algorithm": "Lesser of $29.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.73,"standard_charge_algorithm": "Lesser of $30.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.62,"standard_charge_algorithm": "Lesser of $29.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ESTROGENS FRACTIONATED","code_information":[{"code":"82671","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":154.71,"maximum":154.71,"gross_charge":191,"discounted_cash":56.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.71,"methodology":"fee schedule"}]}]},{"description":"HC ESTROGENS FRACTIONATED","code_information":[{"code":"82671","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":32.3,"maximum":154.71,"gross_charge":191,"discounted_cash":56.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":97.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":77.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":55.23,"standard_charge_algorithm": "Lesser of $55.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32.3,"standard_charge_algorithm": "Lesser of $32.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34.56,"standard_charge_algorithm": "Lesser of $34.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33.27,"standard_charge_algorithm": "Lesser of $33.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":33.91,"standard_charge_algorithm": "Lesser of $33.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35.53,"standard_charge_algorithm": "Lesser of $35.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":34.24,"standard_charge_algorithm": "Lesser of $34.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ESTROGENS TOTAL","code_information":[{"code":"82672","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"}]}]},{"description":"ESTROGENS TOTAL","code_information":[{"code":"82672","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.7,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.11,"standard_charge_algorithm": "Lesser of $37.11 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.7,"standard_charge_algorithm": "Lesser of $21.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.22,"standard_charge_algorithm": "Lesser of $23.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.35,"standard_charge_algorithm": "Lesser of $22.35 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.79,"standard_charge_algorithm": "Lesser of $22.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.87,"standard_charge_algorithm": "Lesser of $23.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23,"standard_charge_algorithm": "Lesser of $23.00 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ESTRONE","code_information":[{"code":"82679","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC ESTRONE","code_information":[{"code":"82679","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.95,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":75.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":59.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.66,"standard_charge_algorithm": "Lesser of $42.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"standard_charge_algorithm": "Lesser of $24.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.7,"standard_charge_algorithm": "Lesser of $26.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.7,"standard_charge_algorithm": "Lesser of $25.70 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.2,"standard_charge_algorithm": "Lesser of $26.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.45,"standard_charge_algorithm": "Lesser of $27.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.45,"standard_charge_algorithm": "Lesser of $26.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ETHYLENE GLYCOL SERUM","code_information":[{"code":"82693","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"ETHYLENE GLYCOL SERUM","code_information":[{"code":"82693","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.9,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.48,"standard_charge_algorithm": "Lesser of $25.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.9,"standard_charge_algorithm": "Lesser of $14.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.94,"standard_charge_algorithm": "Lesser of $15.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.35,"standard_charge_algorithm": "Lesser of $15.35 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.64,"standard_charge_algorithm": "Lesser of $15.64 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.39,"standard_charge_algorithm": "Lesser of $16.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.79,"standard_charge_algorithm": "Lesser of $15.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"minimum":10428,"maximum":42378,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21213,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20054,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13165,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42378,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39732,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31239.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26317,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31376,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24465,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":32883.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35047,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21761,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21761,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10428,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18268.67,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19547.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18816.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19182.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19364.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19182.11,"methodology":"case rate"}]}]},{"description":"FECAL FAT QUALITATIVE","code_information":[{"code":"82705","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.49,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"}]}]},{"description":"FECAL FAT QUALITATIVE","code_information":[{"code":"82705","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.1,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.72,"standard_charge_algorithm": "Lesser of $8.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.46,"standard_charge_algorithm": "Lesser of $5.46 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.25,"standard_charge_algorithm": "Lesser of $5.25 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.36,"standard_charge_algorithm": "Lesser of $5.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.61,"standard_charge_algorithm": "Lesser of $5.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.41,"standard_charge_algorithm": "Lesser of $5.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FECAL LIPIDS TOTAL","code_information":[{"code":"82710","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":593.73,"maximum":593.73,"gross_charge":733,"discounted_cash":216.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":593.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB FECAL LIPIDS TOTAL","code_information":[{"code":"82710","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":593.73,"gross_charge":733,"discounted_cash":216.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.73,"standard_charge_algorithm": "Lesser of $28.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"standard_charge_algorithm": "Lesser of $16.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"standard_charge_algorithm": "Lesser of $17.98 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.3,"standard_charge_algorithm": "Lesser of $17.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.64,"standard_charge_algorithm": "Lesser of $17.64 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.81,"standard_charge_algorithm": "Lesser of $17.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FATTY ACIDS FREE","code_information":[{"code":"82725","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"}]}]},{"description":"HC FATTY ACIDS FREE","code_information":[{"code":"82725","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.73,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.1,"standard_charge_algorithm": "Lesser of $32.10 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.77,"standard_charge_algorithm": "Lesser of $18.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.08,"standard_charge_algorithm": "Lesser of $20.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.33,"standard_charge_algorithm": "Lesser of $19.33 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.71,"standard_charge_algorithm": "Lesser of $19.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.65,"standard_charge_algorithm": "Lesser of $20.65 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.9,"standard_charge_algorithm": "Lesser of $19.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FATTY ACID PROFILE","code_information":[{"code":"82726","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":283.5,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"}]}]},{"description":"HC FATTY ACID PROFILE","code_information":[{"code":"82726","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":283.5,"gross_charge":350,"discounted_cash":103.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":283.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.77,"standard_charge_algorithm": "Lesser of $33.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.75,"standard_charge_algorithm": "Lesser of $19.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.13,"standard_charge_algorithm": "Lesser of $21.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.34,"standard_charge_algorithm": "Lesser of $20.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.74,"standard_charge_algorithm": "Lesser of $20.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.73,"standard_charge_algorithm": "Lesser of $21.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.93,"standard_charge_algorithm": "Lesser of $20.93 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FERRITIN","code_information":[{"code":"82728","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":264.06,"maximum":264.06,"gross_charge":326,"discounted_cash":96.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB FERRITIN","code_information":[{"code":"82728","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.63,"maximum":264.06,"gross_charge":326,"discounted_cash":96.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.31,"standard_charge_algorithm": "Lesser of $23.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.63,"standard_charge_algorithm": "Lesser of $13.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.58,"standard_charge_algorithm": "Lesser of $14.58 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.31,"standard_charge_algorithm": "Lesser of $14.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.45,"standard_charge_algorithm": "Lesser of $14.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FOLATESERUM","code_information":[{"code":"82746","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB FOLATESERUM","code_information":[{"code":"82746","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.7,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.14,"standard_charge_algorithm": "Lesser of $25.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"standard_charge_algorithm": "Lesser of $14.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.73,"standard_charge_algorithm": "Lesser of $15.73 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.14,"standard_charge_algorithm": "Lesser of $15.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.17,"standard_charge_algorithm": "Lesser of $16.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.58,"standard_charge_algorithm": "Lesser of $15.58 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FOLATERBC","code_information":[{"code":"82747","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC LAB FOLATERBC","code_information":[{"code":"82747","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.65,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.18,"standard_charge_algorithm": "Lesser of $30.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.89,"standard_charge_algorithm": "Lesser of $18.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.18,"standard_charge_algorithm": "Lesser of $18.18 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.53,"standard_charge_algorithm": "Lesser of $18.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.41,"standard_charge_algorithm": "Lesser of $19.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.71,"standard_charge_algorithm": "Lesser of $18.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ASAY IGA/IGD/IGG/IGM EA","code_information":[{"code":"82784","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB ASAY IGA/IGD/IGG/IGM EA","code_information":[{"code":"82784","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.9,"standard_charge_algorithm": "Lesser of $15.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"standard_charge_algorithm": "Lesser of $9.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.95,"standard_charge_algorithm": "Lesser of $9.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.58,"standard_charge_algorithm": "Lesser of $9.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.77,"standard_charge_algorithm": "Lesser of $9.77 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.23,"standard_charge_algorithm": "Lesser of $10.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.86,"standard_charge_algorithm": "Lesser of $9.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IMMUNOGLOB A","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOGLOB A","code_information":[{"code":"82784","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.9,"standard_charge_algorithm": "Lesser of $15.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.3,"standard_charge_algorithm": "Lesser of $9.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.95,"standard_charge_algorithm": "Lesser of $9.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.58,"standard_charge_algorithm": "Lesser of $9.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.77,"standard_charge_algorithm": "Lesser of $9.77 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.23,"standard_charge_algorithm": "Lesser of $10.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.86,"standard_charge_algorithm": "Lesser of $9.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IGE TOTAL","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":337.77,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB IGE TOTAL","code_information":[{"code":"82785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.46,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.15,"standard_charge_algorithm": "Lesser of $28.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"standard_charge_algorithm": "Lesser of $16.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.61,"standard_charge_algorithm": "Lesser of $17.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.95,"standard_charge_algorithm": "Lesser of $16.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.28,"standard_charge_algorithm": "Lesser of $17.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.11,"standard_charge_algorithm": "Lesser of $18.11 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.45,"standard_charge_algorithm": "Lesser of $17.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IMMUNOGLOBULIN E","code_information":[{"code":"82785","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":337.77,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOGLOBULIN E","code_information":[{"code":"82785","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.46,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.15,"standard_charge_algorithm": "Lesser of $28.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.46,"standard_charge_algorithm": "Lesser of $16.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.61,"standard_charge_algorithm": "Lesser of $17.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.95,"standard_charge_algorithm": "Lesser of $16.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.28,"standard_charge_algorithm": "Lesser of $17.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.11,"standard_charge_algorithm": "Lesser of $18.11 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.45,"standard_charge_algorithm": "Lesser of $17.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IMMUNOGLOBULIN G SUBCL","code_information":[{"code":"82787","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.73,"maximum":26.73,"gross_charge":33,"discounted_cash":9.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOGLOBULIN G SUBCL","code_information":[{"code":"82787","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.02,"maximum":26.73,"gross_charge":33,"discounted_cash":9.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.71,"standard_charge_algorithm": "Lesser of $13.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.02,"standard_charge_algorithm": "Lesser of $8.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.58,"standard_charge_algorithm": "Lesser of $8.58 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.26,"standard_charge_algorithm": "Lesser of $8.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.42,"standard_charge_algorithm": "Lesser of $8.42 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.82,"standard_charge_algorithm": "Lesser of $8.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.5,"standard_charge_algorithm": "Lesser of $8.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"minimum":7515,"maximum":24130.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14408,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13621,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9320,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20184,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18924,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22923.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18798,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22412,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17319,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24130.21,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23805,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14780,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14780,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7515,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13405.67,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14344.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13807.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14075.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14210.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14075.96,"methodology":"case rate"}]}]},{"description":"POINT OF CARE PH","code_information":[{"code":"82800","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.07,"maximum":38.07,"gross_charge":47,"discounted_cash":13.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"}]}]},{"description":"POINT OF CARE PH","code_information":[{"code":"82800","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.89,"maximum":38.07,"gross_charge":47,"discounted_cash":13.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.81,"standard_charge_algorithm": "Lesser of $18.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11,"standard_charge_algorithm": "Lesser of $11.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"standard_charge_algorithm": "Lesser of $11.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.33,"standard_charge_algorithm": "Lesser of $11.33 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.55,"standard_charge_algorithm": "Lesser of $11.55 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.1,"standard_charge_algorithm": "Lesser of $12.10 or 110 Percent of Billed Charges","median_amount":11,"10th_percentile":11,"90th_percentile":11,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.66,"standard_charge_algorithm": "Lesser of $11.66 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BLOOD GASES","code_information":[{"code":"82803","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD GASES","code_information":[{"code":"82803","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.07,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44.58,"standard_charge_algorithm": "Lesser of $44.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"standard_charge_algorithm": "Lesser of $26.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.89,"standard_charge_algorithm": "Lesser of $27.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.85,"standard_charge_algorithm": "Lesser of $26.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.37,"standard_charge_algorithm": "Lesser of $27.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.68,"standard_charge_algorithm": "Lesser of $28.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.63,"standard_charge_algorithm": "Lesser of $27.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BLOOD GASES WO 02 SAT","code_information":[{"code":"82803","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD GASES WO 02 SAT","code_information":[{"code":"82803","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.07,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44.58,"standard_charge_algorithm": "Lesser of $44.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"standard_charge_algorithm": "Lesser of $26.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.89,"standard_charge_algorithm": "Lesser of $27.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.85,"standard_charge_algorithm": "Lesser of $26.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.37,"standard_charge_algorithm": "Lesser of $27.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.68,"standard_charge_algorithm": "Lesser of $28.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.63,"standard_charge_algorithm": "Lesser of $27.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ARTERIAL BLOOD GAS/PH ANALYSIS","code_information":[{"code":"82805","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":554.04,"maximum":554.04,"gross_charge":684,"discounted_cash":202.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":554.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.04,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL BLOOD GAS/PH ANALYSIS","code_information":[{"code":"82805","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":39.93,"maximum":554.04,"gross_charge":684,"discounted_cash":202.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":554.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":85.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.7,"standard_charge_algorithm": "Lesser of $134.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":155.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":172.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":118.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.77,"standard_charge_algorithm": "Lesser of $78.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.28,"standard_charge_algorithm": "Lesser of $84.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.13,"standard_charge_algorithm": "Lesser of $81.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.71,"standard_charge_algorithm": "Lesser of $82.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.65,"standard_charge_algorithm": "Lesser of $86.65 or 110 Percent of Billed Charges","median_amount":39.93,"10th_percentile":39.93,"90th_percentile":39.93,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.5,"standard_charge_algorithm": "Lesser of $83.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASESBLD-MEASURED O2 SAT.","code_information":[{"code":"82810","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":33.21,"maximum":33.21,"gross_charge":41,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"}]}]},{"description":"GASESBLD-MEASURED O2 SAT.","code_information":[{"code":"82810","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":9.77,"maximum":33.21,"gross_charge":41,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.71,"standard_charge_algorithm": "Lesser of $16.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.77,"standard_charge_algorithm": "Lesser of $9.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.45,"standard_charge_algorithm": "Lesser of $10.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.06,"standard_charge_algorithm": "Lesser of $10.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.26,"standard_charge_algorithm": "Lesser of $10.26 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.75,"standard_charge_algorithm": "Lesser of $10.75 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.36,"standard_charge_algorithm": "Lesser of $10.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"minimum":13691,"maximum":45798,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27720,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26206,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17918,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37410,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35075,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39191.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34207,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40783,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33298,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":41254.26,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45798,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28436,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28436,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13691,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22919.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24523.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23606.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24064.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24294.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24064.99,"methodology":"case rate"}]}]},{"description":"HC LAB GASTRIN","code_information":[{"code":"82941","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB GASTRIN","code_information":[{"code":"82941","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.63,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.15,"standard_charge_algorithm": "Lesser of $30.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.63,"standard_charge_algorithm": "Lesser of $17.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.86,"standard_charge_algorithm": "Lesser of $18.86 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.16,"standard_charge_algorithm": "Lesser of $18.16 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.51,"standard_charge_algorithm": "Lesser of $18.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.39,"standard_charge_algorithm": "Lesser of $19.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.69,"standard_charge_algorithm": "Lesser of $18.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GLUCAGON","code_information":[{"code":"82943","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":51.03,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCAGON","code_information":[{"code":"82943","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.29,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.44,"standard_charge_algorithm": "Lesser of $24.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.29,"standard_charge_algorithm": "Lesser of $14.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"standard_charge_algorithm": "Lesser of $15.29 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.72,"standard_charge_algorithm": "Lesser of $14.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15,"standard_charge_algorithm": "Lesser of $15.00 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.72,"standard_charge_algorithm": "Lesser of $15.72 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.15,"standard_charge_algorithm": "Lesser of $15.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GLUCOSE BODY FLUID","code_information":[{"code":"82945","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":163.62,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOSE BODY FLUID","code_information":[{"code":"82945","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.93,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.72,"standard_charge_algorithm": "Lesser of $6.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.21,"standard_charge_algorithm": "Lesser of $4.21 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.05,"standard_charge_algorithm": "Lesser of $4.05 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.13,"standard_charge_algorithm": "Lesser of $4.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.32,"standard_charge_algorithm": "Lesser of $4.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.17,"standard_charge_algorithm": "Lesser of $4.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GLUCOSE QUANTITATIVE BLOOD","code_information":[{"code":"82947","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE QUANTITATIVE BLOOD","code_information":[{"code":"82947","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.93,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.72,"standard_charge_algorithm": "Lesser of $6.72 or 171 Percent of Billed Charges","median_amount":6.72,"10th_percentile":6.72,"90th_percentile":18.98,"count":"108","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 100 Percent of Billed Charges","median_amount":3.93,"10th_percentile":3.93,"90th_percentile":7.86,"count":"15","methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.21,"standard_charge_algorithm": "Lesser of $4.21 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.05,"standard_charge_algorithm": "Lesser of $4.05 or 103 Percent of Billed Charges","median_amount":4.05,"10th_percentile":4.05,"90th_percentile":8.1,"count":"50","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.13,"standard_charge_algorithm": "Lesser of $4.13 or 105 Percent of Billed Charges","median_amount":4.13,"10th_percentile":4.13,"90th_percentile":8.25,"count":"34","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.32,"standard_charge_algorithm": "Lesser of $4.32 or 110 Percent of Billed Charges","median_amount":4.32,"10th_percentile":4.32,"90th_percentile":17.29,"count":"53","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.17,"standard_charge_algorithm": "Lesser of $4.17 or 106 Percent of Billed Charges","median_amount":8.33,"10th_percentile":4.17,"90th_percentile":16.66,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOMETER","code_information":[{"code":"82947","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOMETER","code_information":[{"code":"82947","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.93,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.72,"standard_charge_algorithm": "Lesser of $6.72 or 171 Percent of Billed Charges","median_amount":6.72,"10th_percentile":6.72,"90th_percentile":18.98,"count":"108","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 100 Percent of Billed Charges","median_amount":3.93,"10th_percentile":3.93,"90th_percentile":7.86,"count":"15","methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.21,"standard_charge_algorithm": "Lesser of $4.21 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.05,"standard_charge_algorithm": "Lesser of $4.05 or 103 Percent of Billed Charges","median_amount":4.05,"10th_percentile":4.05,"90th_percentile":8.1,"count":"50","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.13,"standard_charge_algorithm": "Lesser of $4.13 or 105 Percent of Billed Charges","median_amount":4.13,"10th_percentile":4.13,"90th_percentile":8.25,"count":"34","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.32,"standard_charge_algorithm": "Lesser of $4.32 or 110 Percent of Billed Charges","median_amount":4.32,"10th_percentile":4.32,"90th_percentile":17.29,"count":"53","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.17,"standard_charge_algorithm": "Lesser of $4.17 or 106 Percent of Billed Charges","median_amount":8.33,"10th_percentile":4.17,"90th_percentile":16.66,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"GLUCOSE QUANTITATIVE REAGENT STRIP","code_information":[{"code":"82948","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"GLUCOSE QUANTITATIVE REAGENT STRIP","code_information":[{"code":"82948","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.46,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.62,"standard_charge_algorithm": "Lesser of $8.62 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.04,"standard_charge_algorithm": "Lesser of $5.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"standard_charge_algorithm": "Lesser of $5.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.19,"standard_charge_algorithm": "Lesser of $5.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.29,"standard_charge_algorithm": "Lesser of $5.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GLUCOSE TT FIRST 3 SPECS","code_information":[{"code":"82951","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOSE TT FIRST 3 SPECS","code_information":[{"code":"82951","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.87,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.01,"standard_charge_algorithm": "Lesser of $22.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"standard_charge_algorithm": "Lesser of $12.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.51,"standard_charge_algorithm": "Lesser of $13.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.16,"standard_charge_algorithm": "Lesser of $14.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GLUCOSE TOLEA ADDL SPEC","code_information":[{"code":"82952","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOSE TOLEA ADDL SPEC","code_information":[{"code":"82952","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.92,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.7,"standard_charge_algorithm": "Lesser of $6.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.92,"standard_charge_algorithm": "Lesser of $3.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.19,"standard_charge_algorithm": "Lesser of $4.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.04,"standard_charge_algorithm": "Lesser of $4.04 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.12,"standard_charge_algorithm": "Lesser of $4.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.31,"standard_charge_algorithm": "Lesser of $4.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB G-6-PD QUANT","code_information":[{"code":"82955","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":49.41,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"}]}]},{"description":"HC LAB G-6-PD QUANT","code_information":[{"code":"82955","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.7,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.7,"standard_charge_algorithm": "Lesser of $9.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.38,"standard_charge_algorithm": "Lesser of $10.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.99,"standard_charge_algorithm": "Lesser of $9.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.18,"standard_charge_algorithm": "Lesser of $10.18 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.67,"standard_charge_algorithm": "Lesser of $10.67 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.28,"standard_charge_algorithm": "Lesser of $10.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GLUCOMETER OTHER POC","code_information":[{"code":"82962","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOMETER OTHER POC","code_information":[{"code":"82962","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.28,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.61,"standard_charge_algorithm": "Lesser of $5.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"standard_charge_algorithm": "Lesser of $3.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.51,"standard_charge_algorithm": "Lesser of $3.51 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.38,"standard_charge_algorithm": "Lesser of $3.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.44,"standard_charge_algorithm": "Lesser of $3.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.61,"standard_charge_algorithm": "Lesser of $3.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.48,"standard_charge_algorithm": "Lesser of $3.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GLUCOSE SEMI-QUANT","code_information":[{"code":"82962","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC LAB GLUCOSE SEMI-QUANT","code_information":[{"code":"82962","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.28,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.61,"standard_charge_algorithm": "Lesser of $5.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"standard_charge_algorithm": "Lesser of $3.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.51,"standard_charge_algorithm": "Lesser of $3.51 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.38,"standard_charge_algorithm": "Lesser of $3.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.44,"standard_charge_algorithm": "Lesser of $3.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.61,"standard_charge_algorithm": "Lesser of $3.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.48,"standard_charge_algorithm": "Lesser of $3.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GAMMA GT","code_information":[{"code":"82977","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB GAMMA GT","code_information":[{"code":"82977","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.1,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.31,"standard_charge_algorithm": "Lesser of $12.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"standard_charge_algorithm": "Lesser of $7.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.7,"standard_charge_algorithm": "Lesser of $7.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.42,"standard_charge_algorithm": "Lesser of $7.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.56,"standard_charge_algorithm": "Lesser of $7.56 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.92,"standard_charge_algorithm": "Lesser of $7.92 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.63,"standard_charge_algorithm": "Lesser of $7.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GGT (GGTP)","code_information":[{"code":"82977","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB GGT (GGTP)","code_information":[{"code":"82977","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.1,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.31,"standard_charge_algorithm": "Lesser of $12.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"standard_charge_algorithm": "Lesser of $7.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.7,"standard_charge_algorithm": "Lesser of $7.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.42,"standard_charge_algorithm": "Lesser of $7.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.56,"standard_charge_algorithm": "Lesser of $7.56 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.92,"standard_charge_algorithm": "Lesser of $7.92 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.63,"standard_charge_algorithm": "Lesser of $7.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FRUCTOSAMINE","code_information":[{"code":"82985","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":161.19,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB FRUCTOSAMINE","code_information":[{"code":"82985","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.76,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.66,"standard_charge_algorithm": "Lesser of $28.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.76,"standard_charge_algorithm": "Lesser of $16.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"standard_charge_algorithm": "Lesser of $17.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.26,"standard_charge_algorithm": "Lesser of $17.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.6,"standard_charge_algorithm": "Lesser of $17.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.44,"standard_charge_algorithm": "Lesser of $18.44 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.77,"standard_charge_algorithm": "Lesser of $17.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"minimum":5678,"maximum":22506.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13146,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12428,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8983,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16774,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15727,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21381.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15895,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18950,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16694,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22506.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21720,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13486,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13486,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5678,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12503.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13379,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12878.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13128.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13253.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13128.92,"methodology":"case rate"}]}]},{"description":"HC LAB FOLLICLE STIM HORMONE","code_information":[{"code":"83001","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":290.79,"maximum":290.79,"gross_charge":359,"discounted_cash":106.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":290.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":290.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB FOLLICLE STIM HORMONE","code_information":[{"code":"83001","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.58,"maximum":290.79,"gross_charge":359,"discounted_cash":106.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":290.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":290.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.77,"standard_charge_algorithm": "Lesser of $31.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.58,"standard_charge_algorithm": "Lesser of $18.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.88,"standard_charge_algorithm": "Lesser of $19.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.14,"standard_charge_algorithm": "Lesser of $19.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.51,"standard_charge_algorithm": "Lesser of $19.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.44,"standard_charge_algorithm": "Lesser of $20.44 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LUTENIZING HORMONE","code_information":[{"code":"83002","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":93.15,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"}]}]},{"description":"HC LAB LUTENIZING HORMONE","code_information":[{"code":"83002","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.52,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.67,"standard_charge_algorithm": "Lesser of $31.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.52,"standard_charge_algorithm": "Lesser of $18.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.82,"standard_charge_algorithm": "Lesser of $19.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.08,"standard_charge_algorithm": "Lesser of $19.08 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.45,"standard_charge_algorithm": "Lesser of $19.45 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.37,"standard_charge_algorithm": "Lesser of $20.37 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.63,"standard_charge_algorithm": "Lesser of $19.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GROWTH HORMONE","code_information":[{"code":"83003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB GROWTH HORMONE","code_information":[{"code":"83003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.67,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.51,"standard_charge_algorithm": "Lesser of $28.51 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.67,"standard_charge_algorithm": "Lesser of $16.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.84,"standard_charge_algorithm": "Lesser of $17.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.17,"standard_charge_algorithm": "Lesser of $17.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.5,"standard_charge_algorithm": "Lesser of $17.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.34,"standard_charge_algorithm": "Lesser of $18.34 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.67,"standard_charge_algorithm": "Lesser of $17.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HAPTOGLOBIN","code_information":[{"code":"83010","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":71.28,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"}]}]},{"description":"HC LAB HAPTOGLOBIN","code_information":[{"code":"83010","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.25,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.51,"standard_charge_algorithm": "Lesser of $21.51 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.46,"standard_charge_algorithm": "Lesser of $13.46 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.96,"standard_charge_algorithm": "Lesser of $12.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.21,"standard_charge_algorithm": "Lesser of $13.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.84,"standard_charge_algorithm": "Lesser of $13.84 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.33,"standard_charge_algorithm": "Lesser of $13.33 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HELICOBACTER PYLORI BREATH","code_information":[{"code":"83013","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":155.52,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"}]}]},{"description":"HC HELICOBACTER PYLORI BREATH","code_information":[{"code":"83013","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":67.36,"maximum":204,"gross_charge":192,"discounted_cash":56.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":204,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":115.19,"standard_charge_algorithm": "Lesser of $115.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":164.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":101.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":67.36,"standard_charge_algorithm": "Lesser of $67.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":72.08,"standard_charge_algorithm": "Lesser of $72.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":69.38,"standard_charge_algorithm": "Lesser of $69.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":70.73,"standard_charge_algorithm": "Lesser of $70.73 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":74.1,"standard_charge_algorithm": "Lesser of $74.10 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":71.4,"standard_charge_algorithm": "Lesser of $71.40 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BISMUTH URINE","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":125.55,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"}]}]},{"description":"BISMUTH URINE","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.96,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"standard_charge_algorithm": "Lesser of $21.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.5,"standard_charge_algorithm": "Lesser of $23.50 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.62,"standard_charge_algorithm": "Lesser of $22.62 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.06,"standard_charge_algorithm": "Lesser of $23.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.16,"standard_charge_algorithm": "Lesser of $24.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.28,"standard_charge_algorithm": "Lesser of $23.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC COBALT SERUM","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC COBALT SERUM","code_information":[{"code":"83018","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.96,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.96,"standard_charge_algorithm": "Lesser of $21.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.5,"standard_charge_algorithm": "Lesser of $23.50 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.62,"standard_charge_algorithm": "Lesser of $22.62 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.06,"standard_charge_algorithm": "Lesser of $23.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.16,"standard_charge_algorithm": "Lesser of $24.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.28,"standard_charge_algorithm": "Lesser of $23.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HBG FRACT (ELECTROPHESIS)","code_information":[{"code":"83020","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HBG FRACT (ELECTROPHESIS)","code_information":[{"code":"83020","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.87,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.01,"standard_charge_algorithm": "Lesser of $22.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"standard_charge_algorithm": "Lesser of $12.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.51,"standard_charge_algorithm": "Lesser of $13.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.16,"standard_charge_algorithm": "Lesser of $14.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HEMOGLOBIN A2","code_information":[{"code":"83021","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC HEMOGLOBIN A2","code_information":[{"code":"83021","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.88,"standard_charge_algorithm": "Lesser of $30.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"standard_charge_algorithm": "Lesser of $18.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"standard_charge_algorithm": "Lesser of $19.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.6,"standard_charge_algorithm": "Lesser of $18.60 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.96,"standard_charge_algorithm": "Lesser of $18.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.87,"standard_charge_algorithm": "Lesser of $19.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.14,"standard_charge_algorithm": "Lesser of $19.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HGB FRACTIONATION BY HPLC","code_information":[{"code":"83021","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HGB FRACTIONATION BY HPLC","code_information":[{"code":"83021","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.88,"standard_charge_algorithm": "Lesser of $30.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.06,"standard_charge_algorithm": "Lesser of $18.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.32,"standard_charge_algorithm": "Lesser of $19.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.6,"standard_charge_algorithm": "Lesser of $18.60 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.96,"standard_charge_algorithm": "Lesser of $18.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.87,"standard_charge_algorithm": "Lesser of $19.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.14,"standard_charge_algorithm": "Lesser of $19.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEMOGLOBIN A1C","code_information":[{"code":"83036","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEMOGLOBIN A1C","code_information":[{"code":"83036","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.71,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.6,"standard_charge_algorithm": "Lesser of $16.60 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.71,"standard_charge_algorithm": "Lesser of $9.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.39,"standard_charge_algorithm": "Lesser of $10.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10,"standard_charge_algorithm": "Lesser of $10.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.2,"standard_charge_algorithm": "Lesser of $10.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.68,"standard_charge_algorithm": "Lesser of $10.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.29,"standard_charge_algorithm": "Lesser of $10.29 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB METHEMOGLOBINQUANT","code_information":[{"code":"83050","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB METHEMOGLOBINQUANT","code_information":[{"code":"83050","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.04,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.02,"standard_charge_algorithm": "Lesser of $14.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.2,"standard_charge_algorithm": "Lesser of $8.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.77,"standard_charge_algorithm": "Lesser of $8.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.45,"standard_charge_algorithm": "Lesser of $8.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.61,"standard_charge_algorithm": "Lesser of $8.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.02,"standard_charge_algorithm": "Lesser of $9.02 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.69,"standard_charge_algorithm": "Lesser of $8.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEMOGLOBIN PLASMA","code_information":[{"code":"83051","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEMOGLOBIN PLASMA","code_information":[{"code":"83051","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.31,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.5,"standard_charge_algorithm": "Lesser of $12.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"standard_charge_algorithm": "Lesser of $7.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.82,"standard_charge_algorithm": "Lesser of $7.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.53,"standard_charge_algorithm": "Lesser of $7.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.68,"standard_charge_algorithm": "Lesser of $7.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.04,"standard_charge_algorithm": "Lesser of $8.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.75,"standard_charge_algorithm": "Lesser of $7.75 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEMOSIDERIN URINE","code_information":[{"code":"83070","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEMOSIDERIN URINE","code_information":[{"code":"83070","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.75,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.12,"standard_charge_algorithm": "Lesser of $8.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"standard_charge_algorithm": "Lesser of $5.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.89,"standard_charge_algorithm": "Lesser of $4.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.99,"standard_charge_algorithm": "Lesser of $4.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.04,"standard_charge_algorithm": "Lesser of $5.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEMOSIDERIN URINE","code_information":[{"code":"83070","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HEMOSIDERIN URINE","code_information":[{"code":"83070","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.75,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.12,"standard_charge_algorithm": "Lesser of $8.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"standard_charge_algorithm": "Lesser of $5.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.89,"standard_charge_algorithm": "Lesser of $4.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.99,"standard_charge_algorithm": "Lesser of $4.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.04,"standard_charge_algorithm": "Lesser of $5.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HISTAMINE PLASMA OR URINE","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":140.13,"maximum":140.13,"gross_charge":173,"discounted_cash":51.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"}]}]},{"description":"HC HISTAMINE PLASMA OR URINE","code_information":[{"code":"83088","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.53,"maximum":140.13,"gross_charge":173,"discounted_cash":51.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":89.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.5,"standard_charge_algorithm": "Lesser of $50.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.53,"standard_charge_algorithm": "Lesser of $29.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.6,"standard_charge_algorithm": "Lesser of $31.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.42,"standard_charge_algorithm": "Lesser of $30.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31.01,"standard_charge_algorithm": "Lesser of $31.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.48,"standard_charge_algorithm": "Lesser of $32.48 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.3,"standard_charge_algorithm": "Lesser of $31.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HOMOCYSTEINE","code_information":[{"code":"83090","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":86.67,"maximum":86.67,"gross_charge":107,"discounted_cash":31.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.67,"methodology":"fee schedule"}]}]},{"description":"HC LAB HOMOCYSTEINE","code_information":[{"code":"83090","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.92,"maximum":86.67,"gross_charge":107,"discounted_cash":31.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.64,"standard_charge_algorithm": "Lesser of $30.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.17,"standard_charge_algorithm": "Lesser of $19.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.46,"standard_charge_algorithm": "Lesser of $18.46 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.82,"standard_charge_algorithm": "Lesser of $18.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.71,"standard_charge_algorithm": "Lesser of $19.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19,"standard_charge_algorithm": "Lesser of $19.00 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"minimum":6109,"maximum":18904.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10346,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9781,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6109,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17209,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16135,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17959.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12915,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15397,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11353,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18904.76,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17094,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10613,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10613,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10502.64,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11237.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10817.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11027.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11132.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11027.78,"methodology":"case rate"}]}]},{"description":"HOMOVANILLIC ACID (HVA)","code_information":[{"code":"83150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":79.38,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"}]}]},{"description":"HOMOVANILLIC ACID (HVA)","code_information":[{"code":"83150","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":22.41,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.32,"standard_charge_algorithm": "Lesser of $38.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.41,"standard_charge_algorithm": "Lesser of $22.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.98,"standard_charge_algorithm": "Lesser of $23.98 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.08,"standard_charge_algorithm": "Lesser of $23.08 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.53,"standard_charge_algorithm": "Lesser of $23.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.65,"standard_charge_algorithm": "Lesser of $24.65 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.75,"standard_charge_algorithm": "Lesser of $23.75 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":4191,"maximum":14237.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6718,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6351,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4191,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12032,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11281,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13525.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7572,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9027,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7789,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14237.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11100,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6892,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6892,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7909.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8463.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8147.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8305.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8384.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8305.4,"methodology":"case rate"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":2908,"maximum":11606.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4672,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4417,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2908,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8040,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7538,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11025.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5448,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6495,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5404,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":11606.03,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7720,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4793,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4793,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6447.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6899.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6641.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6770.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6834.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6770.18,"methodology":"case rate"}]}]},{"description":"ACUTE LEUKEMIA WITH MCC","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"minimum":31810,"maximum":94898,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49685,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46971,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31810,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":94898,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":88974,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":66033.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59774,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71265,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59114,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":69509.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82086,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50967,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50967,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48980,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38616.17,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41319.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39774.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40546.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40933.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40546.98,"methodology":"case rate"}]}]},{"description":"HC LAB 17-OH CORTICOSTEROID","code_information":[{"code":"83491","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC LAB 17-OH CORTICOSTEROID","code_information":[{"code":"83491","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.9,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.61,"standard_charge_algorithm": "Lesser of $30.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"standard_charge_algorithm": "Lesser of $17.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"standard_charge_algorithm": "Lesser of $19.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.44,"standard_charge_algorithm": "Lesser of $18.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.79,"standard_charge_algorithm": "Lesser of $18.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 5-HIAA","code_information":[{"code":"83497","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB 5-HIAA","code_information":[{"code":"83497","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.9,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"standard_charge_algorithm": "Lesser of $12.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"standard_charge_algorithm": "Lesser of $13.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.29,"standard_charge_algorithm": "Lesser of $13.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.67,"standard_charge_algorithm": "Lesser of $13.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 5-HIAA URINE 24 HOUR","code_information":[{"code":"83497","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB 5-HIAA URINE 24 HOUR","code_information":[{"code":"83497","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.9,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"standard_charge_algorithm": "Lesser of $12.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"standard_charge_algorithm": "Lesser of $13.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.29,"standard_charge_algorithm": "Lesser of $13.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.67,"standard_charge_algorithm": "Lesser of $13.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 17-OH PROGESTERONE","code_information":[{"code":"83498","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB 17-OH PROGESTERONE","code_information":[{"code":"83498","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.17,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":82.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":65.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.46,"standard_charge_algorithm": "Lesser of $46.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.17,"standard_charge_algorithm": "Lesser of $27.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.07,"standard_charge_algorithm": "Lesser of $29.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.99,"standard_charge_algorithm": "Lesser of $27.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.53,"standard_charge_algorithm": "Lesser of $28.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.89,"standard_charge_algorithm": "Lesser of $29.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.8,"standard_charge_algorithm": "Lesser of $28.80 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ACUTE LEUKEMIA WITH CC","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"minimum":12701,"maximum":59290,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19200,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18151,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12701,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59290,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55588,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28778.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22668,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27025,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23602,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30293.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31720,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19695,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19695,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14057,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16829.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18007.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17334.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17671.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17839.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17671.17,"methodology":"case rate"}]}]},{"description":"HC LAB IMMUNASSY NONIFECT AGNT","code_information":[{"code":"83516","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNASSY NONIFECT AGNT","code_information":[{"code":"83516","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.53,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"standard_charge_algorithm": "Lesser of $11.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.22,"standard_charge_algorithm": "Lesser of $12.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MYELOPEROXIDASE AB","code_information":[{"code":"83516","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYELOPEROXIDASE AB","code_information":[{"code":"83516","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.53,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"standard_charge_algorithm": "Lesser of $11.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.22,"standard_charge_algorithm": "Lesser of $12.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TRANSGLUTAMINASE IGA AUTO AB","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB TRANSGLUTAMINASE IGA AUTO AB","code_information":[{"code":"83516","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.53,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"standard_charge_algorithm": "Lesser of $11.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.22,"standard_charge_algorithm": "Lesser of $12.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GROWTH HORMONE RELEASING HORMO","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":853.74,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"}]}]},{"description":"HC LAB GROWTH HORMONE RELEASING HORMO","code_information":[{"code":"83519","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.4,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.46,"standard_charge_algorithm": "Lesser of $31.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"standard_charge_algorithm": "Lesser of $18.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.95,"standard_charge_algorithm": "Lesser of $18.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.32,"standard_charge_algorithm": "Lesser of $19.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.24,"standard_charge_algorithm": "Lesser of $20.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.5,"standard_charge_algorithm": "Lesser of $19.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RADIOIMMUNOASSAY","code_information":[{"code":"83519","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":853.74,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"}]}]},{"description":"HC LAB RADIOIMMUNOASSAY","code_information":[{"code":"83519","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.4,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.46,"standard_charge_algorithm": "Lesser of $31.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"standard_charge_algorithm": "Lesser of $18.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.95,"standard_charge_algorithm": "Lesser of $18.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.32,"standard_charge_algorithm": "Lesser of $19.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.24,"standard_charge_algorithm": "Lesser of $20.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.5,"standard_charge_algorithm": "Lesser of $19.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTIPROTEINASE 3 (PR3) ANTIBODY","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"ANTIPROTEINASE 3 (PR3) ANTIBODY","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.53,"standard_charge_algorithm": "Lesser of $29.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19,"standard_charge_algorithm": "Lesser of $19.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.31,"standard_charge_algorithm": "Lesser of $18.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BETA AMYLOID 42/40 RATIO CSF","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":195.21,"maximum":195.21,"gross_charge":241,"discounted_cash":71.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.21,"methodology":"fee schedule"}]}]},{"description":"BETA AMYLOID 42/40 RATIO CSF","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":195.21,"gross_charge":241,"discounted_cash":71.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.53,"standard_charge_algorithm": "Lesser of $29.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19,"standard_charge_algorithm": "Lesser of $19.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.31,"standard_charge_algorithm": "Lesser of $18.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FGQ1B","code_information":[{"code":"83520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":170.1,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"}]}]},{"description":"FGQ1B","code_information":[{"code":"83520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.53,"standard_charge_algorithm": "Lesser of $29.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19,"standard_charge_algorithm": "Lesser of $19.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.31,"standard_charge_algorithm": "Lesser of $18.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IMMUNOASSAY NOS","code_information":[{"code":"83520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":88.29,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOASSAY NOS","code_information":[{"code":"83520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.53,"standard_charge_algorithm": "Lesser of $29.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19,"standard_charge_algorithm": "Lesser of $19.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.31,"standard_charge_algorithm": "Lesser of $18.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THROMBIN-ANTITHROMBIN COMPLEX","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":88.29,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB THROMBIN-ANTITHROMBIN COMPLEX","code_information":[{"code":"83520","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.53,"standard_charge_algorithm": "Lesser of $29.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19,"standard_charge_algorithm": "Lesser of $19.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.31,"standard_charge_algorithm": "Lesser of $18.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMMUNOGLOBULINS LIGHT CHAINS","code_information":[{"code":"83521","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":65.61,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"IMMUNOGLOBULINS LIGHT CHAINS","code_information":[{"code":"83521","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.15,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"HC LAB INSULIN","code_information":[{"code":"83525","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":57.51,"maximum":57.51,"gross_charge":71,"discounted_cash":21.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"}]}]},{"description":"HC LAB INSULIN","code_information":[{"code":"83525","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.43,"maximum":57.51,"gross_charge":71,"discounted_cash":21.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.55,"standard_charge_algorithm": "Lesser of $19.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.43,"standard_charge_algorithm": "Lesser of $11.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.23,"standard_charge_algorithm": "Lesser of $12.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.77,"standard_charge_algorithm": "Lesser of $11.77 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12,"standard_charge_algorithm": "Lesser of $12.00 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.57,"standard_charge_algorithm": "Lesser of $12.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.12,"standard_charge_algorithm": "Lesser of $12.12 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FREE INSULIN","code_information":[{"code":"83527","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC FREE INSULIN","code_information":[{"code":"83527","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":12.95,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.14,"standard_charge_algorithm": "Lesser of $22.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"standard_charge_algorithm": "Lesser of $12.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.86,"standard_charge_algorithm": "Lesser of $13.86 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.34,"standard_charge_algorithm": "Lesser of $13.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.6,"standard_charge_algorithm": "Lesser of $13.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.24,"standard_charge_algorithm": "Lesser of $14.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IRON SERUM","code_information":[{"code":"83540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB IRON SERUM","code_information":[{"code":"83540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LIVER TISSUE FOR IRON","code_information":[{"code":"83540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB LIVER TISSUE FOR IRON","code_information":[{"code":"83540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TOTAL IRON BIND CAP","code_information":[{"code":"83550","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":262.44,"maximum":262.44,"gross_charge":324,"discounted_cash":95.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":262.44,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOTAL IRON BIND CAP","code_information":[{"code":"83550","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.74,"maximum":262.44,"gross_charge":324,"discounted_cash":95.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":262.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.95,"standard_charge_algorithm": "Lesser of $14.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.74,"standard_charge_algorithm": "Lesser of $8.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.35,"standard_charge_algorithm": "Lesser of $9.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9,"standard_charge_algorithm": "Lesser of $9.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.18,"standard_charge_algorithm": "Lesser of $9.18 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.61,"standard_charge_algorithm": "Lesser of $9.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.26,"standard_charge_algorithm": "Lesser of $9.26 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 17-KETOSTEROIDSURINE","code_information":[{"code":"83586","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB 17-KETOSTEROIDSURINE","code_information":[{"code":"83586","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.8,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.89,"standard_charge_algorithm": "Lesser of $21.89 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.8,"standard_charge_algorithm": "Lesser of $12.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.7,"standard_charge_algorithm": "Lesser of $13.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.08,"standard_charge_algorithm": "Lesser of $14.08 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.57,"standard_charge_algorithm": "Lesser of $13.57 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ACUTE LEUKEMIA WITHOUT CC/MCC","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"minimum":5691,"maximum":20288.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11422,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10798,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8021,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14585,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13674,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19274.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16957,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20217,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14907,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20288.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18871,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11717,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11717,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5691,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11271.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12060.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11609.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11835.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11947.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11835.18,"methodology":"case rate"}]}]},{"description":"HC LAB LACTATE CSF","code_information":[{"code":"83605","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.18,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"}]}]},{"description":"HC LAB LACTATE CSF","code_information":[{"code":"83605","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.57,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.78,"standard_charge_algorithm": "Lesser of $19.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"standard_charge_algorithm": "Lesser of $11.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"standard_charge_algorithm": "Lesser of $12.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.92,"standard_charge_algorithm": "Lesser of $11.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.15,"standard_charge_algorithm": "Lesser of $12.15 or 105 Percent of Billed Charges","median_amount":12.15,"10th_percentile":12.15,"90th_percentile":12.15,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 110 Percent of Billed Charges","median_amount":11.57,"10th_percentile":11.57,"90th_percentile":11.57,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.26,"standard_charge_algorithm": "Lesser of $12.26 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LACTIC ACID","code_information":[{"code":"83605","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":63.18,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"}]}]},{"description":"HC LAB LACTIC ACID","code_information":[{"code":"83605","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.57,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.78,"standard_charge_algorithm": "Lesser of $19.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"standard_charge_algorithm": "Lesser of $11.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"standard_charge_algorithm": "Lesser of $12.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.92,"standard_charge_algorithm": "Lesser of $11.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.15,"standard_charge_algorithm": "Lesser of $12.15 or 105 Percent of Billed Charges","median_amount":12.15,"10th_percentile":12.15,"90th_percentile":12.15,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 110 Percent of Billed Charges","median_amount":11.57,"10th_percentile":11.57,"90th_percentile":11.57,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.26,"standard_charge_algorithm": "Lesser of $12.26 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LDH","code_information":[{"code":"83615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC LAB LDH","code_information":[{"code":"83615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.04,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.33,"standard_charge_algorithm": "Lesser of $10.33 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.04,"standard_charge_algorithm": "Lesser of $6.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.46,"standard_charge_algorithm": "Lesser of $6.46 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.22,"standard_charge_algorithm": "Lesser of $6.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.34,"standard_charge_algorithm": "Lesser of $6.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.64,"standard_charge_algorithm": "Lesser of $6.64 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.4,"standard_charge_algorithm": "Lesser of $6.40 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LDH ISOENZYMES TOTAL","code_information":[{"code":"83625","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":51.03,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB LDH ISOENZYMES TOTAL","code_information":[{"code":"83625","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.79,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.87,"standard_charge_algorithm": "Lesser of $21.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.79,"standard_charge_algorithm": "Lesser of $12.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.69,"standard_charge_algorithm": "Lesser of $13.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.17,"standard_charge_algorithm": "Lesser of $13.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.43,"standard_charge_algorithm": "Lesser of $13.43 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.07,"standard_charge_algorithm": "Lesser of $14.07 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.56,"standard_charge_algorithm": "Lesser of $13.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LACTOFERRIN FECAL BY ELISA","code_information":[{"code":"83630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":103.68,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"}]}]},{"description":"HC LACTOFERRIN FECAL BY ELISA","code_information":[{"code":"83630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":15.05,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.69,"standard_charge_algorithm": "Lesser of $33.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.7,"standard_charge_algorithm": "Lesser of $19.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.08,"standard_charge_algorithm": "Lesser of $21.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.68,"standard_charge_algorithm": "Lesser of $20.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.67,"standard_charge_algorithm": "Lesser of $21.67 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.88,"standard_charge_algorithm": "Lesser of $20.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LEAD","code_information":[{"code":"83655","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB LEAD","code_information":[{"code":"83655","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.19,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.71,"standard_charge_algorithm": "Lesser of $20.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.96,"standard_charge_algorithm": "Lesser of $12.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.47,"standard_charge_algorithm": "Lesser of $12.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.72,"standard_charge_algorithm": "Lesser of $12.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.32,"standard_charge_algorithm": "Lesser of $13.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LEAD WB","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB LEAD WB","code_information":[{"code":"83655","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.19,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.71,"standard_charge_algorithm": "Lesser of $20.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.96,"standard_charge_algorithm": "Lesser of $12.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.47,"standard_charge_algorithm": "Lesser of $12.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.72,"standard_charge_algorithm": "Lesser of $12.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.32,"standard_charge_algorithm": "Lesser of $13.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LIPASE","code_information":[{"code":"83690","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":341.01,"maximum":341.01,"gross_charge":421,"discounted_cash":124.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":341.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":341.01,"methodology":"fee schedule"}]}]},{"description":"HC LAB LIPASE","code_information":[{"code":"83690","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.89,"maximum":341.01,"gross_charge":421,"discounted_cash":124.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":341.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":341.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.78,"standard_charge_algorithm": "Lesser of $11.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"standard_charge_algorithm": "Lesser of $6.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.37,"standard_charge_algorithm": "Lesser of $7.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.1,"standard_charge_algorithm": "Lesser of $7.10 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.23,"standard_charge_algorithm": "Lesser of $7.23 or 105 Percent of Billed Charges","median_amount":7.23,"10th_percentile":7.23,"90th_percentile":7.23,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.58,"standard_charge_algorithm": "Lesser of $7.58 or 110 Percent of Billed Charges","median_amount":6.89,"10th_percentile":0.66,"90th_percentile":6.89,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LIPOPROTEIN A","code_information":[{"code":"83695","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":337.77,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB LIPOPROTEIN A","code_information":[{"code":"83695","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.32,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.49,"standard_charge_algorithm": "Lesser of $24.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.32,"standard_charge_algorithm": "Lesser of $14.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.75,"standard_charge_algorithm": "Lesser of $14.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.04,"standard_charge_algorithm": "Lesser of $15.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.75,"standard_charge_algorithm": "Lesser of $15.75 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.18,"standard_charge_algorithm": "Lesser of $15.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LP PLA2 ENZYME","code_information":[{"code":"83698","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":301.32,"maximum":301.32,"gross_charge":372,"discounted_cash":110.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":301.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":301.32,"methodology":"fee schedule"}]}]},{"description":"HC LP PLA2 ENZYME","code_information":[{"code":"83698","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":46.31,"maximum":301.32,"gross_charge":372,"discounted_cash":110.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":301.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":301.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":46.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":79.19,"standard_charge_algorithm": "Lesser of $79.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":101.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":69.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46.31,"standard_charge_algorithm": "Lesser of $46.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49.55,"standard_charge_algorithm": "Lesser of $49.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47.7,"standard_charge_algorithm": "Lesser of $47.70 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48.63,"standard_charge_algorithm": "Lesser of $48.63 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":50.94,"standard_charge_algorithm": "Lesser of $50.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":49.09,"standard_charge_algorithm": "Lesser of $49.09 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"minimum":27520,"maximum":112454,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45010,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42551,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27520,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":112454,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105434,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60320.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58176,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69360,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51143,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":63495.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74362,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46171,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46171,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27792,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35275.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37744.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36333.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37038.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37391.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37038.79,"methodology":"case rate"}]}]},{"description":"HC NMR LIPOPROFILE","code_information":[{"code":"83704","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":169.29,"maximum":169.29,"gross_charge":209,"discounted_cash":61.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.29,"methodology":"fee schedule"}]}]},{"description":"HC NMR LIPOPROFILE","code_information":[{"code":"83704","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":34.19,"maximum":169.29,"gross_charge":209,"discounted_cash":61.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":95.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":58.46,"standard_charge_algorithm": "Lesser of $58.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":76.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":34.19,"standard_charge_algorithm": "Lesser of $34.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36.58,"standard_charge_algorithm": "Lesser of $36.58 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":35.22,"standard_charge_algorithm": "Lesser of $35.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.9,"standard_charge_algorithm": "Lesser of $35.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37.61,"standard_charge_algorithm": "Lesser of $37.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":36.24,"standard_charge_algorithm": "Lesser of $36.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FHP HDL","code_information":[{"code":"83718","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB FHP HDL","code_information":[{"code":"83718","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.19,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14,"standard_charge_algorithm": "Lesser of $14.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"standard_charge_algorithm": "Lesser of $8.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.76,"standard_charge_algorithm": "Lesser of $8.76 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.44,"standard_charge_algorithm": "Lesser of $8.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.01,"standard_charge_algorithm": "Lesser of $9.01 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.68,"standard_charge_algorithm": "Lesser of $8.68 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HDL CHOLESTEROL","code_information":[{"code":"83718","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB HDL CHOLESTEROL","code_information":[{"code":"83718","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.19,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14,"standard_charge_algorithm": "Lesser of $14.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.19,"standard_charge_algorithm": "Lesser of $8.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.76,"standard_charge_algorithm": "Lesser of $8.76 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.44,"standard_charge_algorithm": "Lesser of $8.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.01,"standard_charge_algorithm": "Lesser of $9.01 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.68,"standard_charge_algorithm": "Lesser of $8.68 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DIRECT LDL","code_information":[{"code":"83721","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC DIRECT LDL","code_information":[{"code":"83721","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.5,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.95,"standard_charge_algorithm": "Lesser of $17.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.5,"standard_charge_algorithm": "Lesser of $10.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.23,"standard_charge_algorithm": "Lesser of $11.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.81,"standard_charge_algorithm": "Lesser of $10.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.03,"standard_charge_algorithm": "Lesser of $11.03 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.55,"standard_charge_algorithm": "Lesser of $11.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.13,"standard_charge_algorithm": "Lesser of $11.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GONADOTROPIN RELEASING HORMONE","code_information":[{"code":"83727","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"GONADOTROPIN RELEASING HORMONE","code_information":[{"code":"83727","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.19,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.39,"standard_charge_algorithm": "Lesser of $29.39 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"standard_charge_algorithm": "Lesser of $17.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"standard_charge_algorithm": "Lesser of $18.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.91,"standard_charge_algorithm": "Lesser of $18.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.22,"standard_charge_algorithm": "Lesser of $18.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MAGNESIUM","code_information":[{"code":"83735","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB MAGNESIUM","code_information":[{"code":"83735","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.7,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.46,"standard_charge_algorithm": "Lesser of $11.46 or 171 Percent of Billed Charges","median_amount":43,"10th_percentile":43,"90th_percentile":43,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"standard_charge_algorithm": "Lesser of $6.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.17,"standard_charge_algorithm": "Lesser of $7.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.9,"standard_charge_algorithm": "Lesser of $6.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.04,"standard_charge_algorithm": "Lesser of $7.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.37,"standard_charge_algorithm": "Lesser of $7.37 or 110 Percent of Billed Charges","median_amount":6.7,"10th_percentile":6.7,"90th_percentile":6.7,"count":"14","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.1,"standard_charge_algorithm": "Lesser of $7.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MAGNESIUM STOOL","code_information":[{"code":"83735","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB MAGNESIUM STOOL","code_information":[{"code":"83735","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.7,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.46,"standard_charge_algorithm": "Lesser of $11.46 or 171 Percent of Billed Charges","median_amount":43,"10th_percentile":43,"90th_percentile":43,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.7,"standard_charge_algorithm": "Lesser of $6.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.17,"standard_charge_algorithm": "Lesser of $7.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.9,"standard_charge_algorithm": "Lesser of $6.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.04,"standard_charge_algorithm": "Lesser of $7.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.37,"standard_charge_algorithm": "Lesser of $7.37 or 110 Percent of Billed Charges","median_amount":6.7,"10th_percentile":6.7,"90th_percentile":6.7,"count":"14","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.1,"standard_charge_algorithm": "Lesser of $7.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MANGANESE (B)","code_information":[{"code":"83785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB MANGANESE (B)","code_information":[{"code":"83785","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":74.48,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":59.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.57,"standard_charge_algorithm": "Lesser of $45.57 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"standard_charge_algorithm": "Lesser of $26.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.52,"standard_charge_algorithm": "Lesser of $28.52 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.45,"standard_charge_algorithm": "Lesser of $27.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.98,"standard_charge_algorithm": "Lesser of $27.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.32,"standard_charge_algorithm": "Lesser of $29.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.25,"standard_charge_algorithm": "Lesser of $28.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC IODINE SERUM PLASMA OR URINE","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC IODINE SERUM PLASMA OR URINE","code_information":[{"code":"83789","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.45,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.23,"standard_charge_algorithm": "Lesser of $41.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.11,"standard_charge_algorithm": "Lesser of $24.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.8,"standard_charge_algorithm": "Lesser of $25.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.83,"standard_charge_algorithm": "Lesser of $24.83 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.32,"standard_charge_algorithm": "Lesser of $25.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.52,"standard_charge_algorithm": "Lesser of $26.52 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.56,"standard_charge_algorithm": "Lesser of $25.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"minimum":8781,"maximum":30121,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18231,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17236,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11372,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29355,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27523,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27595.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24040,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28662,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21134,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29048.06,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30121,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18702,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18702,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8781,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16137.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17267.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16621.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16944.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17106.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16944.71,"methodology":"case rate"}]}]},{"description":"HC LAB MERCURY","code_information":[{"code":"83825","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB MERCURY","code_information":[{"code":"83825","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.26,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.8,"standard_charge_algorithm": "Lesser of $27.80 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"standard_charge_algorithm": "Lesser of $16.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.4,"standard_charge_algorithm": "Lesser of $17.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.75,"standard_charge_algorithm": "Lesser of $16.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.07,"standard_charge_algorithm": "Lesser of $17.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.89,"standard_charge_algorithm": "Lesser of $17.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.24,"standard_charge_algorithm": "Lesser of $17.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URINE MERCURY","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINE MERCURY","code_information":[{"code":"83825","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.26,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.8,"standard_charge_algorithm": "Lesser of $27.80 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.26,"standard_charge_algorithm": "Lesser of $16.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.4,"standard_charge_algorithm": "Lesser of $17.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.75,"standard_charge_algorithm": "Lesser of $16.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.07,"standard_charge_algorithm": "Lesser of $17.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.89,"standard_charge_algorithm": "Lesser of $17.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.24,"standard_charge_algorithm": "Lesser of $17.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB METANEPHRINES","code_information":[{"code":"83835","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":95.58,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"}]}]},{"description":"HC LAB METANEPHRINES","code_information":[{"code":"83835","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.97,"standard_charge_algorithm": "Lesser of $28.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.45,"standard_charge_algorithm": "Lesser of $17.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.63,"standard_charge_algorithm": "Lesser of $18.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.96,"standard_charge_algorithm": "Lesser of $17.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB METANEPHRINES FRACT UR 24 HR","code_information":[{"code":"83835","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":95.58,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"}]}]},{"description":"HC LAB METANEPHRINES FRACT UR 24 HR","code_information":[{"code":"83835","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.97,"standard_charge_algorithm": "Lesser of $28.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.45,"standard_charge_algorithm": "Lesser of $17.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.63,"standard_charge_algorithm": "Lesser of $18.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.96,"standard_charge_algorithm": "Lesser of $17.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MYELIN BASIC PROTEINCSF","code_information":[{"code":"83873","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYELIN BASIC PROTEINCSF","code_information":[{"code":"83873","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.2,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.41,"standard_charge_algorithm": "Lesser of $29.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.2,"standard_charge_algorithm": "Lesser of $17.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.4,"standard_charge_algorithm": "Lesser of $18.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.72,"standard_charge_algorithm": "Lesser of $17.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.06,"standard_charge_algorithm": "Lesser of $18.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.92,"standard_charge_algorithm": "Lesser of $18.92 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.23,"standard_charge_algorithm": "Lesser of $18.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MYOGLOBIN","code_information":[{"code":"83874","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":53.46,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYOGLOBIN","code_information":[{"code":"83874","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.92,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.09,"standard_charge_algorithm": "Lesser of $22.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.92,"standard_charge_algorithm": "Lesser of $12.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.31,"standard_charge_algorithm": "Lesser of $13.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.57,"standard_charge_algorithm": "Lesser of $13.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.21,"standard_charge_algorithm": "Lesser of $14.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.7,"standard_charge_algorithm": "Lesser of $13.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB NATRIURETIC PEPTDE","code_information":[{"code":"83880","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":281.07,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"}]}]},{"description":"HC LAB NATRIURETIC PEPTDE","code_information":[{"code":"83880","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":39.26,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":67.13,"standard_charge_algorithm": "Lesser of $67.13 or 171 Percent of Billed Charges","median_amount":263.68,"10th_percentile":263.68,"90th_percentile":263.68,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":77.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"standard_charge_algorithm": "Lesser of $39.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":42.01,"standard_charge_algorithm": "Lesser of $42.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":40.44,"standard_charge_algorithm": "Lesser of $40.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":41.22,"standard_charge_algorithm": "Lesser of $41.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":43.19,"standard_charge_algorithm": "Lesser of $43.19 or 110 Percent of Billed Charges","median_amount":39.26,"10th_percentile":37.41,"90th_percentile":347,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":41.62,"standard_charge_algorithm": "Lesser of $41.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PRO-BNP","code_information":[{"code":"83880","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"PRO-BNP","code_information":[{"code":"83880","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":39.26,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":67.13,"standard_charge_algorithm": "Lesser of $67.13 or 171 Percent of Billed Charges","median_amount":263.68,"10th_percentile":263.68,"90th_percentile":263.68,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":77.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":39.26,"standard_charge_algorithm": "Lesser of $39.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":42.01,"standard_charge_algorithm": "Lesser of $42.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":40.44,"standard_charge_algorithm": "Lesser of $40.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":41.22,"standard_charge_algorithm": "Lesser of $41.22 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":43.19,"standard_charge_algorithm": "Lesser of $43.19 or 110 Percent of Billed Charges","median_amount":39.26,"10th_percentile":37.41,"90th_percentile":347,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":41.62,"standard_charge_algorithm": "Lesser of $41.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FREE KAPPA LAMBDA","code_information":[{"code":"83883","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC LAB FREE KAPPA LAMBDA","code_information":[{"code":"83883","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.26,"standard_charge_algorithm": "Lesser of $23.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"standard_charge_algorithm": "Lesser of $13.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.01,"standard_charge_algorithm": "Lesser of $14.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.28,"standard_charge_algorithm": "Lesser of $14.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.96,"standard_charge_algorithm": "Lesser of $14.96 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.42,"standard_charge_algorithm": "Lesser of $14.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB NEPHELOMETRY EA ANALYTE","code_information":[{"code":"83883","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC LAB NEPHELOMETRY EA ANALYTE","code_information":[{"code":"83883","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.26,"standard_charge_algorithm": "Lesser of $23.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.6,"standard_charge_algorithm": "Lesser of $13.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.01,"standard_charge_algorithm": "Lesser of $14.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.28,"standard_charge_algorithm": "Lesser of $14.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.96,"standard_charge_algorithm": "Lesser of $14.96 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.42,"standard_charge_algorithm": "Lesser of $14.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ASSAY NEURFLMNT LIGHT CHAIN","code_information":[{"code":"83884","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"ASSAY NEURFLMNT LIGHT CHAIN","code_information":[{"code":"83884","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.4,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"}]}]},{"description":"NICKEL PLASMA","code_information":[{"code":"83885","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"NICKEL PLASMA","code_information":[{"code":"83885","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":24.51,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":74.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.91,"standard_charge_algorithm": "Lesser of $41.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.51,"standard_charge_algorithm": "Lesser of $24.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.23,"standard_charge_algorithm": "Lesser of $26.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.25,"standard_charge_algorithm": "Lesser of $25.25 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.74,"standard_charge_algorithm": "Lesser of $25.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.96,"standard_charge_algorithm": "Lesser of $26.96 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.98,"standard_charge_algorithm": "Lesser of $25.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"minimum":5968,"maximum":21441.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12318,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11646,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7403,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12390,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11617,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20369.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14859,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17716,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13758,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21441.75,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20352,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12636,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12636,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5968,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11912.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12745.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12269.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12507.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12626.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12507.69,"methodology":"case rate"}]}]},{"description":"HC LAB 5-NUCLEOTIDASE","code_information":[{"code":"83915","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":98.01,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"}]}]},{"description":"HC LAB 5-NUCLEOTIDASE","code_information":[{"code":"83915","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.15,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.07,"standard_charge_algorithm": "Lesser of $19.07 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.15,"standard_charge_algorithm": "Lesser of $11.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.93,"standard_charge_algorithm": "Lesser of $11.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.48,"standard_charge_algorithm": "Lesser of $11.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.71,"standard_charge_algorithm": "Lesser of $11.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.27,"standard_charge_algorithm": "Lesser of $12.27 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.82,"standard_charge_algorithm": "Lesser of $11.82 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OLIGOCLONAL BANDS","code_information":[{"code":"83916","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB OLIGOCLONAL BANDS","code_information":[{"code":"83916","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.39,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.84,"standard_charge_algorithm": "Lesser of $46.84 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.39,"standard_charge_algorithm": "Lesser of $27.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.31,"standard_charge_algorithm": "Lesser of $29.31 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.21,"standard_charge_algorithm": "Lesser of $28.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.76,"standard_charge_algorithm": "Lesser of $28.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.13,"standard_charge_algorithm": "Lesser of $30.13 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.03,"standard_charge_algorithm": "Lesser of $29.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ORGANIC ACIDS URINE 83918","code_information":[{"code":"83918","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"HC ORGANIC ACIDS URINE 83918","code_information":[{"code":"83918","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":23.16,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40.36,"standard_charge_algorithm": "Lesser of $40.36 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"standard_charge_algorithm": "Lesser of $23.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"standard_charge_algorithm": "Lesser of $25.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.31,"standard_charge_algorithm": "Lesser of $24.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.78,"standard_charge_algorithm": "Lesser of $24.78 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.96,"standard_charge_algorithm": "Lesser of $25.96 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.02,"standard_charge_algorithm": "Lesser of $25.02 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORGANIC ACIDS (URINE)","code_information":[{"code":"83919","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"ORGANIC ACIDS (URINE)","code_information":[{"code":"83919","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.45,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.13,"standard_charge_algorithm": "Lesser of $28.13 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.45,"standard_charge_algorithm": "Lesser of $16.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.6,"standard_charge_algorithm": "Lesser of $17.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.27,"standard_charge_algorithm": "Lesser of $17.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.09,"standard_charge_algorithm": "Lesser of $18.09 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.44,"standard_charge_algorithm": "Lesser of $17.44 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB METHYLMALONIC ACID SRM","code_information":[{"code":"83921","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB METHYLMALONIC ACID SRM","code_information":[{"code":"83921","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.21,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.27,"standard_charge_algorithm": "Lesser of $36.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.21,"standard_charge_algorithm": "Lesser of $21.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.69,"standard_charge_algorithm": "Lesser of $22.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.33,"standard_charge_algorithm": "Lesser of $23.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.48,"standard_charge_algorithm": "Lesser of $22.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OSMOLALITYSE","code_information":[{"code":"83930","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"HC LAB OSMOLALITYSE","code_information":[{"code":"83930","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.61,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.3,"standard_charge_algorithm": "Lesser of $11.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.61,"standard_charge_algorithm": "Lesser of $6.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.07,"standard_charge_algorithm": "Lesser of $7.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.81,"standard_charge_algorithm": "Lesser of $6.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.94,"standard_charge_algorithm": "Lesser of $6.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.27,"standard_charge_algorithm": "Lesser of $7.27 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.01,"standard_charge_algorithm": "Lesser of $7.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OSMOLALITY UR.","code_information":[{"code":"83935","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB OSMOLALITY UR.","code_information":[{"code":"83935","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.82,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.66,"standard_charge_algorithm": "Lesser of $11.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.82,"standard_charge_algorithm": "Lesser of $6.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.02,"standard_charge_algorithm": "Lesser of $7.02 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.16,"standard_charge_algorithm": "Lesser of $7.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.5,"standard_charge_algorithm": "Lesser of $7.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.23,"standard_charge_algorithm": "Lesser of $7.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC OSTEOCALCIN","code_information":[{"code":"83937","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"HC OSTEOCALCIN","code_information":[{"code":"83937","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":29.85,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":51.04,"standard_charge_algorithm": "Lesser of $51.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.85,"standard_charge_algorithm": "Lesser of $29.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.94,"standard_charge_algorithm": "Lesser of $31.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.75,"standard_charge_algorithm": "Lesser of $30.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31.34,"standard_charge_algorithm": "Lesser of $31.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.84,"standard_charge_algorithm": "Lesser of $32.84 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.64,"standard_charge_algorithm": "Lesser of $31.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OXALATE URINE RANDOM","code_information":[{"code":"83945","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB OXALATE URINE RANDOM","code_information":[{"code":"83945","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.45,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.71,"standard_charge_algorithm": "Lesser of $24.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"standard_charge_algorithm": "Lesser of $14.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"standard_charge_algorithm": "Lesser of $15.46 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.88,"standard_charge_algorithm": "Lesser of $14.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OXALATES URINE","code_information":[{"code":"83945","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB OXALATES URINE","code_information":[{"code":"83945","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.45,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.71,"standard_charge_algorithm": "Lesser of $24.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"standard_charge_algorithm": "Lesser of $14.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"standard_charge_algorithm": "Lesser of $15.46 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.88,"standard_charge_algorithm": "Lesser of $14.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PTH (INTRAOPERATIVE) HIXSON","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":503.82,"maximum":503.82,"gross_charge":622,"discounted_cash":184.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB PTH (INTRAOPERATIVE) HIXSON","code_information":[{"code":"83970","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":41.28,"maximum":503.82,"gross_charge":622,"discounted_cash":184.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":99.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70.59,"standard_charge_algorithm": "Lesser of $70.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":90.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":100.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"standard_charge_algorithm": "Lesser of $41.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.17,"standard_charge_algorithm": "Lesser of $44.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.52,"standard_charge_algorithm": "Lesser of $42.52 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.34,"standard_charge_algorithm": "Lesser of $43.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.76,"standard_charge_algorithm": "Lesser of $43.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PTH INTACT","code_information":[{"code":"83970","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":503.82,"maximum":503.82,"gross_charge":622,"discounted_cash":184.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB PTH INTACT","code_information":[{"code":"83970","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":41.28,"maximum":503.82,"gross_charge":622,"discounted_cash":184.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":125.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":99.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70.59,"standard_charge_algorithm": "Lesser of $70.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":90.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":100.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.28,"standard_charge_algorithm": "Lesser of $41.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.17,"standard_charge_algorithm": "Lesser of $44.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.52,"standard_charge_algorithm": "Lesser of $42.52 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.34,"standard_charge_algorithm": "Lesser of $43.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.76,"standard_charge_algorithm": "Lesser of $43.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GASTRIC PH","code_information":[{"code":"83986","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC LAB GASTRIC PH","code_information":[{"code":"83986","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.58,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.12,"standard_charge_algorithm": "Lesser of $6.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"standard_charge_algorithm": "Lesser of $3.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.83,"standard_charge_algorithm": "Lesser of $3.83 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.69,"standard_charge_algorithm": "Lesser of $3.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.76,"standard_charge_algorithm": "Lesser of $3.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.94,"standard_charge_algorithm": "Lesser of $3.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.79,"standard_charge_algorithm": "Lesser of $3.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PH BODY FLUID NOS","code_information":[{"code":"83986","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC LAB PH BODY FLUID NOS","code_information":[{"code":"83986","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.58,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.12,"standard_charge_algorithm": "Lesser of $6.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.58,"standard_charge_algorithm": "Lesser of $3.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.83,"standard_charge_algorithm": "Lesser of $3.83 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.69,"standard_charge_algorithm": "Lesser of $3.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.76,"standard_charge_algorithm": "Lesser of $3.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.94,"standard_charge_algorithm": "Lesser of $3.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.79,"standard_charge_algorithm": "Lesser of $3.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CALPROTECTIN STOOL","code_information":[{"code":"83993","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":270.54,"maximum":270.54,"gross_charge":334,"discounted_cash":98.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":270.54,"methodology":"fee schedule"}]}]},{"description":"HC CALPROTECTIN STOOL","code_information":[{"code":"83993","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.63,"maximum":270.54,"gross_charge":334,"discounted_cash":98.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.57,"standard_charge_algorithm": "Lesser of $33.57 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.63,"standard_charge_algorithm": "Lesser of $19.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21,"standard_charge_algorithm": "Lesser of $21.00 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.22,"standard_charge_algorithm": "Lesser of $20.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.59,"standard_charge_algorithm": "Lesser of $21.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"minimum":17755,"maximum":47360,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28666,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27100,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17755,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37042,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34729,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40347.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33584,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40040,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32996,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42470.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47360,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29406,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29406,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24720,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23594.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25246.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24302.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24774.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25010.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24774.59,"methodology":"case rate"}]}]},{"description":"HC LAB PROSTATIC ACID PHOSPHT","code_information":[{"code":"84066","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROSTATIC ACID PHOSPHT","code_information":[{"code":"84066","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.66,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.52,"standard_charge_algorithm": "Lesser of $16.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.66,"standard_charge_algorithm": "Lesser of $9.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.34,"standard_charge_algorithm": "Lesser of $10.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.95,"standard_charge_algorithm": "Lesser of $9.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.14,"standard_charge_algorithm": "Lesser of $10.14 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.63,"standard_charge_algorithm": "Lesser of $10.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.24,"standard_charge_algorithm": "Lesser of $10.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALKALINE PHOSPHATASE","code_information":[{"code":"84075","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALKALINE PHOSPHATASE","code_information":[{"code":"84075","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TOTAL ALK PHOS","code_information":[{"code":"84075","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOTAL ALK PHOS","code_information":[{"code":"84075","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALK PHOSPHT ISOENZYME","code_information":[{"code":"84080","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":65.61,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALK PHOSPHT ISOENZYME","code_information":[{"code":"84080","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.78,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.27,"standard_charge_algorithm": "Lesser of $25.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.81,"standard_charge_algorithm": "Lesser of $15.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.52,"standard_charge_algorithm": "Lesser of $15.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.26,"standard_charge_algorithm": "Lesser of $16.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.67,"standard_charge_algorithm": "Lesser of $15.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ALKP ISO LIVER","code_information":[{"code":"84080","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":65.61,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"HC LAB ALKP ISO LIVER","code_information":[{"code":"84080","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.78,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.27,"standard_charge_algorithm": "Lesser of $25.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.81,"standard_charge_algorithm": "Lesser of $15.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.52,"standard_charge_algorithm": "Lesser of $15.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.26,"standard_charge_algorithm": "Lesser of $16.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.67,"standard_charge_algorithm": "Lesser of $15.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"minimum":8445,"maximum":23726.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14095,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13325,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8940,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21413,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20076,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22540.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17238,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20552,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16613,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23726.65,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23286,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14459,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14459,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8445,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13181.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14104.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13576.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13840.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13972.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13840.55,"methodology":"case rate"}]}]},{"description":"HC LAB PHOSPHORUS","code_information":[{"code":"84100","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":140.13,"maximum":140.13,"gross_charge":173,"discounted_cash":51.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB PHOSPHORUS","code_information":[{"code":"84100","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":140.13,"gross_charge":173,"discounted_cash":51.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.11,"standard_charge_algorithm": "Lesser of $8.11 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.74,"standard_charge_algorithm": "Lesser of $4.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.07,"standard_charge_algorithm": "Lesser of $5.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.88,"standard_charge_algorithm": "Lesser of $4.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.98,"standard_charge_algorithm": "Lesser of $4.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.21,"standard_charge_algorithm": "Lesser of $5.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.02,"standard_charge_algorithm": "Lesser of $5.02 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PHOSPHORUS 24HR URINE","code_information":[{"code":"84105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB PHOSPHORUS 24HR URINE","code_information":[{"code":"84105","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.78,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.88,"standard_charge_algorithm": "Lesser of $9.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"standard_charge_algorithm": "Lesser of $5.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.18,"standard_charge_algorithm": "Lesser of $6.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.07,"standard_charge_algorithm": "Lesser of $6.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.36,"standard_charge_algorithm": "Lesser of $6.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.13,"standard_charge_algorithm": "Lesser of $6.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URINE PHOSPHORUS","code_information":[{"code":"84105","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINE PHOSPHORUS","code_information":[{"code":"84105","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.78,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.88,"standard_charge_algorithm": "Lesser of $9.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.78,"standard_charge_algorithm": "Lesser of $5.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.18,"standard_charge_algorithm": "Lesser of $6.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.07,"standard_charge_algorithm": "Lesser of $6.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.36,"standard_charge_algorithm": "Lesser of $6.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.13,"standard_charge_algorithm": "Lesser of $6.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8411","type":"APR-DRG"}],"standard_charges":[{"minimum":11846,"maximum":11846,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11846,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11846,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11846,"methodology":"case rate"}]}]},{"description":"HC LAB PORPHOBILINOGEN QUAN","code_information":[{"code":"84110","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB PORPHOBILINOGEN QUAN","code_information":[{"code":"84110","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.44,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"standard_charge_algorithm": "Lesser of $8.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.03,"standard_charge_algorithm": "Lesser of $9.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.69,"standard_charge_algorithm": "Lesser of $8.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.28,"standard_charge_algorithm": "Lesser of $9.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.95,"standard_charge_algorithm": "Lesser of $8.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PORPHOBILINOGEN UR 24 HR","code_information":[{"code":"84110","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB PORPHOBILINOGEN UR 24 HR","code_information":[{"code":"84110","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.44,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.44,"standard_charge_algorithm": "Lesser of $8.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.03,"standard_charge_algorithm": "Lesser of $9.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.69,"standard_charge_algorithm": "Lesser of $8.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.28,"standard_charge_algorithm": "Lesser of $9.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.95,"standard_charge_algorithm": "Lesser of $8.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8412","type":"APR-DRG"}],"standard_charges":[{"minimum":13485,"maximum":13485,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13485,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13485,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13485,"methodology":"case rate"}]}]},{"description":"HC LAB PORPHYRINS TOTAL","code_information":[{"code":"84120","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":76.14,"maximum":76.14,"gross_charge":94,"discounted_cash":27.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB PORPHYRINS TOTAL","code_information":[{"code":"84120","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.71,"maximum":76.14,"gross_charge":94,"discounted_cash":27.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.15,"standard_charge_algorithm": "Lesser of $25.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"standard_charge_algorithm": "Lesser of $14.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.15,"standard_charge_algorithm": "Lesser of $15.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.45,"standard_charge_algorithm": "Lesser of $15.45 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.18,"standard_charge_algorithm": "Lesser of $16.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.59,"standard_charge_algorithm": "Lesser of $15.59 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PORPHYRINS URINE 24 HR","code_information":[{"code":"84120","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":76.14,"maximum":76.14,"gross_charge":94,"discounted_cash":27.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB PORPHYRINS URINE 24 HR","code_information":[{"code":"84120","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.71,"maximum":76.14,"gross_charge":94,"discounted_cash":27.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.15,"standard_charge_algorithm": "Lesser of $25.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.71,"standard_charge_algorithm": "Lesser of $14.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.15,"standard_charge_algorithm": "Lesser of $15.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.45,"standard_charge_algorithm": "Lesser of $15.45 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.18,"standard_charge_algorithm": "Lesser of $16.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.59,"standard_charge_algorithm": "Lesser of $15.59 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8413","type":"APR-DRG"}],"standard_charges":[{"minimum":46063,"maximum":46063,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46063,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46063,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46063,"methodology":"case rate"}]}]},{"description":"HC LAB ASSAY SERUM POTASSIUM","code_information":[{"code":"84132","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB ASSAY SERUM POTASSIUM","code_information":[{"code":"84132","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.76,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.14,"standard_charge_algorithm": "Lesser of $8.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"standard_charge_algorithm": "Lesser of $4.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.09,"standard_charge_algorithm": "Lesser of $5.09 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.9,"standard_charge_algorithm": "Lesser of $4.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5,"standard_charge_algorithm": "Lesser of $5.00 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.24,"standard_charge_algorithm": "Lesser of $5.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.05,"standard_charge_algorithm": "Lesser of $5.05 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB POTASSIUM","code_information":[{"code":"84132","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB POTASSIUM","code_information":[{"code":"84132","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.76,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.14,"standard_charge_algorithm": "Lesser of $8.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.76,"standard_charge_algorithm": "Lesser of $4.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.09,"standard_charge_algorithm": "Lesser of $5.09 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.9,"standard_charge_algorithm": "Lesser of $4.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5,"standard_charge_algorithm": "Lesser of $5.00 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.24,"standard_charge_algorithm": "Lesser of $5.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.05,"standard_charge_algorithm": "Lesser of $5.05 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB POTASSIUM URINE","code_information":[{"code":"84133","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":166.05,"maximum":166.05,"gross_charge":205,"discounted_cash":60.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB POTASSIUM URINE","code_information":[{"code":"84133","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.73,"maximum":166.05,"gross_charge":205,"discounted_cash":60.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.09,"standard_charge_algorithm": "Lesser of $8.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"standard_charge_algorithm": "Lesser of $5.06 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.87,"standard_charge_algorithm": "Lesser of $4.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.97,"standard_charge_algorithm": "Lesser of $4.97 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.2,"standard_charge_algorithm": "Lesser of $5.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.01,"standard_charge_algorithm": "Lesser of $5.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PREALBUMIN","code_information":[{"code":"84134","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB PREALBUMIN","code_information":[{"code":"84134","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.59,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.95,"standard_charge_algorithm": "Lesser of $24.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.59,"standard_charge_algorithm": "Lesser of $14.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.61,"standard_charge_algorithm": "Lesser of $15.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.05,"standard_charge_algorithm": "Lesser of $16.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.47,"standard_charge_algorithm": "Lesser of $15.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT","code_information":[{"code":"8414","type":"APR-DRG"}],"standard_charges":[{"minimum":125517,"maximum":125517,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125517,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125517,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125517,"methodology":"case rate"}]}]},{"description":"HC PREGNENOLONE","code_information":[{"code":"84140","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC PREGNENOLONE","code_information":[{"code":"84140","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.35,"standard_charge_algorithm": "Lesser of $35.35 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.67,"standard_charge_algorithm": "Lesser of $20.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.12,"standard_charge_algorithm": "Lesser of $22.12 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.7,"standard_charge_algorithm": "Lesser of $21.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.74,"standard_charge_algorithm": "Lesser of $22.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.91,"standard_charge_algorithm": "Lesser of $21.91 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC 17 HYDROXYPREGNENOLONE MS","code_information":[{"code":"84143","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":110.97,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"}]}]},{"description":"HC 17 HYDROXYPREGNENOLONE MS","code_information":[{"code":"84143","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":22.81,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.01,"standard_charge_algorithm": "Lesser of $39.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.81,"standard_charge_algorithm": "Lesser of $22.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.41,"standard_charge_algorithm": "Lesser of $24.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.49,"standard_charge_algorithm": "Lesser of $23.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.95,"standard_charge_algorithm": "Lesser of $23.95 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.09,"standard_charge_algorithm": "Lesser of $25.09 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.18,"standard_charge_algorithm": "Lesser of $24.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROGESTERONE","code_information":[{"code":"84144","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":77.76,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROGESTERONE","code_information":[{"code":"84144","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.86,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.67,"standard_charge_algorithm": "Lesser of $35.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.86,"standard_charge_algorithm": "Lesser of $20.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.32,"standard_charge_algorithm": "Lesser of $22.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.49,"standard_charge_algorithm": "Lesser of $21.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.9,"standard_charge_algorithm": "Lesser of $21.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.95,"standard_charge_algorithm": "Lesser of $22.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.11,"standard_charge_algorithm": "Lesser of $22.11 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROCALCITONIN (PCT)","code_information":[{"code":"84145","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROCALCITONIN (PCT)","code_information":[{"code":"84145","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.92,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.55,"standard_charge_algorithm": "Lesser of $46.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"standard_charge_algorithm": "Lesser of $27.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.13,"standard_charge_algorithm": "Lesser of $29.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.04,"standard_charge_algorithm": "Lesser of $28.04 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.58,"standard_charge_algorithm": "Lesser of $28.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.94,"standard_charge_algorithm": "Lesser of $29.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.85,"standard_charge_algorithm": "Lesser of $28.85 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PROCALCITONIN (LABCORP)","code_information":[{"code":"84145","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"PROCALCITONIN (LABCORP)","code_information":[{"code":"84145","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":26.92,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.55,"standard_charge_algorithm": "Lesser of $46.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.22,"standard_charge_algorithm": "Lesser of $27.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.13,"standard_charge_algorithm": "Lesser of $29.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.04,"standard_charge_algorithm": "Lesser of $28.04 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.58,"standard_charge_algorithm": "Lesser of $28.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.94,"standard_charge_algorithm": "Lesser of $29.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.85,"standard_charge_algorithm": "Lesser of $28.85 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROLACTIN","code_information":[{"code":"84146","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":90.72,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROLACTIN","code_information":[{"code":"84146","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.38,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.14,"standard_charge_algorithm": "Lesser of $33.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.38,"standard_charge_algorithm": "Lesser of $19.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.74,"standard_charge_algorithm": "Lesser of $20.74 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.96,"standard_charge_algorithm": "Lesser of $19.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.35,"standard_charge_algorithm": "Lesser of $20.35 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.32,"standard_charge_algorithm": "Lesser of $21.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.54,"standard_charge_algorithm": "Lesser of $20.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROSTATIC SPECIFIC ANTIGEN","code_information":[{"code":"84153","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":85.86,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROSTATIC SPECIFIC ANTIGEN","code_information":[{"code":"84153","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":18.39,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.45,"standard_charge_algorithm": "Lesser of $31.45 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"standard_charge_algorithm": "Lesser of $18.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.68,"standard_charge_algorithm": "Lesser of $19.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.94,"standard_charge_algorithm": "Lesser of $18.94 or 103 Percent of Billed Charges","median_amount":18.94,"10th_percentile":18.39,"90th_percentile":18.94,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 105 Percent of Billed Charges","median_amount":19.31,"10th_percentile":19.31,"90th_percentile":19.31,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.23,"standard_charge_algorithm": "Lesser of $20.23 or 110 Percent of Billed Charges","median_amount":20.23,"10th_percentile":20.23,"90th_percentile":20.23,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.49,"standard_charge_algorithm": "Lesser of $19.49 or 106 Percent of Billed Charges","median_amount":19.49,"10th_percentile":19.49,"90th_percentile":19.49,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"HC LAB PSA TOTAL","code_information":[{"code":"84153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.86,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB PSA TOTAL","code_information":[{"code":"84153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.39,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.45,"standard_charge_algorithm": "Lesser of $31.45 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"standard_charge_algorithm": "Lesser of $18.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.68,"standard_charge_algorithm": "Lesser of $19.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.94,"standard_charge_algorithm": "Lesser of $18.94 or 103 Percent of Billed Charges","median_amount":18.94,"10th_percentile":18.39,"90th_percentile":18.94,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 105 Percent of Billed Charges","median_amount":19.31,"10th_percentile":19.31,"90th_percentile":19.31,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.23,"standard_charge_algorithm": "Lesser of $20.23 or 110 Percent of Billed Charges","median_amount":20.23,"10th_percentile":20.23,"90th_percentile":20.23,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.49,"standard_charge_algorithm": "Lesser of $19.49 or 106 Percent of Billed Charges","median_amount":19.49,"10th_percentile":19.49,"90th_percentile":19.49,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"HC LAB PSA FREE","code_information":[{"code":"84154","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"}]}]},{"description":"HC LAB PSA FREE","code_information":[{"code":"84154","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.39,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.45,"standard_charge_algorithm": "Lesser of $31.45 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"standard_charge_algorithm": "Lesser of $18.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.68,"standard_charge_algorithm": "Lesser of $19.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.94,"standard_charge_algorithm": "Lesser of $18.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.23,"standard_charge_algorithm": "Lesser of $20.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.49,"standard_charge_algorithm": "Lesser of $19.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN TOTAL SERUM","code_information":[{"code":"84155","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":90.72,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN TOTAL SERUM","code_information":[{"code":"84155","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.67,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.28,"standard_charge_algorithm": "Lesser of $6.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"standard_charge_algorithm": "Lesser of $3.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.78,"standard_charge_algorithm": "Lesser of $3.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.04,"standard_charge_algorithm": "Lesser of $4.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.89,"standard_charge_algorithm": "Lesser of $3.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T PROTEIN (ELECT)","code_information":[{"code":"84155","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":90.72,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"}]}]},{"description":"HC LAB T PROTEIN (ELECT)","code_information":[{"code":"84155","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.67,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.28,"standard_charge_algorithm": "Lesser of $6.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"standard_charge_algorithm": "Lesser of $3.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.78,"standard_charge_algorithm": "Lesser of $3.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.04,"standard_charge_algorithm": "Lesser of $4.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.89,"standard_charge_algorithm": "Lesser of $3.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN 24 HOUR URINE","code_information":[{"code":"84156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN 24 HOUR URINE","code_information":[{"code":"84156","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":3.67,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.28,"standard_charge_algorithm": "Lesser of $6.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"standard_charge_algorithm": "Lesser of $3.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.78,"standard_charge_algorithm": "Lesser of $3.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.04,"standard_charge_algorithm": "Lesser of $4.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.89,"standard_charge_algorithm": "Lesser of $3.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN URINE","code_information":[{"code":"84156","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN URINE","code_information":[{"code":"84156","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.67,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.28,"standard_charge_algorithm": "Lesser of $6.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.67,"standard_charge_algorithm": "Lesser of $3.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.93,"standard_charge_algorithm": "Lesser of $3.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.78,"standard_charge_algorithm": "Lesser of $3.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.04,"standard_charge_algorithm": "Lesser of $4.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.89,"standard_charge_algorithm": "Lesser of $3.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CSF TOTAL PROTEIN","code_information":[{"code":"84157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB CSF TOTAL PROTEIN","code_information":[{"code":"84157","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.84,"standard_charge_algorithm": "Lesser of $6.84 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"standard_charge_algorithm": "Lesser of $4.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"standard_charge_algorithm": "Lesser of $4.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.12,"standard_charge_algorithm": "Lesser of $4.12 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.2,"standard_charge_algorithm": "Lesser of $4.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.24,"standard_charge_algorithm": "Lesser of $4.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN OTH SPEC","code_information":[{"code":"84157","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN OTH SPEC","code_information":[{"code":"84157","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.84,"standard_charge_algorithm": "Lesser of $6.84 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4,"standard_charge_algorithm": "Lesser of $4.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"standard_charge_algorithm": "Lesser of $4.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.12,"standard_charge_algorithm": "Lesser of $4.12 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.2,"standard_charge_algorithm": "Lesser of $4.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.24,"standard_charge_algorithm": "Lesser of $4.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN ELECT SERUM","code_information":[{"code":"84165","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":188.73,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN ELECT SERUM","code_information":[{"code":"84165","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.37,"standard_charge_algorithm": "Lesser of $18.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"standard_charge_algorithm": "Lesser of $10.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"standard_charge_algorithm": "Lesser of $11.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.28,"standard_charge_algorithm": "Lesser of $11.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.81,"standard_charge_algorithm": "Lesser of $11.81 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.38,"standard_charge_algorithm": "Lesser of $11.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CSF ELECTROPHORESIS","code_information":[{"code":"84166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":142.56,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB CSF ELECTROPHORESIS","code_information":[{"code":"84166","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.83,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.49,"standard_charge_algorithm": "Lesser of $30.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"standard_charge_algorithm": "Lesser of $17.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.08,"standard_charge_algorithm": "Lesser of $19.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.36,"standard_charge_algorithm": "Lesser of $18.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.72,"standard_charge_algorithm": "Lesser of $18.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.61,"standard_charge_algorithm": "Lesser of $19.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.9,"standard_charge_algorithm": "Lesser of $18.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN EP FRACT & QUAL","code_information":[{"code":"84166","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":142.56,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN EP FRACT & QUAL","code_information":[{"code":"84166","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.83,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.49,"standard_charge_algorithm": "Lesser of $30.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.83,"standard_charge_algorithm": "Lesser of $17.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.08,"standard_charge_algorithm": "Lesser of $19.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.36,"standard_charge_algorithm": "Lesser of $18.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.72,"standard_charge_algorithm": "Lesser of $18.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.61,"standard_charge_algorithm": "Lesser of $19.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.9,"standard_charge_algorithm": "Lesser of $18.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HSV IGG 1 AND 2","code_information":[{"code":"84181","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"HC HSV IGG 1 AND 2","code_information":[{"code":"84181","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.03,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.12,"standard_charge_algorithm": "Lesser of $29.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.22,"standard_charge_algorithm": "Lesser of $18.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.54,"standard_charge_algorithm": "Lesser of $17.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.88,"standard_charge_algorithm": "Lesser of $17.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.73,"standard_charge_algorithm": "Lesser of $18.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTI-HU ABY LINE BLOT","code_information":[{"code":"84182","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"ANTI-HU ABY LINE BLOT","code_information":[{"code":"84182","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.33,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.95,"standard_charge_algorithm": "Lesser of $49.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"standard_charge_algorithm": "Lesser of $29.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.25,"standard_charge_algorithm": "Lesser of $31.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.67,"standard_charge_algorithm": "Lesser of $30.67 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.13,"standard_charge_algorithm": "Lesser of $32.13 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.96,"standard_charge_algorithm": "Lesser of $30.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN WB IM ID FOR BANDS","code_information":[{"code":"84182","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":861.84,"maximum":861.84,"gross_charge":1064,"discounted_cash":314.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":861.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":861.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":861.84,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN WB IM ID FOR BANDS","code_information":[{"code":"84182","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.33,"maximum":861.84,"gross_charge":1064,"discounted_cash":314.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":861.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":861.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":861.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.95,"standard_charge_algorithm": "Lesser of $49.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"standard_charge_algorithm": "Lesser of $29.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.25,"standard_charge_algorithm": "Lesser of $31.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.67,"standard_charge_algorithm": "Lesser of $30.67 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.13,"standard_charge_algorithm": "Lesser of $32.13 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.96,"standard_charge_algorithm": "Lesser of $30.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"minimum":6059,"maximum":17758.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9456,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8939,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6059,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15956,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14960,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16870.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11930,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14223,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11259,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17758.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15622,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9700,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9700,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6761,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9866.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10556.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10162.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10359.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10457.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10359.33,"methodology":"case rate"}]}]},{"description":"HC PROTOPORPHYRIN FEP/ZPP","code_information":[{"code":"84202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":65.61,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"HC PROTOPORPHYRIN FEP/ZPP","code_information":[{"code":"84202","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.35,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.54,"standard_charge_algorithm": "Lesser of $24.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.35,"standard_charge_algorithm": "Lesser of $14.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.35,"standard_charge_algorithm": "Lesser of $15.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.07,"standard_charge_algorithm": "Lesser of $15.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.79,"standard_charge_algorithm": "Lesser of $15.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.21,"standard_charge_algorithm": "Lesser of $15.21 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PRO-INSULIN","code_information":[{"code":"84206","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":466.56,"maximum":466.56,"gross_charge":576,"discounted_cash":170.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":466.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":466.56,"methodology":"fee schedule"}]}]},{"description":"HC PRO-INSULIN","code_information":[{"code":"84206","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.06,"maximum":466.56,"gross_charge":576,"discounted_cash":170.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":466.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":466.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.64,"standard_charge_algorithm": "Lesser of $45.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.69,"standard_charge_algorithm": "Lesser of $26.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.56,"standard_charge_algorithm": "Lesser of $28.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.49,"standard_charge_algorithm": "Lesser of $27.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.02,"standard_charge_algorithm": "Lesser of $28.02 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.36,"standard_charge_algorithm": "Lesser of $29.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.29,"standard_charge_algorithm": "Lesser of $28.29 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VITAMIN B6 (B)","code_information":[{"code":"84207","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":586.44,"maximum":586.44,"gross_charge":724,"discounted_cash":214.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":586.44,"methodology":"fee schedule"}]}]},{"description":"HC VITAMIN B6 (B)","code_information":[{"code":"84207","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":28.1,"maximum":586.44,"gross_charge":724,"discounted_cash":214.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":85.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48.05,"standard_charge_algorithm": "Lesser of $48.05 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28.1,"standard_charge_algorithm": "Lesser of $28.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30.07,"standard_charge_algorithm": "Lesser of $30.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.94,"standard_charge_algorithm": "Lesser of $28.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29.5,"standard_charge_algorithm": "Lesser of $29.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.91,"standard_charge_algorithm": "Lesser of $30.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.79,"standard_charge_algorithm": "Lesser of $29.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8421","type":"APR-DRG"}],"standard_charges":[{"minimum":7774,"maximum":7774,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7774,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7774,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7774,"methodology":"case rate"}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8422","type":"APR-DRG"}],"standard_charges":[{"minimum":13773,"maximum":13773,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13773,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13773,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13773,"methodology":"case rate"}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8423","type":"APR-DRG"}],"standard_charges":[{"minimum":31069,"maximum":31069,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31069,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31069,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31069,"methodology":"case rate"}]}]},{"description":"HC LAB NONENDOCRINE RECEPT ASY","code_information":[{"code":"84238","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":482.76,"maximum":482.76,"gross_charge":596,"discounted_cash":176.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":482.76,"methodology":"fee schedule"}]}]},{"description":"HC LAB NONENDOCRINE RECEPT ASY","code_information":[{"code":"84238","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.57,"maximum":482.76,"gross_charge":596,"discounted_cash":176.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":110.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":87.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":62.53,"standard_charge_algorithm": "Lesser of $62.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":80.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":89.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36.57,"standard_charge_algorithm": "Lesser of $36.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39.13,"standard_charge_algorithm": "Lesser of $39.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":37.67,"standard_charge_algorithm": "Lesser of $37.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38.4,"standard_charge_algorithm": "Lesser of $38.40 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40.23,"standard_charge_algorithm": "Lesser of $40.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38.76,"standard_charge_algorithm": "Lesser of $38.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS","code_information":[{"code":"8424","type":"APR-DRG"}],"standard_charges":[{"minimum":62778,"maximum":62778,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62778,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62778,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62778,"methodology":"case rate"}]}]},{"description":"HC LAB RENIN PLASMA","code_information":[{"code":"84244","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.97,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"}]}]},{"description":"HC LAB RENIN PLASMA","code_information":[{"code":"84244","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.99,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.6,"standard_charge_algorithm": "Lesser of $37.60 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"standard_charge_algorithm": "Lesser of $21.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.53,"standard_charge_algorithm": "Lesser of $23.53 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.65,"standard_charge_algorithm": "Lesser of $22.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.09,"standard_charge_algorithm": "Lesser of $23.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.19,"standard_charge_algorithm": "Lesser of $24.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.31,"standard_charge_algorithm": "Lesser of $23.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RENNIN DIRECT","code_information":[{"code":"84244","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":110.97,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"}]}]},{"description":"HC LAB RENNIN DIRECT","code_information":[{"code":"84244","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.99,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.6,"standard_charge_algorithm": "Lesser of $37.60 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.99,"standard_charge_algorithm": "Lesser of $21.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.53,"standard_charge_algorithm": "Lesser of $23.53 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.65,"standard_charge_algorithm": "Lesser of $22.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.09,"standard_charge_algorithm": "Lesser of $23.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.19,"standard_charge_algorithm": "Lesser of $24.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.31,"standard_charge_algorithm": "Lesser of $23.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VITAMIN B2 WHOLE BLOOD","code_information":[{"code":"84252","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":328.86,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"}]}]},{"description":"HC VITAMIN B2 WHOLE BLOOD","code_information":[{"code":"84252","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":20.24,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.61,"standard_charge_algorithm": "Lesser of $34.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"standard_charge_algorithm": "Lesser of $20.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.66,"standard_charge_algorithm": "Lesser of $21.66 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.85,"standard_charge_algorithm": "Lesser of $20.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.25,"standard_charge_algorithm": "Lesser of $21.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.26,"standard_charge_algorithm": "Lesser of $22.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.45,"standard_charge_algorithm": "Lesser of $21.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SELENIUM SERUM/PLASMA","code_information":[{"code":"84255","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC SELENIUM SERUM/PLASMA","code_information":[{"code":"84255","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.53,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.66,"standard_charge_algorithm": "Lesser of $43.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.53,"standard_charge_algorithm": "Lesser of $25.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.32,"standard_charge_algorithm": "Lesser of $27.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.3,"standard_charge_algorithm": "Lesser of $26.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.81,"standard_charge_algorithm": "Lesser of $26.81 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.08,"standard_charge_algorithm": "Lesser of $28.08 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.06,"standard_charge_algorithm": "Lesser of $27.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SEROTONIN","code_information":[{"code":"84260","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB SEROTONIN","code_information":[{"code":"84260","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":30.98,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52.98,"standard_charge_algorithm": "Lesser of $52.98 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":75.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30.98,"standard_charge_algorithm": "Lesser of $30.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33.15,"standard_charge_algorithm": "Lesser of $33.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31.91,"standard_charge_algorithm": "Lesser of $31.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32.53,"standard_charge_algorithm": "Lesser of $32.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34.08,"standard_charge_algorithm": "Lesser of $34.08 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32.84,"standard_charge_algorithm": "Lesser of $32.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"84270","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.73,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.16,"standard_charge_algorithm": "Lesser of $37.16 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"standard_charge_algorithm": "Lesser of $21.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.25,"standard_charge_algorithm": "Lesser of $23.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.38,"standard_charge_algorithm": "Lesser of $22.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.82,"standard_charge_algorithm": "Lesser of $22.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.9,"standard_charge_algorithm": "Lesser of $23.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.03,"standard_charge_algorithm": "Lesser of $23.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TEBG(SHBG)","code_information":[{"code":"84270","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102.06,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"}]}]},{"description":"HC LAB TEBG(SHBG)","code_information":[{"code":"84270","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.73,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.16,"standard_charge_algorithm": "Lesser of $37.16 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.73,"standard_charge_algorithm": "Lesser of $21.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.25,"standard_charge_algorithm": "Lesser of $23.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.38,"standard_charge_algorithm": "Lesser of $22.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.82,"standard_charge_algorithm": "Lesser of $22.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.9,"standard_charge_algorithm": "Lesser of $23.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.03,"standard_charge_algorithm": "Lesser of $23.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LIPID ASSOCIATED SIALIC ACID","code_information":[{"code":"84275","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":259.2,"maximum":259.2,"gross_charge":320,"discounted_cash":94.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"}]}]},{"description":"HC LIPID ASSOCIATED SIALIC ACID","code_information":[{"code":"84275","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.44,"maximum":259.2,"gross_charge":320,"discounted_cash":94.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.98,"standard_charge_algorithm": "Lesser of $22.98 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"standard_charge_algorithm": "Lesser of $14.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.84,"standard_charge_algorithm": "Lesser of $13.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.25,"standard_charge_algorithm": "Lesser of $14.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ASSAY SERUM SODIUM","code_information":[{"code":"84295","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":22.68,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"HC LAB ASSAY SERUM SODIUM","code_information":[{"code":"84295","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.81,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.23,"standard_charge_algorithm": "Lesser of $8.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"standard_charge_algorithm": "Lesser of $4.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.15,"standard_charge_algorithm": "Lesser of $5.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.95,"standard_charge_algorithm": "Lesser of $4.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.05,"standard_charge_algorithm": "Lesser of $5.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.29,"standard_charge_algorithm": "Lesser of $5.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SODIUM","code_information":[{"code":"84295","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.68,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"HC LAB SODIUM","code_information":[{"code":"84295","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.81,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.23,"standard_charge_algorithm": "Lesser of $8.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.81,"standard_charge_algorithm": "Lesser of $4.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.15,"standard_charge_algorithm": "Lesser of $5.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.95,"standard_charge_algorithm": "Lesser of $4.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.05,"standard_charge_algorithm": "Lesser of $5.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.29,"standard_charge_algorithm": "Lesser of $5.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"minimum":7535,"maximum":29337,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17019,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16089,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10571,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29337,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27505,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26113.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20941,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24967,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19644,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27488.18,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28118,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17458,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17458,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7535,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15271.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16340.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15729.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16034.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16187.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16034.78,"methodology":"case rate"}]}]},{"description":"HC LAB SODIUM URINE","code_information":[{"code":"84300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB SODIUM URINE","code_information":[{"code":"84300","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.87,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"standard_charge_algorithm": "Lesser of $5.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.41,"standard_charge_algorithm": "Lesser of $5.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.21,"standard_charge_algorithm": "Lesser of $5.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.31,"standard_charge_algorithm": "Lesser of $5.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.57,"standard_charge_algorithm": "Lesser of $5.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.36,"standard_charge_algorithm": "Lesser of $5.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SODIUN URINE","code_information":[{"code":"84300","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB SODIUN URINE","code_information":[{"code":"84300","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.87,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.06,"standard_charge_algorithm": "Lesser of $5.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.41,"standard_charge_algorithm": "Lesser of $5.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.21,"standard_charge_algorithm": "Lesser of $5.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.31,"standard_charge_algorithm": "Lesser of $5.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.57,"standard_charge_algorithm": "Lesser of $5.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.36,"standard_charge_algorithm": "Lesser of $5.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SODIUM FECAL","code_information":[{"code":"84302","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.01,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"}]}]},{"description":"HC LAB SODIUM FECAL","code_information":[{"code":"84302","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.31,"standard_charge_algorithm": "Lesser of $8.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"standard_charge_algorithm": "Lesser of $4.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.2,"standard_charge_algorithm": "Lesser of $5.20 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.01,"standard_charge_algorithm": "Lesser of $5.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.35,"standard_charge_algorithm": "Lesser of $5.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.15,"standard_charge_algorithm": "Lesser of $5.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SODIUM FECES","code_information":[{"code":"84302","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB SODIUM FECES","code_information":[{"code":"84302","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.31,"standard_charge_algorithm": "Lesser of $8.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.86,"standard_charge_algorithm": "Lesser of $4.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.2,"standard_charge_algorithm": "Lesser of $5.20 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.01,"standard_charge_algorithm": "Lesser of $5.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.1,"standard_charge_algorithm": "Lesser of $5.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.35,"standard_charge_algorithm": "Lesser of $5.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.15,"standard_charge_algorithm": "Lesser of $5.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IGF-1 (SOMATOMEDIN-C)","code_information":[{"code":"84305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":69.66,"maximum":69.66,"gross_charge":86,"discounted_cash":25.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.66,"methodology":"fee schedule"}]}]},{"description":"HC LAB IGF-1 (SOMATOMEDIN-C)","code_information":[{"code":"84305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.26,"maximum":69.66,"gross_charge":86,"discounted_cash":25.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.35,"standard_charge_algorithm": "Lesser of $36.35 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"standard_charge_algorithm": "Lesser of $21.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.75,"standard_charge_algorithm": "Lesser of $22.75 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.9,"standard_charge_algorithm": "Lesser of $21.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.32,"standard_charge_algorithm": "Lesser of $22.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.39,"standard_charge_algorithm": "Lesser of $23.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.54,"standard_charge_algorithm": "Lesser of $22.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IGF-1 WITH Z-SCORE","code_information":[{"code":"84305","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":93.15,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"}]}]},{"description":"IGF-1 WITH Z-SCORE","code_information":[{"code":"84305","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.26,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.35,"standard_charge_algorithm": "Lesser of $36.35 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.26,"standard_charge_algorithm": "Lesser of $21.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.75,"standard_charge_algorithm": "Lesser of $22.75 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.9,"standard_charge_algorithm": "Lesser of $21.90 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.32,"standard_charge_algorithm": "Lesser of $22.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.39,"standard_charge_algorithm": "Lesser of $23.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.54,"standard_charge_algorithm": "Lesser of $22.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8431","type":"APR-DRG"}],"standard_charges":[{"minimum":3444,"maximum":3444,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3444,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3444,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3444,"methodology":"case rate"}]}]},{"description":"HC LAB ADENOSINE DEAMINASE PL FLD","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"HC LAB ADENOSINE DEAMINASE PL FLD","code_information":[{"code":"84311","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"standard_charge_algorithm": "Lesser of $8.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.67,"standard_charge_algorithm": "Lesser of $8.67 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.34,"standard_charge_algorithm": "Lesser of $8.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.51,"standard_charge_algorithm": "Lesser of $8.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.91,"standard_charge_algorithm": "Lesser of $8.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.59,"standard_charge_algorithm": "Lesser of $8.59 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SPECTROPHOTOMETRY ANLYT NES","code_information":[{"code":"84311","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"HC LAB SPECTROPHOTOMETRY ANLYT NES","code_information":[{"code":"84311","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.1,"standard_charge_algorithm": "Lesser of $8.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.67,"standard_charge_algorithm": "Lesser of $8.67 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.34,"standard_charge_algorithm": "Lesser of $8.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.51,"standard_charge_algorithm": "Lesser of $8.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.91,"standard_charge_algorithm": "Lesser of $8.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.59,"standard_charge_algorithm": "Lesser of $8.59 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SPECIF GRAVITY FLD","code_information":[{"code":"84315","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"HC LAB SPECIF GRAVITY FLD","code_information":[{"code":"84315","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.28,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.61,"standard_charge_algorithm": "Lesser of $5.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.28,"standard_charge_algorithm": "Lesser of $3.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.51,"standard_charge_algorithm": "Lesser of $3.51 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.38,"standard_charge_algorithm": "Lesser of $3.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.44,"standard_charge_algorithm": "Lesser of $3.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.61,"standard_charge_algorithm": "Lesser of $3.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.48,"standard_charge_algorithm": "Lesser of $3.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8432","type":"APR-DRG"}],"standard_charges":[{"minimum":4258,"maximum":4258,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4258,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4258,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4258,"methodology":"case rate"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8433","type":"APR-DRG"}],"standard_charges":[{"minimum":7161,"maximum":7161,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7161,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7161,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7161,"methodology":"case rate"}]}]},{"description":"EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8434","type":"APR-DRG"}],"standard_charges":[{"minimum":14747,"maximum":14747,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14747,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14747,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14747,"methodology":"case rate"}]}]},{"description":"HC LAB STOOL REDUCING SUBSTANCES","code_information":[{"code":"84376","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB STOOL REDUCING SUBSTANCES","code_information":[{"code":"84376","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.5,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"standard_charge_algorithm": "Lesser of $9.40 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"standard_charge_algorithm": "Lesser of $5.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"standard_charge_algorithm": "Lesser of $5.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"standard_charge_algorithm": "Lesser of $5.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"standard_charge_algorithm": "Lesser of $5.78 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"standard_charge_algorithm": "Lesser of $6.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"standard_charge_algorithm": "Lesser of $5.83 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TOTAL REDUC SUBSSTOOL","code_information":[{"code":"84376","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOTAL REDUC SUBSSTOOL","code_information":[{"code":"84376","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.5,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"standard_charge_algorithm": "Lesser of $9.40 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"standard_charge_algorithm": "Lesser of $5.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"standard_charge_algorithm": "Lesser of $5.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"standard_charge_algorithm": "Lesser of $5.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"standard_charge_algorithm": "Lesser of $5.78 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"standard_charge_algorithm": "Lesser of $6.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"standard_charge_algorithm": "Lesser of $5.83 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC GLYCOMARK (15 AG)","code_information":[{"code":"84378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":139.32,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"}]}]},{"description":"HC GLYCOMARK (15 AG)","code_information":[{"code":"84378","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.53,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"standard_charge_algorithm": "Lesser of $11.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.22,"standard_charge_algorithm": "Lesser of $12.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SULFATE QUANT 24 HR UR","code_information":[{"code":"84392","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":172.53,"maximum":172.53,"gross_charge":213,"discounted_cash":63.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.53,"methodology":"fee schedule"}]}]},{"description":"HC SULFATE QUANT 24 HR UR","code_information":[{"code":"84392","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.49,"maximum":172.53,"gross_charge":213,"discounted_cash":63.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.39,"standard_charge_algorithm": "Lesser of $9.39 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.87,"standard_charge_algorithm": "Lesser of $5.87 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.65,"standard_charge_algorithm": "Lesser of $5.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.76,"standard_charge_algorithm": "Lesser of $5.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.04,"standard_charge_algorithm": "Lesser of $6.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.82,"standard_charge_algorithm": "Lesser of $5.82 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TAU PHOSPHORYLATED EA","code_information":[{"code":"84393","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"TAU PHOSPHORYLATED EA","code_information":[{"code":"84393","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.4,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"}]}]},{"description":"TOTAL TAU","code_information":[{"code":"84394","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"TOTAL TAU","code_information":[{"code":"84394","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.4,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"minimum":5095,"maximum":19415.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10744,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10157,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6574,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14600,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13688,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18445.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12329,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14699,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12218,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19415.87,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17750,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11021,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11021,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5095,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10786.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11541.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11110.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11325.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11433.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11325.92,"methodology":"case rate"}]}]},{"description":"HC LAB TESTOSTERONE FREE","code_information":[{"code":"84402","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC LAB TESTOSTERONE FREE","code_information":[{"code":"84402","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.47,"maximum":63.45,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.55,"standard_charge_algorithm": "Lesser of $43.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.47,"standard_charge_algorithm": "Lesser of $25.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.25,"standard_charge_algorithm": "Lesser of $27.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.23,"standard_charge_algorithm": "Lesser of $26.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.74,"standard_charge_algorithm": "Lesser of $26.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.02,"standard_charge_algorithm": "Lesser of $28.02 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27,"standard_charge_algorithm": "Lesser of $27.00 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TESTOSTERONE TOTAL","code_information":[{"code":"84403","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":170.1,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"}]}]},{"description":"HC LAB TESTOSTERONE TOTAL","code_information":[{"code":"84403","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.81,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44.14,"standard_charge_algorithm": "Lesser of $44.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"standard_charge_algorithm": "Lesser of $25.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.62,"standard_charge_algorithm": "Lesser of $27.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.58,"standard_charge_algorithm": "Lesser of $26.58 or 103 Percent of Billed Charges","median_amount":26.58,"10th_percentile":26.58,"90th_percentile":26.58,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.1,"standard_charge_algorithm": "Lesser of $27.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.39,"standard_charge_algorithm": "Lesser of $28.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.36,"standard_charge_algorithm": "Lesser of $27.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TESTOSTERONE TOTAL BY LC MS/M","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":170.1,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"}]}]},{"description":"HC LAB TESTOSTERONE TOTAL BY LC MS/M","code_information":[{"code":"84403","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":25.81,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44.14,"standard_charge_algorithm": "Lesser of $44.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"standard_charge_algorithm": "Lesser of $25.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.62,"standard_charge_algorithm": "Lesser of $27.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.58,"standard_charge_algorithm": "Lesser of $26.58 or 103 Percent of Billed Charges","median_amount":26.58,"10th_percentile":26.58,"90th_percentile":26.58,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.1,"standard_charge_algorithm": "Lesser of $27.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.39,"standard_charge_algorithm": "Lesser of $28.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.36,"standard_charge_algorithm": "Lesser of $27.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8441","type":"APR-DRG"}],"standard_charges":[{"minimum":2559,"maximum":2559,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2559,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2559,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2559,"methodology":"case rate"}]}]},{"description":"BIOVLBL TESTOSTERONE DIRECT","code_information":[{"code":"84410","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"BIOVLBL TESTOSTERONE DIRECT","code_information":[{"code":"84410","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":161.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":127.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":87.69,"standard_charge_algorithm": "Lesser of $87.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":112.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":51.28,"standard_charge_algorithm": "Lesser of $51.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":54.87,"standard_charge_algorithm": "Lesser of $54.87 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":52.82,"standard_charge_algorithm": "Lesser of $52.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":53.84,"standard_charge_algorithm": "Lesser of $53.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":56.41,"standard_charge_algorithm": "Lesser of $56.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":54.36,"standard_charge_algorithm": "Lesser of $54.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8442","type":"APR-DRG"}],"standard_charges":[{"minimum":5115,"maximum":5115,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5115,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5115,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5115,"methodology":"case rate"}]}]},{"description":"HC LAB VITAMIN B-1 THIAMINE PLASMA","code_information":[{"code":"84425","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN B-1 THIAMINE PLASMA","code_information":[{"code":"84425","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.23,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":64.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.3,"standard_charge_algorithm": "Lesser of $36.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"standard_charge_algorithm": "Lesser of $21.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.72,"standard_charge_algorithm": "Lesser of $22.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.87,"standard_charge_algorithm": "Lesser of $21.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.29,"standard_charge_algorithm": "Lesser of $22.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.35,"standard_charge_algorithm": "Lesser of $23.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.5,"standard_charge_algorithm": "Lesser of $22.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN B1(THIAMINE)","code_information":[{"code":"84425","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN B1(THIAMINE)","code_information":[{"code":"84425","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.23,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":64.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.3,"standard_charge_algorithm": "Lesser of $36.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.23,"standard_charge_algorithm": "Lesser of $21.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.72,"standard_charge_algorithm": "Lesser of $22.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.87,"standard_charge_algorithm": "Lesser of $21.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.29,"standard_charge_algorithm": "Lesser of $22.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.35,"standard_charge_algorithm": "Lesser of $23.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.5,"standard_charge_algorithm": "Lesser of $22.50 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8443","type":"APR-DRG"}],"standard_charges":[{"minimum":7228,"maximum":7228,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7228,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7228,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7228,"methodology":"case rate"}]}]},{"description":"HC THIOCYANATE","code_information":[{"code":"84430","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC THIOCYANATE","code_information":[{"code":"84430","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":8.11,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.89,"standard_charge_algorithm": "Lesser of $19.89 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.63,"standard_charge_algorithm": "Lesser of $11.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.44,"standard_charge_algorithm": "Lesser of $12.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.21,"standard_charge_algorithm": "Lesser of $12.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.79,"standard_charge_algorithm": "Lesser of $12.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THYROGLOBULIN","code_information":[{"code":"84432","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB THYROGLOBULIN","code_information":[{"code":"84432","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.06,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.46,"standard_charge_algorithm": "Lesser of $27.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"standard_charge_algorithm": "Lesser of $16.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.18,"standard_charge_algorithm": "Lesser of $17.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.54,"standard_charge_algorithm": "Lesser of $16.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.86,"standard_charge_algorithm": "Lesser of $16.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.67,"standard_charge_algorithm": "Lesser of $17.67 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.02,"standard_charge_algorithm": "Lesser of $17.02 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T4 THYROXINE","code_information":[{"code":"84436","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB T4 THYROXINE","code_information":[{"code":"84436","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.87,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.75,"standard_charge_algorithm": "Lesser of $11.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.87,"standard_charge_algorithm": "Lesser of $6.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.35,"standard_charge_algorithm": "Lesser of $7.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.08,"standard_charge_algorithm": "Lesser of $7.08 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.21,"standard_charge_algorithm": "Lesser of $7.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.56,"standard_charge_algorithm": "Lesser of $7.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.28,"standard_charge_algorithm": "Lesser of $7.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FREE T4","code_information":[{"code":"84439","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":142.56,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB FREE T4","code_information":[{"code":"84439","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.02,"maximum":142.56,"gross_charge":176,"discounted_cash":52.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.42,"standard_charge_algorithm": "Lesser of $15.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.02,"standard_charge_algorithm": "Lesser of $9.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.65,"standard_charge_algorithm": "Lesser of $9.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.29,"standard_charge_algorithm": "Lesser of $9.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.47,"standard_charge_algorithm": "Lesser of $9.47 or 105 Percent of Billed Charges","median_amount":9.47,"10th_percentile":9.47,"90th_percentile":9.47,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.92,"standard_charge_algorithm": "Lesser of $9.92 or 110 Percent of Billed Charges","median_amount":9.02,"10th_percentile":9.02,"90th_percentile":9.02,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.56,"standard_charge_algorithm": "Lesser of $9.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT","code_information":[{"code":"8444","type":"APR-DRG"}],"standard_charges":[{"minimum":17421,"maximum":17421,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17421,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17421,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17421,"methodology":"case rate"}]}]},{"description":"HC LAB THYROXINE BIND GLOB(TBG)","code_information":[{"code":"84442","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":63.18,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"}]}]},{"description":"HC LAB THYROXINE BIND GLOB(TBG)","code_information":[{"code":"84442","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.78,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.27,"standard_charge_algorithm": "Lesser of $25.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.78,"standard_charge_algorithm": "Lesser of $14.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.81,"standard_charge_algorithm": "Lesser of $15.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.52,"standard_charge_algorithm": "Lesser of $15.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.26,"standard_charge_algorithm": "Lesser of $16.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.67,"standard_charge_algorithm": "Lesser of $15.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TSH","code_information":[{"code":"84443","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":157.95,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"}]}]},{"description":"HC LAB TSH","code_information":[{"code":"84443","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.73,"standard_charge_algorithm": "Lesser of $28.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"standard_charge_algorithm": "Lesser of $16.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"standard_charge_algorithm": "Lesser of $17.98 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.3,"standard_charge_algorithm": "Lesser of $17.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.64,"standard_charge_algorithm": "Lesser of $17.64 or 105 Percent of Billed Charges","median_amount":17.64,"10th_percentile":17.64,"90th_percentile":17.64,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 110 Percent of Billed Charges","median_amount":16.8,"10th_percentile":16.8,"90th_percentile":16.8,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.81,"standard_charge_algorithm": "Lesser of $17.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TSH","code_information":[{"code":"84443","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":157.95,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"}]}]},{"description":"HC LAB TSH","code_information":[{"code":"84443","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.73,"standard_charge_algorithm": "Lesser of $28.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.8,"standard_charge_algorithm": "Lesser of $16.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"standard_charge_algorithm": "Lesser of $17.98 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.3,"standard_charge_algorithm": "Lesser of $17.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.64,"standard_charge_algorithm": "Lesser of $17.64 or 105 Percent of Billed Charges","median_amount":17.64,"10th_percentile":17.64,"90th_percentile":17.64,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.48,"standard_charge_algorithm": "Lesser of $18.48 or 110 Percent of Billed Charges","median_amount":16.8,"10th_percentile":16.8,"90th_percentile":16.8,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.81,"standard_charge_algorithm": "Lesser of $17.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THYRD STIM IMM GLOB(TSI)","code_information":[{"code":"84445","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":188.73,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"HC LAB THYRD STIM IMM GLOB(TSI)","code_information":[{"code":"84445","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.92,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":86.97,"standard_charge_algorithm": "Lesser of $86.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":111.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":50.86,"standard_charge_algorithm": "Lesser of $50.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":54.42,"standard_charge_algorithm": "Lesser of $54.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":52.39,"standard_charge_algorithm": "Lesser of $52.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":53.4,"standard_charge_algorithm": "Lesser of $53.40 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":55.95,"standard_charge_algorithm": "Lesser of $55.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":53.91,"standard_charge_algorithm": "Lesser of $53.91 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN E","code_information":[{"code":"84446","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":98.82,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN E","code_information":[{"code":"84446","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.25,"standard_charge_algorithm": "Lesser of $24.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.6,"standard_charge_algorithm": "Lesser of $15.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN E-ALPHA","code_information":[{"code":"84446","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":98.82,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN E-ALPHA","code_information":[{"code":"84446","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.25,"standard_charge_algorithm": "Lesser of $24.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.6,"standard_charge_algorithm": "Lesser of $15.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SGOT (AST)","code_information":[{"code":"84450","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":103.68,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"}]}]},{"description":"HC LAB SGOT (AST)","code_information":[{"code":"84450","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SGPT (ALT)","code_information":[{"code":"84460","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB SGPT (ALT)","code_information":[{"code":"84460","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.3,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.06,"standard_charge_algorithm": "Lesser of $9.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.3,"standard_charge_algorithm": "Lesser of $5.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.67,"standard_charge_algorithm": "Lesser of $5.67 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.46,"standard_charge_algorithm": "Lesser of $5.46 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.57,"standard_charge_algorithm": "Lesser of $5.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.83,"standard_charge_algorithm": "Lesser of $5.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.62,"standard_charge_algorithm": "Lesser of $5.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TRANSFERRIN","code_information":[{"code":"84466","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"HC LAB TRANSFERRIN","code_information":[{"code":"84466","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.76,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.82,"standard_charge_algorithm": "Lesser of $21.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.76,"standard_charge_algorithm": "Lesser of $12.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.14,"standard_charge_algorithm": "Lesser of $13.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.4,"standard_charge_algorithm": "Lesser of $13.40 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.53,"standard_charge_algorithm": "Lesser of $13.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FHP TRIGLYCERIDES","code_information":[{"code":"84478","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB FHP TRIGLYCERIDES","code_information":[{"code":"84478","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.74,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.82,"standard_charge_algorithm": "Lesser of $9.82 or 171 Percent of Billed Charges","median_amount":9.82,"10th_percentile":9.82,"90th_percentile":9.82,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"standard_charge_algorithm": "Lesser of $6.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.91,"standard_charge_algorithm": "Lesser of $5.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.03,"standard_charge_algorithm": "Lesser of $6.03 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.31,"standard_charge_algorithm": "Lesser of $6.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.08,"standard_charge_algorithm": "Lesser of $6.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TRIGLYCERIDE","code_information":[{"code":"84478","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB TRIGLYCERIDE","code_information":[{"code":"84478","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.74,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.82,"standard_charge_algorithm": "Lesser of $9.82 or 171 Percent of Billed Charges","median_amount":9.82,"10th_percentile":9.82,"90th_percentile":9.82,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.14,"standard_charge_algorithm": "Lesser of $6.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.91,"standard_charge_algorithm": "Lesser of $5.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.03,"standard_charge_algorithm": "Lesser of $6.03 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.31,"standard_charge_algorithm": "Lesser of $6.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.08,"standard_charge_algorithm": "Lesser of $6.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"84479","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC T3 UPTAKE","code_information":[{"code":"84479","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T3","code_information":[{"code":"84480","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":63.99,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"}]}]},{"description":"HC LAB T3","code_information":[{"code":"84480","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.25,"standard_charge_algorithm": "Lesser of $24.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.6,"standard_charge_algorithm": "Lesser of $15.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRIODOTHYRONINE (T3)","code_information":[{"code":"84480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":63.99,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"}]}]},{"description":"TRIODOTHYRONINE (T3)","code_information":[{"code":"84480","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.25,"standard_charge_algorithm": "Lesser of $24.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.89,"standard_charge_algorithm": "Lesser of $14.89 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.6,"standard_charge_algorithm": "Lesser of $15.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T3 FREE","code_information":[{"code":"84481","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":92.34,"maximum":92.34,"gross_charge":114,"discounted_cash":33.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.34,"methodology":"fee schedule"}]}]},{"description":"HC LAB T3 FREE","code_information":[{"code":"84481","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":92.34,"gross_charge":114,"discounted_cash":33.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.97,"standard_charge_algorithm": "Lesser of $28.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.45,"standard_charge_algorithm": "Lesser of $17.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.63,"standard_charge_algorithm": "Lesser of $18.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.96,"standard_charge_algorithm": "Lesser of $17.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T3 FREE","code_information":[{"code":"84481","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":92.34,"maximum":92.34,"gross_charge":114,"discounted_cash":33.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.34,"methodology":"fee schedule"}]}]},{"description":"HC LAB T3 FREE","code_information":[{"code":"84481","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.94,"maximum":92.34,"gross_charge":114,"discounted_cash":33.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.97,"standard_charge_algorithm": "Lesser of $28.97 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.94,"standard_charge_algorithm": "Lesser of $16.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.13,"standard_charge_algorithm": "Lesser of $18.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.45,"standard_charge_algorithm": "Lesser of $17.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.79,"standard_charge_algorithm": "Lesser of $17.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.63,"standard_charge_algorithm": "Lesser of $18.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.96,"standard_charge_algorithm": "Lesser of $17.96 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T3 REVERSE","code_information":[{"code":"84482","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB T3 REVERSE","code_information":[{"code":"84482","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.76,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.95,"standard_charge_algorithm": "Lesser of $26.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.76,"standard_charge_algorithm": "Lesser of $15.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.86,"standard_charge_algorithm": "Lesser of $16.86 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.23,"standard_charge_algorithm": "Lesser of $16.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.34,"standard_charge_algorithm": "Lesser of $17.34 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.71,"standard_charge_algorithm": "Lesser of $16.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TROPONIN","code_information":[{"code":"84484","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":434.97,"maximum":434.97,"gross_charge":537,"discounted_cash":158.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.97,"methodology":"fee schedule"}]}]},{"description":"HC LAB TROPONIN","code_information":[{"code":"84484","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.47,"maximum":434.97,"gross_charge":537,"discounted_cash":158.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.32,"standard_charge_algorithm": "Lesser of $21.32 or 171 Percent of Billed Charges","median_amount":138.28,"10th_percentile":138.28,"90th_percentile":138.28,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.47,"standard_charge_algorithm": "Lesser of $12.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.34,"standard_charge_algorithm": "Lesser of $13.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.09,"standard_charge_algorithm": "Lesser of $13.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.72,"standard_charge_algorithm": "Lesser of $13.72 or 110 Percent of Billed Charges","median_amount":12.47,"10th_percentile":12.47,"90th_percentile":45.53,"count":"23","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.22,"standard_charge_algorithm": "Lesser of $13.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"minimum":4290,"maximum":15271.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7522,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7111,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4914,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12102,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11347,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14508,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9139,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10896,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9132,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15271.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12427,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7716,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7716,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4290,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8484.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9078.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8738.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8908.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8993.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8908.43,"methodology":"case rate"}]}]},{"description":"HC LAB UREA NITROGEN BLOOD","code_information":[{"code":"84520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":159.57,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"}]}]},{"description":"HC LAB UREA NITROGEN BLOOD","code_information":[{"code":"84520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.95,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.75,"standard_charge_algorithm": "Lesser of $6.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.95,"standard_charge_algorithm": "Lesser of $3.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.23,"standard_charge_algorithm": "Lesser of $4.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.07,"standard_charge_algorithm": "Lesser of $4.07 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.15,"standard_charge_algorithm": "Lesser of $4.15 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.34,"standard_charge_algorithm": "Lesser of $4.34 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.19,"standard_charge_algorithm": "Lesser of $4.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB UREA NITROGEN 24HR URINE","code_information":[{"code":"84540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB UREA NITROGEN 24HR URINE","code_information":[{"code":"84540","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.56,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.51,"standard_charge_algorithm": "Lesser of $9.51 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"standard_charge_algorithm": "Lesser of $5.56 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.73,"standard_charge_algorithm": "Lesser of $5.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.84,"standard_charge_algorithm": "Lesser of $5.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.12,"standard_charge_algorithm": "Lesser of $6.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.89,"standard_charge_algorithm": "Lesser of $5.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB UREA NITROGEN URINE","code_information":[{"code":"84540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB UREA NITROGEN URINE","code_information":[{"code":"84540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.56,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.51,"standard_charge_algorithm": "Lesser of $9.51 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.56,"standard_charge_algorithm": "Lesser of $5.56 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.73,"standard_charge_algorithm": "Lesser of $5.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.84,"standard_charge_algorithm": "Lesser of $5.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.12,"standard_charge_algorithm": "Lesser of $6.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.89,"standard_charge_algorithm": "Lesser of $5.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC UREA NITROGEN CLEARANCE","code_information":[{"code":"84545","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC UREA NITROGEN CLEARANCE","code_information":[{"code":"84545","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.31,"standard_charge_algorithm": "Lesser of $12.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.2,"standard_charge_algorithm": "Lesser of $7.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.7,"standard_charge_algorithm": "Lesser of $7.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.42,"standard_charge_algorithm": "Lesser of $7.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.56,"standard_charge_algorithm": "Lesser of $7.56 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.92,"standard_charge_algorithm": "Lesser of $7.92 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.63,"standard_charge_algorithm": "Lesser of $7.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URIC ACID","code_information":[{"code":"84550","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":207.36,"maximum":207.36,"gross_charge":256,"discounted_cash":75.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":207.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB URIC ACID","code_information":[{"code":"84550","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.52,"maximum":207.36,"gross_charge":256,"discounted_cash":75.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":207.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.73,"standard_charge_algorithm": "Lesser of $7.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.52,"standard_charge_algorithm": "Lesser of $4.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.84,"standard_charge_algorithm": "Lesser of $4.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.66,"standard_charge_algorithm": "Lesser of $4.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.97,"standard_charge_algorithm": "Lesser of $4.97 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.79,"standard_charge_algorithm": "Lesser of $4.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URIC ACID 24HR URINE","code_information":[{"code":"84560","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":22.68,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"HC LAB URIC ACID 24HR URINE","code_information":[{"code":"84560","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":5.08,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.69,"standard_charge_algorithm": "Lesser of $8.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"standard_charge_algorithm": "Lesser of $5.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.23,"standard_charge_algorithm": "Lesser of $5.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.33,"standard_charge_algorithm": "Lesser of $5.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URIC ACID URINE","code_information":[{"code":"84560","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.68,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"HC LAB URIC ACID URINE","code_information":[{"code":"84560","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.08,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.69,"standard_charge_algorithm": "Lesser of $8.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"standard_charge_algorithm": "Lesser of $5.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.23,"standard_charge_algorithm": "Lesser of $5.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.33,"standard_charge_algorithm": "Lesser of $5.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VMA","code_information":[{"code":"84585","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB VMA","code_information":[{"code":"84585","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.5,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":37.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.5,"standard_charge_algorithm": "Lesser of $26.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.5,"standard_charge_algorithm": "Lesser of $15.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.96,"standard_charge_algorithm": "Lesser of $15.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.27,"standard_charge_algorithm": "Lesser of $16.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.05,"standard_charge_algorithm": "Lesser of $17.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.43,"standard_charge_algorithm": "Lesser of $16.43 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VASOACTIVE INTSTNL PEPTD","code_information":[{"code":"84586","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB VASOACTIVE INTSTNL PEPTD","code_information":[{"code":"84586","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":24.8,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60.41,"standard_charge_algorithm": "Lesser of $60.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":77.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"standard_charge_algorithm": "Lesser of $35.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.8,"standard_charge_algorithm": "Lesser of $37.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.39,"standard_charge_algorithm": "Lesser of $36.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37.1,"standard_charge_algorithm": "Lesser of $37.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.86,"standard_charge_algorithm": "Lesser of $38.86 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.45,"standard_charge_algorithm": "Lesser of $37.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANTIDURETIC HRMN(ADH)","code_information":[{"code":"84588","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":129.6,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTIDURETIC HRMN(ADH)","code_information":[{"code":"84588","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":33.94,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":58.04,"standard_charge_algorithm": "Lesser of $58.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":74.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":82.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.94,"standard_charge_algorithm": "Lesser of $33.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36.32,"standard_charge_algorithm": "Lesser of $36.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.96,"standard_charge_algorithm": "Lesser of $34.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.64,"standard_charge_algorithm": "Lesser of $35.64 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37.33,"standard_charge_algorithm": "Lesser of $37.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.98,"standard_charge_algorithm": "Lesser of $35.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VITAMIN A","code_information":[{"code":"84590","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"HC LAB VITAMIN A","code_information":[{"code":"84590","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.85,"standard_charge_algorithm": "Lesser of $19.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"standard_charge_algorithm": "Lesser of $11.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"standard_charge_algorithm": "Lesser of $12.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.96,"standard_charge_algorithm": "Lesser of $11.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.19,"standard_charge_algorithm": "Lesser of $12.19 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.31,"standard_charge_algorithm": "Lesser of $12.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VITAMIN B3 B5 OR B7","code_information":[{"code":"84591","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC VITAMIN B3 B5 OR B7","code_information":[{"code":"84591","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":16.31,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.17,"standard_charge_algorithm": "Lesser of $29.17 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.06,"standard_charge_algorithm": "Lesser of $17.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.25,"standard_charge_algorithm": "Lesser of $18.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.57,"standard_charge_algorithm": "Lesser of $17.57 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.91,"standard_charge_algorithm": "Lesser of $17.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.77,"standard_charge_algorithm": "Lesser of $18.77 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.08,"standard_charge_algorithm": "Lesser of $18.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC VITAMIN K 1","code_information":[{"code":"84597","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":123.93,"maximum":123.93,"gross_charge":153,"discounted_cash":45.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.93,"methodology":"fee schedule"}]}]},{"description":"HC VITAMIN K 1","code_information":[{"code":"84597","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.72,"maximum":123.93,"gross_charge":153,"discounted_cash":45.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.46,"standard_charge_algorithm": "Lesser of $23.46 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.72,"standard_charge_algorithm": "Lesser of $13.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.68,"standard_charge_algorithm": "Lesser of $14.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.13,"standard_charge_algorithm": "Lesser of $14.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.41,"standard_charge_algorithm": "Lesser of $14.41 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.09,"standard_charge_algorithm": "Lesser of $15.09 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.54,"standard_charge_algorithm": "Lesser of $14.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"minimum":13038,"maximum":37927,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22956,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21702,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13885,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35801,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33566,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33369.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26039,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31045,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25804,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":35125.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37927,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23549,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23549,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13038,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19514.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20880.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20099.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20490.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20685.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20490.01,"methodology":"case rate"}]}]},{"description":"HC LAB ZINC","code_information":[{"code":"84630","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HC LAB ZINC","code_information":[{"code":"84630","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.39,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.48,"standard_charge_algorithm": "Lesser of $19.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"standard_charge_algorithm": "Lesser of $11.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.19,"standard_charge_algorithm": "Lesser of $12.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.73,"standard_charge_algorithm": "Lesser of $11.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.96,"standard_charge_algorithm": "Lesser of $11.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.53,"standard_charge_algorithm": "Lesser of $12.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.07,"standard_charge_algorithm": "Lesser of $12.07 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ZINC RBC","code_information":[{"code":"84630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HC LAB ZINC RBC","code_information":[{"code":"84630","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":11.39,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.48,"standard_charge_algorithm": "Lesser of $19.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.39,"standard_charge_algorithm": "Lesser of $11.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.19,"standard_charge_algorithm": "Lesser of $12.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.73,"standard_charge_algorithm": "Lesser of $11.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.96,"standard_charge_algorithm": "Lesser of $11.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.53,"standard_charge_algorithm": "Lesser of $12.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.07,"standard_charge_algorithm": "Lesser of $12.07 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB C-PEPTIDE","code_information":[{"code":"84681","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB C-PEPTIDE","code_information":[{"code":"84681","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"minimum":6889,"maximum":20288.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11422,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10798,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6889,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16908,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15853,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19274.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13166,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15698,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12803,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20288.88,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18871,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11717,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11717,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7325,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11271.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12060.62,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11609.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11835.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11947.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11835.18,"methodology":"case rate"}]}]},{"description":"HC LAB HCG QUANTITATIVE","code_information":[{"code":"84702","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC LAB HCG QUANTITATIVE","code_information":[{"code":"84702","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.03,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.74,"standard_charge_algorithm": "Lesser of $25.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.1,"standard_charge_algorithm": "Lesser of $16.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.5,"standard_charge_algorithm": "Lesser of $15.50 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.8,"standard_charge_algorithm": "Lesser of $15.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.95,"standard_charge_algorithm": "Lesser of $15.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HCG QUALITATIVE","code_information":[{"code":"84703","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":383.94,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB HCG QUALITATIVE","code_information":[{"code":"84703","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.52,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.86,"standard_charge_algorithm": "Lesser of $12.86 or 171 Percent of Billed Charges","median_amount":90.86,"10th_percentile":90.86,"90th_percentile":90.86,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.52,"standard_charge_algorithm": "Lesser of $7.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.05,"standard_charge_algorithm": "Lesser of $8.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.75,"standard_charge_algorithm": "Lesser of $7.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.9,"standard_charge_algorithm": "Lesser of $7.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.27,"standard_charge_algorithm": "Lesser of $8.27 or 110 Percent of Billed Charges","median_amount":27.88,"10th_percentile":27.88,"90th_percentile":27.88,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.97,"standard_charge_algorithm": "Lesser of $7.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"minimum":3661,"maximum":15232,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7361,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6959,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4751,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15232,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14282,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14311.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10043,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11973,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8829,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15064.6,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12162,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7551,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7551,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3661,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8369.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8955.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8620.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8787.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8871.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8787.69,"methodology":"case rate"}]}]},{"description":"RADIOTHERAPY","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"minimum":5135,"maximum":39669,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24010,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22699,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15291,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14879,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13950,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34657.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25281,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30141,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28416,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36482.1,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39669,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24630,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24630,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5135,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20267.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21686.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20875.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21281.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21483.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21281.23,"methodology":"case rate"}]}]},{"description":"DHT FREE LCMS/DIALYSIS","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"DHT FREE LCMS/DIALYSIS","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.8,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"}]}]},{"description":"HC OSMOLALITY FECES","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HC OSMOLALITY FECES","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":10.35,"maximum":56.33,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":34.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":34.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"}]}]},{"description":"HC POTASSIUM STOOL","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":387.99,"maximum":387.99,"gross_charge":479,"discounted_cash":141.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":387.99,"methodology":"fee schedule"}]}]},{"description":"HC POTASSIUM STOOL","code_information":[{"code":"84999","type":"CPT"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":50.58,"maximum":387.99,"gross_charge":479,"discounted_cash":141.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":239.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":239.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITH OTHER PROCEDURES","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"minimum":62286.19,"maximum":154188,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82806,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":78283,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":154188,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":144562,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":106509.39,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":112115.15,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136806,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":84943,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":84943,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":62286.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":66646.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":64154.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":65400.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":66023.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":65400.5,"methodology":"case rate"}]}]},{"description":"HC DIFFERENTIAL (AUTOMATED)","code_information":[{"code":"85004","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC DIFFERENTIAL (AUTOMATED)","code_information":[{"code":"85004","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DIFFERENTIAL","code_information":[{"code":"85007","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":79.38,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"}]}]},{"description":"HC DIFFERENTIAL","code_information":[{"code":"85007","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":3.8,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.5,"standard_charge_algorithm": "Lesser of $6.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"standard_charge_algorithm": "Lesser of $3.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"standard_charge_algorithm": "Lesser of $4.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.91,"standard_charge_algorithm": "Lesser of $3.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.99,"standard_charge_algorithm": "Lesser of $3.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.18,"standard_charge_algorithm": "Lesser of $4.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.03,"standard_charge_algorithm": "Lesser of $4.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WBC DIFF MANUAL","code_information":[{"code":"85007","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":79.38,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB WBC DIFF MANUAL","code_information":[{"code":"85007","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.8,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.5,"standard_charge_algorithm": "Lesser of $6.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.8,"standard_charge_algorithm": "Lesser of $3.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.07,"standard_charge_algorithm": "Lesser of $4.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.91,"standard_charge_algorithm": "Lesser of $3.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.99,"standard_charge_algorithm": "Lesser of $3.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.18,"standard_charge_algorithm": "Lesser of $4.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.03,"standard_charge_algorithm": "Lesser of $4.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WBC DIFF BUFFY COAT","code_information":[{"code":"85009","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":92.34,"maximum":92.34,"gross_charge":114,"discounted_cash":33.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.34,"methodology":"fee schedule"}]}]},{"description":"HC LAB WBC DIFF BUFFY COAT","code_information":[{"code":"85009","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.07,"maximum":92.34,"gross_charge":114,"discounted_cash":33.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.67,"standard_charge_algorithm": "Lesser of $8.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.07,"standard_charge_algorithm": "Lesser of $5.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.42,"standard_charge_algorithm": "Lesser of $5.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.32,"standard_charge_algorithm": "Lesser of $5.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.58,"standard_charge_algorithm": "Lesser of $5.58 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.37,"standard_charge_algorithm": "Lesser of $5.37 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8501","type":"APR-DRG"}],"standard_charges":[{"minimum":13366,"maximum":13366,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13366,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13366,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13366,"methodology":"case rate"}]}]},{"description":"HC LAB HEMATOCRIT","code_information":[{"code":"85014","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEMATOCRIT","code_information":[{"code":"85014","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.05,"standard_charge_algorithm": "Lesser of $4.05 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"standard_charge_algorithm": "Lesser of $2.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"standard_charge_algorithm": "Lesser of $2.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.44,"standard_charge_algorithm": "Lesser of $2.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.49,"standard_charge_algorithm": "Lesser of $2.49 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.61,"standard_charge_algorithm": "Lesser of $2.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.51,"standard_charge_algorithm": "Lesser of $2.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEMOGLOBIN","code_information":[{"code":"85018","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":97.2,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEMOGLOBIN","code_information":[{"code":"85018","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.05,"standard_charge_algorithm": "Lesser of $4.05 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.37,"standard_charge_algorithm": "Lesser of $2.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"standard_charge_algorithm": "Lesser of $2.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.44,"standard_charge_algorithm": "Lesser of $2.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.49,"standard_charge_algorithm": "Lesser of $2.49 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.61,"standard_charge_algorithm": "Lesser of $2.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.51,"standard_charge_algorithm": "Lesser of $2.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8502","type":"APR-DRG"}],"standard_charges":[{"minimum":16651,"maximum":16651,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16651,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16651,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16651,"methodology":"case rate"}]}]},{"description":"HC LAB CBC W/AUTO DIFF","code_information":[{"code":"85025","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":226.8,"maximum":226.8,"gross_charge":280,"discounted_cash":82.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":226.8,"methodology":"fee schedule"}]}]},{"description":"HC LAB CBC W/AUTO DIFF","code_information":[{"code":"85025","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.77,"maximum":226.8,"gross_charge":280,"discounted_cash":82.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.29,"standard_charge_algorithm": "Lesser of $13.29 or 171 Percent of Billed Charges","median_amount":57.15,"10th_percentile":55.5,"90th_percentile":57.15,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.77,"standard_charge_algorithm": "Lesser of $7.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.31,"standard_charge_algorithm": "Lesser of $8.31 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8,"standard_charge_algorithm": "Lesser of $8.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.16,"standard_charge_algorithm": "Lesser of $8.16 or 105 Percent of Billed Charges","median_amount":8.16,"10th_percentile":8.16,"90th_percentile":8.16,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.55,"standard_charge_algorithm": "Lesser of $8.55 or 110 Percent of Billed Charges","median_amount":7.77,"10th_percentile":7.77,"90th_percentile":7.77,"count":"42","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.24,"standard_charge_algorithm": "Lesser of $8.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CBC (W/PLT&HEMOGRAM)","code_information":[{"code":"85027","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":232.47,"maximum":232.47,"gross_charge":287,"discounted_cash":84.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.47,"methodology":"fee schedule"}]}]},{"description":"HC LAB CBC (W/PLT&HEMOGRAM)","code_information":[{"code":"85027","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":232.47,"gross_charge":287,"discounted_cash":84.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8503","type":"APR-DRG"}],"standard_charges":[{"minimum":17926,"maximum":17926,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17926,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17926,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17926,"methodology":"case rate"}]}]},{"description":"PROCEDURE WITH DIAGNOSIS OF REHABILITATION AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES","code_information":[{"code":"8504","type":"APR-DRG"}],"standard_charges":[{"minimum":28762,"maximum":28762,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28762,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28762,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28762,"methodology":"case rate"}]}]},{"description":"HC LAB RBC AUTOMATED","code_information":[{"code":"85041","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB RBC AUTOMATED","code_information":[{"code":"85041","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.02,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.16,"standard_charge_algorithm": "Lesser of $5.16 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.23,"standard_charge_algorithm": "Lesser of $3.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.11,"standard_charge_algorithm": "Lesser of $3.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.17,"standard_charge_algorithm": "Lesser of $3.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.32,"standard_charge_algorithm": "Lesser of $3.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.2,"standard_charge_algorithm": "Lesser of $3.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RETICULOCYTE AUTO","code_information":[{"code":"85045","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB RETICULOCYTE AUTO","code_information":[{"code":"85045","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.99,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.82,"standard_charge_algorithm": "Lesser of $6.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.99,"standard_charge_algorithm": "Lesser of $3.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.11,"standard_charge_algorithm": "Lesser of $4.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.19,"standard_charge_algorithm": "Lesser of $4.19 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.39,"standard_charge_algorithm": "Lesser of $4.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.23,"standard_charge_algorithm": "Lesser of $4.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WBC AUTOMATED","code_information":[{"code":"85048","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.39,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB WBC AUTOMATED","code_information":[{"code":"85048","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.54,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.34,"standard_charge_algorithm": "Lesser of $4.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"standard_charge_algorithm": "Lesser of $2.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.72,"standard_charge_algorithm": "Lesser of $2.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.62,"standard_charge_algorithm": "Lesser of $2.62 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.79,"standard_charge_algorithm": "Lesser of $2.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.69,"standard_charge_algorithm": "Lesser of $2.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WHITE CELL COUNT","code_information":[{"code":"85048","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":15.39,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB WHITE CELL COUNT","code_information":[{"code":"85048","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.54,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.34,"standard_charge_algorithm": "Lesser of $4.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.54,"standard_charge_algorithm": "Lesser of $2.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.72,"standard_charge_algorithm": "Lesser of $2.72 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.62,"standard_charge_algorithm": "Lesser of $2.62 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.79,"standard_charge_algorithm": "Lesser of $2.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.69,"standard_charge_algorithm": "Lesser of $2.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PLATELET COUNT AUTO","code_information":[{"code":"85049","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":210.6,"maximum":210.6,"gross_charge":260,"discounted_cash":76.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLATELET COUNT AUTO","code_information":[{"code":"85049","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.48,"maximum":210.6,"gross_charge":260,"discounted_cash":76.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.66,"standard_charge_algorithm": "Lesser of $7.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.79,"standard_charge_algorithm": "Lesser of $4.79 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.93,"standard_charge_algorithm": "Lesser of $4.93 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR II (2)","code_information":[{"code":"85210","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":444.69,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR II (2)","code_information":[{"code":"85210","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.98,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.2,"standard_charge_algorithm": "Lesser of $22.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.98,"standard_charge_algorithm": "Lesser of $12.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.89,"standard_charge_algorithm": "Lesser of $13.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.63,"standard_charge_algorithm": "Lesser of $13.63 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.28,"standard_charge_algorithm": "Lesser of $14.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.76,"standard_charge_algorithm": "Lesser of $13.76 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COAG FACTOR V ASSAY","code_information":[{"code":"85220","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":433.35,"maximum":433.35,"gross_charge":535,"discounted_cash":158.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":433.35,"methodology":"fee schedule"}]}]},{"description":"HC LAB COAG FACTOR V ASSAY","code_information":[{"code":"85220","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":17.65,"maximum":433.35,"gross_charge":535,"discounted_cash":158.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.18,"standard_charge_algorithm": "Lesser of $30.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.89,"standard_charge_algorithm": "Lesser of $18.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.18,"standard_charge_algorithm": "Lesser of $18.18 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.53,"standard_charge_algorithm": "Lesser of $18.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.41,"standard_charge_algorithm": "Lesser of $19.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.71,"standard_charge_algorithm": "Lesser of $18.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR V (5)","code_information":[{"code":"85220","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR V (5)","code_information":[{"code":"85220","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.65,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.18,"standard_charge_algorithm": "Lesser of $30.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.89,"standard_charge_algorithm": "Lesser of $18.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.18,"standard_charge_algorithm": "Lesser of $18.18 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.53,"standard_charge_algorithm": "Lesser of $18.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.41,"standard_charge_algorithm": "Lesser of $19.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.71,"standard_charge_algorithm": "Lesser of $18.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR VII (7)","code_information":[{"code":"85230","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR VII (7)","code_information":[{"code":"85230","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.9,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.61,"standard_charge_algorithm": "Lesser of $30.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"standard_charge_algorithm": "Lesser of $17.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"standard_charge_algorithm": "Lesser of $19.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.44,"standard_charge_algorithm": "Lesser of $18.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.79,"standard_charge_algorithm": "Lesser of $18.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR VIII (8)","code_information":[{"code":"85240","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":93.96,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR VIII (8)","code_information":[{"code":"85240","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.9,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.61,"standard_charge_algorithm": "Lesser of $30.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"standard_charge_algorithm": "Lesser of $17.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"standard_charge_algorithm": "Lesser of $19.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.44,"standard_charge_algorithm": "Lesser of $18.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.79,"standard_charge_algorithm": "Lesser of $18.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RISTOCETIN COFACTOR/VWF ACTIVITY","code_information":[{"code":"85245","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":122.31,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"}]}]},{"description":"HC LAB RISTOCETIN COFACTOR/VWF ACTIVITY","code_information":[{"code":"85245","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.94,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.23,"standard_charge_algorithm": "Lesser of $39.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"standard_charge_algorithm": "Lesser of $22.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.55,"standard_charge_algorithm": "Lesser of $24.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.63,"standard_charge_algorithm": "Lesser of $23.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.09,"standard_charge_algorithm": "Lesser of $24.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.23,"standard_charge_algorithm": "Lesser of $25.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.32,"standard_charge_algorithm": "Lesser of $24.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR VIII VWF ANTIGEN","code_information":[{"code":"85246","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":119.07,"maximum":119.07,"gross_charge":147,"discounted_cash":43.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.07,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR VIII VWF ANTIGEN","code_information":[{"code":"85246","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.94,"maximum":119.07,"gross_charge":147,"discounted_cash":43.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.23,"standard_charge_algorithm": "Lesser of $39.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"standard_charge_algorithm": "Lesser of $22.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.55,"standard_charge_algorithm": "Lesser of $24.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.63,"standard_charge_algorithm": "Lesser of $23.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.09,"standard_charge_algorithm": "Lesser of $24.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.23,"standard_charge_algorithm": "Lesser of $25.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.32,"standard_charge_algorithm": "Lesser of $24.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VWF MULTIMERS","code_information":[{"code":"85247","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":232.47,"maximum":232.47,"gross_charge":287,"discounted_cash":84.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.47,"methodology":"fee schedule"}]}]},{"description":"HC LAB VWF MULTIMERS","code_information":[{"code":"85247","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.94,"maximum":232.47,"gross_charge":287,"discounted_cash":84.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.23,"standard_charge_algorithm": "Lesser of $39.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.94,"standard_charge_algorithm": "Lesser of $22.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.55,"standard_charge_algorithm": "Lesser of $24.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.63,"standard_charge_algorithm": "Lesser of $23.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.09,"standard_charge_algorithm": "Lesser of $24.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.23,"standard_charge_algorithm": "Lesser of $25.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.32,"standard_charge_algorithm": "Lesser of $24.32 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR IX (9)","code_information":[{"code":"85250","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR IX (9)","code_information":[{"code":"85250","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.04,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.56,"standard_charge_algorithm": "Lesser of $32.56 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.04,"standard_charge_algorithm": "Lesser of $19.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.37,"standard_charge_algorithm": "Lesser of $20.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.61,"standard_charge_algorithm": "Lesser of $19.61 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.99,"standard_charge_algorithm": "Lesser of $19.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.94,"standard_charge_algorithm": "Lesser of $20.94 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.18,"standard_charge_algorithm": "Lesser of $20.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR X (10)","code_information":[{"code":"85260","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":444.69,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR X (10)","code_information":[{"code":"85260","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.9,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.61,"standard_charge_algorithm": "Lesser of $30.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"standard_charge_algorithm": "Lesser of $17.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"standard_charge_algorithm": "Lesser of $19.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.44,"standard_charge_algorithm": "Lesser of $18.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.79,"standard_charge_algorithm": "Lesser of $18.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR XI (11)","code_information":[{"code":"85270","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR XI (11)","code_information":[{"code":"85270","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.9,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.61,"standard_charge_algorithm": "Lesser of $30.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"standard_charge_algorithm": "Lesser of $17.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.15,"standard_charge_algorithm": "Lesser of $19.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.44,"standard_charge_algorithm": "Lesser of $18.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.79,"standard_charge_algorithm": "Lesser of $18.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.97,"standard_charge_algorithm": "Lesser of $18.97 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR XII (12)","code_information":[{"code":"85280","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR XII (12)","code_information":[{"code":"85280","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.09,"standard_charge_algorithm": "Lesser of $33.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.7,"standard_charge_algorithm": "Lesser of $20.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.93,"standard_charge_algorithm": "Lesser of $19.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.51,"standard_charge_algorithm": "Lesser of $20.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR XIII (13)","code_information":[{"code":"85291","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":328.86,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR XIII (13)","code_information":[{"code":"85291","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.11,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.58,"standard_charge_algorithm": "Lesser of $15.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.11,"standard_charge_algorithm": "Lesser of $9.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.75,"standard_charge_algorithm": "Lesser of $9.75 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.38,"standard_charge_algorithm": "Lesser of $9.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.57,"standard_charge_algorithm": "Lesser of $9.57 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.02,"standard_charge_algorithm": "Lesser of $10.02 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.66,"standard_charge_algorithm": "Lesser of $9.66 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":28403,"maximum":87699,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44957,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42501,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":28403,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":87699,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":82224,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60255.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52975,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63159,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52783,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":63426.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74275,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46117,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46117,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33279,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35237.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37703.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36294.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36998.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37351.36,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":36998.99,"methodology":"case rate"}]}]},{"description":"HC LAB ANTI-THROMBIN III","code_information":[{"code":"85300","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTI-THROMBIN III","code_information":[{"code":"85300","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.85,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.26,"standard_charge_algorithm": "Lesser of $20.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.85,"standard_charge_algorithm": "Lesser of $11.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.21,"standard_charge_algorithm": "Lesser of $12.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.44,"standard_charge_algorithm": "Lesser of $12.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.04,"standard_charge_algorithm": "Lesser of $13.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.56,"standard_charge_algorithm": "Lesser of $12.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ANTITHROMBIN ANTIGEN","code_information":[{"code":"85301","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC ANTITHROMBIN ANTIGEN","code_information":[{"code":"85301","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.81,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.49,"standard_charge_algorithm": "Lesser of $18.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.81,"standard_charge_algorithm": "Lesser of $10.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"standard_charge_algorithm": "Lesser of $11.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.13,"standard_charge_algorithm": "Lesser of $11.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.35,"standard_charge_algorithm": "Lesser of $11.35 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.89,"standard_charge_algorithm": "Lesser of $11.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.46,"standard_charge_algorithm": "Lesser of $11.46 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN C ANTIGENIC","code_information":[{"code":"85302","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN C ANTIGENIC","code_information":[{"code":"85302","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.01,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.54,"standard_charge_algorithm": "Lesser of $20.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"standard_charge_algorithm": "Lesser of $12.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.85,"standard_charge_algorithm": "Lesser of $12.85 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.37,"standard_charge_algorithm": "Lesser of $12.37 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.61,"standard_charge_algorithm": "Lesser of $12.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.21,"standard_charge_algorithm": "Lesser of $13.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN C ACTIVITY","code_information":[{"code":"85303","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN C ACTIVITY","code_information":[{"code":"85303","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.84,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.67,"standard_charge_algorithm": "Lesser of $23.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"standard_charge_algorithm": "Lesser of $13.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.81,"standard_charge_algorithm": "Lesser of $14.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.26,"standard_charge_algorithm": "Lesser of $14.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.53,"standard_charge_algorithm": "Lesser of $14.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.67,"standard_charge_algorithm": "Lesser of $14.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PROT C ACTIVITY (CHROMOGENIC)","code_information":[{"code":"85303","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"PROT C ACTIVITY (CHROMOGENIC)","code_information":[{"code":"85303","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":13.84,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.67,"standard_charge_algorithm": "Lesser of $23.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.84,"standard_charge_algorithm": "Lesser of $13.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.81,"standard_charge_algorithm": "Lesser of $14.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.26,"standard_charge_algorithm": "Lesser of $14.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.53,"standard_charge_algorithm": "Lesser of $14.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.67,"standard_charge_algorithm": "Lesser of $14.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN S-TOTAL","code_information":[{"code":"85305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN S-TOTAL","code_information":[{"code":"85305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.61,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.85,"standard_charge_algorithm": "Lesser of $19.85 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.61,"standard_charge_algorithm": "Lesser of $11.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.42,"standard_charge_algorithm": "Lesser of $12.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.96,"standard_charge_algorithm": "Lesser of $11.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.19,"standard_charge_algorithm": "Lesser of $12.19 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.31,"standard_charge_algorithm": "Lesser of $12.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN S FREE","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN S FREE","code_information":[{"code":"85306","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":15.32,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.2,"standard_charge_algorithm": "Lesser of $26.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"standard_charge_algorithm": "Lesser of $16.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.78,"standard_charge_algorithm": "Lesser of $15.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.09,"standard_charge_algorithm": "Lesser of $16.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.24,"standard_charge_algorithm": "Lesser of $16.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PROTEIN S-FREE","code_information":[{"code":"85306","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB PROTEIN S-FREE","code_information":[{"code":"85306","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.32,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.2,"standard_charge_algorithm": "Lesser of $26.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"standard_charge_algorithm": "Lesser of $16.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.78,"standard_charge_algorithm": "Lesser of $15.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.09,"standard_charge_algorithm": "Lesser of $16.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.24,"standard_charge_algorithm": "Lesser of $16.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ACT PROTEIN C RESIST","code_information":[{"code":"85307","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB ACT PROTEIN C RESIST","code_information":[{"code":"85307","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.32,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.2,"standard_charge_algorithm": "Lesser of $26.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.32,"standard_charge_algorithm": "Lesser of $15.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.39,"standard_charge_algorithm": "Lesser of $16.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.78,"standard_charge_algorithm": "Lesser of $15.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.09,"standard_charge_algorithm": "Lesser of $16.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.24,"standard_charge_algorithm": "Lesser of $16.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FACTOR INHIBITOR TEST","code_information":[{"code":"85335","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":306.99,"maximum":306.99,"gross_charge":379,"discounted_cash":112.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.99,"methodology":"fee schedule"}]}]},{"description":"HC LAB FACTOR INHIBITOR TEST","code_information":[{"code":"85335","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.87,"maximum":306.99,"gross_charge":379,"discounted_cash":112.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.01,"standard_charge_algorithm": "Lesser of $22.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"standard_charge_algorithm": "Lesser of $12.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.51,"standard_charge_algorithm": "Lesser of $13.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.16,"standard_charge_algorithm": "Lesser of $14.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ACT","code_information":[{"code":"85347","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":213.03,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB ACT","code_information":[{"code":"85347","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.28,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"standard_charge_algorithm": "Lesser of $7.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"standard_charge_algorithm": "Lesser of $4.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"standard_charge_algorithm": "Lesser of $4.58 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"standard_charge_algorithm": "Lesser of $4.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"standard_charge_algorithm": "Lesser of $4.49 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"standard_charge_algorithm": "Lesser of $4.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FIBRIN DEGRADATION PRODUCTS","code_information":[{"code":"85362","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":24.3,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"}]}]},{"description":"FIBRIN DEGRADATION PRODUCTS","code_information":[{"code":"85362","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.89,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.78,"standard_charge_algorithm": "Lesser of $11.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.89,"standard_charge_algorithm": "Lesser of $6.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.37,"standard_charge_algorithm": "Lesser of $7.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.1,"standard_charge_algorithm": "Lesser of $7.10 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.23,"standard_charge_algorithm": "Lesser of $7.23 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.58,"standard_charge_algorithm": "Lesser of $7.58 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC APTT PATIENT","code_information":[{"code":"85370","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.92,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"}]}]},{"description":"HC APTT PATIENT","code_information":[{"code":"85370","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.43,"maximum":32.15,"gross_charge":32,"discounted_cash":9.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.26,"standard_charge_algorithm": "Lesser of $21.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.43,"standard_charge_algorithm": "Lesser of $12.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.3,"standard_charge_algorithm": "Lesser of $13.30 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.8,"standard_charge_algorithm": "Lesser of $12.80 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.05,"standard_charge_algorithm": "Lesser of $13.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.67,"standard_charge_algorithm": "Lesser of $13.67 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB D-DIMER","code_information":[{"code":"85379","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":442.26,"maximum":442.26,"gross_charge":546,"discounted_cash":161.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"}]}]},{"description":"HC LAB D-DIMER","code_information":[{"code":"85379","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.18,"maximum":442.26,"gross_charge":546,"discounted_cash":161.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.41,"standard_charge_algorithm": "Lesser of $17.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"standard_charge_algorithm": "Lesser of $10.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.89,"standard_charge_algorithm": "Lesser of $10.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.2,"standard_charge_algorithm": "Lesser of $11.20 or 110 Percent of Billed Charges","median_amount":10.18,"10th_percentile":9.28,"90th_percentile":546,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.79,"standard_charge_algorithm": "Lesser of $10.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FIBRINOGEN","code_information":[{"code":"85384","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":332.91,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"}]}]},{"description":"HC LAB FIBRINOGEN","code_information":[{"code":"85384","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.72,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.62,"standard_charge_algorithm": "Lesser of $16.62 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"standard_charge_algorithm": "Lesser of $9.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.4,"standard_charge_algorithm": "Lesser of $10.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.01,"standard_charge_algorithm": "Lesser of $10.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.21,"standard_charge_algorithm": "Lesser of $10.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.3,"standard_charge_algorithm": "Lesser of $10.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FIBRINOGEN ACTIVITY","code_information":[{"code":"85384","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":332.91,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"}]}]},{"description":"HC LAB FIBRINOGEN ACTIVITY","code_information":[{"code":"85384","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":9.72,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.62,"standard_charge_algorithm": "Lesser of $16.62 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.72,"standard_charge_algorithm": "Lesser of $9.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.4,"standard_charge_algorithm": "Lesser of $10.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.01,"standard_charge_algorithm": "Lesser of $10.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.21,"standard_charge_algorithm": "Lesser of $10.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.3,"standard_charge_algorithm": "Lesser of $10.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FIBRINOLYSIS OR COAGULOPATHY S","code_information":[{"code":"85390","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC FIBRINOLYSIS OR COAGULOPATHY S","code_information":[{"code":"85390","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.27,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.47,"standard_charge_algorithm": "Lesser of $26.47 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"standard_charge_algorithm": "Lesser of $15.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.56,"standard_charge_algorithm": "Lesser of $16.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.94,"standard_charge_algorithm": "Lesser of $15.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.25,"standard_charge_algorithm": "Lesser of $16.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.41,"standard_charge_algorithm": "Lesser of $16.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HEMOSTASIS SCREEN","code_information":[{"code":"85390","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC HEMOSTASIS SCREEN","code_information":[{"code":"85390","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":7.27,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.47,"standard_charge_algorithm": "Lesser of $26.47 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.48,"standard_charge_algorithm": "Lesser of $15.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.56,"standard_charge_algorithm": "Lesser of $16.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.94,"standard_charge_algorithm": "Lesser of $15.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.25,"standard_charge_algorithm": "Lesser of $16.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.41,"standard_charge_algorithm": "Lesser of $16.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VWF CLEAV PROTEASE ACT","code_information":[{"code":"85397","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":451.17,"maximum":451.17,"gross_charge":557,"discounted_cash":164.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.17,"methodology":"fee schedule"}]}]},{"description":"HC LAB VWF CLEAV PROTEASE ACT","code_information":[{"code":"85397","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":30,"maximum":451.17,"gross_charge":557,"discounted_cash":164.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30.86,"standard_charge_algorithm": "Lesser of $30.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33.02,"standard_charge_algorithm": "Lesser of $33.02 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31.79,"standard_charge_algorithm": "Lesser of $31.79 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32.4,"standard_charge_algorithm": "Lesser of $32.40 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":33.95,"standard_charge_algorithm": "Lesser of $33.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32.71,"standard_charge_algorithm": "Lesser of $32.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"minimum":11580,"maximum":66469,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17961,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16980,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11580,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66469,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62319,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27265.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22219,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26491,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21519,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28700.01,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29674,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18424,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18424,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13763,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15944.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17060.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16422.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16741.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16901.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16741.68,"methodology":"case rate"}]}]},{"description":"HC PLASMINOGEN ACTIVATOR INHIB 1","code_information":[{"code":"85415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":167.67,"maximum":167.67,"gross_charge":207,"discounted_cash":61.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.67,"methodology":"fee schedule"}]}]},{"description":"HC PLASMINOGEN ACTIVATOR INHIB 1","code_information":[{"code":"85415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.19,"maximum":167.67,"gross_charge":207,"discounted_cash":61.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.39,"standard_charge_algorithm": "Lesser of $29.39 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"standard_charge_algorithm": "Lesser of $17.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"standard_charge_algorithm": "Lesser of $18.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.91,"standard_charge_algorithm": "Lesser of $18.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.22,"standard_charge_algorithm": "Lesser of $18.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PLAMINOGEN ACT INHIBITOR-1 AG","code_information":[{"code":"85415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"PLAMINOGEN ACT INHIBITOR-1 AG","code_information":[{"code":"85415","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.19,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.39,"standard_charge_algorithm": "Lesser of $29.39 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"standard_charge_algorithm": "Lesser of $17.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.39,"standard_charge_algorithm": "Lesser of $18.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.91,"standard_charge_algorithm": "Lesser of $18.91 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.22,"standard_charge_algorithm": "Lesser of $18.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PLASMINOGEN","code_information":[{"code":"85420","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":444.69,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLASMINOGEN","code_information":[{"code":"85420","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.53,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.17,"standard_charge_algorithm": "Lesser of $11.17 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.53,"standard_charge_algorithm": "Lesser of $6.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.99,"standard_charge_algorithm": "Lesser of $6.99 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.73,"standard_charge_algorithm": "Lesser of $6.73 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.18,"standard_charge_algorithm": "Lesser of $7.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB KLEIHAUER WORKUP","code_information":[{"code":"85460","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":121.5,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB KLEIHAUER WORKUP","code_information":[{"code":"85460","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.4,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.22,"standard_charge_algorithm": "Lesser of $13.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.73,"standard_charge_algorithm": "Lesser of $7.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.27,"standard_charge_algorithm": "Lesser of $8.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.96,"standard_charge_algorithm": "Lesser of $7.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.12,"standard_charge_algorithm": "Lesser of $8.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.5,"standard_charge_algorithm": "Lesser of $8.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.19,"standard_charge_algorithm": "Lesser of $8.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"minimum":8683,"maximum":56347,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14612,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13814,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9668,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56347,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52829,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23173.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16513,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19687,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17968,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24392.69,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24142,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14990,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14990,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8683,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13551.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14500.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13958.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14229.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14364.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14229.07,"methodology":"case rate"}]}]},{"description":"HC LAB HEPARIN ASSAY","code_information":[{"code":"85520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEPARIN ASSAY","code_information":[{"code":"85520","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.09,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.38,"standard_charge_algorithm": "Lesser of $22.38 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.09,"standard_charge_algorithm": "Lesser of $13.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.01,"standard_charge_algorithm": "Lesser of $14.01 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.48,"standard_charge_algorithm": "Lesser of $13.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.74,"standard_charge_algorithm": "Lesser of $13.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.4,"standard_charge_algorithm": "Lesser of $14.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.88,"standard_charge_algorithm": "Lesser of $13.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LEUKOCYTE ALK PHOS(LAP)","code_information":[{"code":"85540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.86,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB LEUKOCYTE ALK PHOS(LAP)","code_information":[{"code":"85540","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.5,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.71,"standard_charge_algorithm": "Lesser of $14.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.2,"standard_charge_algorithm": "Lesser of $9.20 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.03,"standard_charge_algorithm": "Lesser of $9.03 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.12,"standard_charge_algorithm": "Lesser of $9.12 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LYSOZYME","code_information":[{"code":"85549","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LYSOZYME","code_information":[{"code":"85549","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.75,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.06,"standard_charge_algorithm": "Lesser of $32.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.75,"standard_charge_algorithm": "Lesser of $18.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.06,"standard_charge_algorithm": "Lesser of $20.06 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.69,"standard_charge_algorithm": "Lesser of $19.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.63,"standard_charge_algorithm": "Lesser of $20.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.88,"standard_charge_algorithm": "Lesser of $19.88 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PLT AGGREG EA AGENT","code_information":[{"code":"85576","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":430.11,"maximum":430.11,"gross_charge":531,"discounted_cash":157.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":430.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLT AGGREG EA AGENT","code_information":[{"code":"85576","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":430.11,"gross_charge":531,"discounted_cash":157.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.6,"standard_charge_algorithm": "Lesser of $42.60 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"standard_charge_algorithm": "Lesser of $24.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"standard_charge_algorithm": "Lesser of $26.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.66,"standard_charge_algorithm": "Lesser of $25.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.16,"standard_charge_algorithm": "Lesser of $26.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.4,"standard_charge_algorithm": "Lesser of $27.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.4,"standard_charge_algorithm": "Lesser of $26.40 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TEG ASPIRIN (AA)","code_information":[{"code":"85576","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":430.11,"maximum":430.11,"gross_charge":531,"discounted_cash":157.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":430.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB TEG ASPIRIN (AA)","code_information":[{"code":"85576","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":24.91,"maximum":430.11,"gross_charge":531,"discounted_cash":157.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.6,"standard_charge_algorithm": "Lesser of $42.60 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.91,"standard_charge_algorithm": "Lesser of $24.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.65,"standard_charge_algorithm": "Lesser of $26.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.66,"standard_charge_algorithm": "Lesser of $25.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.16,"standard_charge_algorithm": "Lesser of $26.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.4,"standard_charge_algorithm": "Lesser of $27.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.4,"standard_charge_algorithm": "Lesser of $26.40 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HEXAGONAL PHASE PHOSPHOLIPID","code_information":[{"code":"85598","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HEXAGONAL PHASE PHOSPHOLIPID","code_information":[{"code":"85598","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.98,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.75,"standard_charge_algorithm": "Lesser of $30.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"standard_charge_algorithm": "Lesser of $17.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.24,"standard_charge_algorithm": "Lesser of $19.24 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.52,"standard_charge_algorithm": "Lesser of $18.52 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.88,"standard_charge_algorithm": "Lesser of $18.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.78,"standard_charge_algorithm": "Lesser of $19.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.06,"standard_charge_algorithm": "Lesser of $19.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"minimum":23838,"maximum":67002,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40555,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38340,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25159,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66193,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62060,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":54876.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47697,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56866,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46755,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":57764.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67002,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41601,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41601,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23838,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32091.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34337.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":33054.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":33695.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34016.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":33695.84,"methodology":"case rate"}]}]},{"description":"HC LAB PT","code_information":[{"code":"85610","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":209.79,"maximum":209.79,"gross_charge":259,"discounted_cash":76.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB PT","code_information":[{"code":"85610","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.29,"maximum":209.79,"gross_charge":259,"discounted_cash":76.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.34,"standard_charge_algorithm": "Lesser of $7.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"standard_charge_algorithm": "Lesser of $4.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.59,"standard_charge_algorithm": "Lesser of $4.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.42,"standard_charge_algorithm": "Lesser of $4.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.5,"standard_charge_algorithm": "Lesser of $4.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.72,"standard_charge_algorithm": "Lesser of $4.72 or 110 Percent of Billed Charges","median_amount":4.29,"10th_percentile":4.29,"90th_percentile":4.29,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PT (NOT ORD)","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":209.79,"maximum":209.79,"gross_charge":259,"discounted_cash":76.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB PT (NOT ORD)","code_information":[{"code":"85610","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.29,"maximum":209.79,"gross_charge":259,"discounted_cash":76.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.34,"standard_charge_algorithm": "Lesser of $7.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"standard_charge_algorithm": "Lesser of $4.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.59,"standard_charge_algorithm": "Lesser of $4.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.42,"standard_charge_algorithm": "Lesser of $4.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.5,"standard_charge_algorithm": "Lesser of $4.50 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.72,"standard_charge_algorithm": "Lesser of $4.72 or 110 Percent of Billed Charges","median_amount":4.29,"10th_percentile":4.29,"90th_percentile":4.29,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 1/1 MIX PT","code_information":[{"code":"85611","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB 1/1 MIX PT","code_information":[{"code":"85611","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.94,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.74,"standard_charge_algorithm": "Lesser of $6.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.94,"standard_charge_algorithm": "Lesser of $3.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.22,"standard_charge_algorithm": "Lesser of $4.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.06,"standard_charge_algorithm": "Lesser of $4.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.14,"standard_charge_algorithm": "Lesser of $4.14 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.33,"standard_charge_algorithm": "Lesser of $4.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.18,"standard_charge_algorithm": "Lesser of $4.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RUSSELL VIPER VEN TM DIL","code_information":[{"code":"85613","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":43.74,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"}]}]},{"description":"HC LAB RUSSELL VIPER VEN TM DIL","code_information":[{"code":"85613","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.58,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.38,"standard_charge_algorithm": "Lesser of $16.38 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.58,"standard_charge_algorithm": "Lesser of $9.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.25,"standard_charge_algorithm": "Lesser of $10.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.87,"standard_charge_algorithm": "Lesser of $9.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.06,"standard_charge_algorithm": "Lesser of $10.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.54,"standard_charge_algorithm": "Lesser of $10.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.15,"standard_charge_algorithm": "Lesser of $10.15 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SED RATE","code_information":[{"code":"85651","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB SED RATE","code_information":[{"code":"85651","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SED RATE UNAUTOMATED","code_information":[{"code":"85651","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB SED RATE UNAUTOMATED","code_information":[{"code":"85651","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SED RATE","code_information":[{"code":"85652","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":147.42,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"}]}]},{"description":"HC LAB SED RATE","code_information":[{"code":"85652","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":2.7,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.62,"standard_charge_algorithm": "Lesser of $4.62 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"standard_charge_algorithm": "Lesser of $2.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.89,"standard_charge_algorithm": "Lesser of $2.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.78,"standard_charge_algorithm": "Lesser of $2.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.86,"standard_charge_algorithm": "Lesser of $2.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SEDIMENTATION RATE (SED)","code_information":[{"code":"85652","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":147.42,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"}]}]},{"description":"HC LAB SEDIMENTATION RATE (SED)","code_information":[{"code":"85652","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.7,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.62,"standard_charge_algorithm": "Lesser of $4.62 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"standard_charge_algorithm": "Lesser of $2.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.89,"standard_charge_algorithm": "Lesser of $2.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.78,"standard_charge_algorithm": "Lesser of $2.78 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.86,"standard_charge_algorithm": "Lesser of $2.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SICKLE CELL PREP","code_information":[{"code":"85660","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.86,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"}]}]},{"description":"HC LAB SICKLE CELL PREP","code_information":[{"code":"85660","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.51,"maximum":85.86,"gross_charge":106,"discounted_cash":31.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.42,"standard_charge_algorithm": "Lesser of $9.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"standard_charge_algorithm": "Lesser of $5.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"standard_charge_algorithm": "Lesser of $5.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.68,"standard_charge_algorithm": "Lesser of $5.68 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.79,"standard_charge_algorithm": "Lesser of $5.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.06,"standard_charge_algorithm": "Lesser of $6.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.84,"standard_charge_algorithm": "Lesser of $5.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HGB SOLUBILITY","code_information":[{"code":"85660","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HGB SOLUBILITY","code_information":[{"code":"85660","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.51,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.42,"standard_charge_algorithm": "Lesser of $9.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.51,"standard_charge_algorithm": "Lesser of $5.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.9,"standard_charge_algorithm": "Lesser of $5.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.68,"standard_charge_algorithm": "Lesser of $5.68 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.79,"standard_charge_algorithm": "Lesser of $5.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.06,"standard_charge_algorithm": "Lesser of $6.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.84,"standard_charge_algorithm": "Lesser of $5.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THROMBIN TIME","code_information":[{"code":"85670","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB THROMBIN TIME","code_information":[{"code":"85670","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.77,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.87,"standard_charge_algorithm": "Lesser of $9.87 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"standard_charge_algorithm": "Lesser of $5.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.17,"standard_charge_algorithm": "Lesser of $6.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.94,"standard_charge_algorithm": "Lesser of $5.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.06,"standard_charge_algorithm": "Lesser of $6.06 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.35,"standard_charge_algorithm": "Lesser of $6.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.12,"standard_charge_algorithm": "Lesser of $6.12 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"minimum":10608,"maximum":32359,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19586,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18516,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12134,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25997,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24374,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29251.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22796,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27179,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22549,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30790.66,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32359,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20092,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20092,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10608,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17105.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18303.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17619.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17961.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18132.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17961.22,"methodology":"case rate"}]}]},{"description":"HC LAB MS PARTIAL THROMB TIME","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":225.18,"maximum":225.18,"gross_charge":278,"discounted_cash":82.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.18,"methodology":"fee schedule"}]}]},{"description":"HC LAB MS PARTIAL THROMB TIME","code_information":[{"code":"85730","type":"CPT"},{"code":"0305","type":"RC"}],"standard_charges":[{"minimum":6.01,"maximum":225.18,"gross_charge":278,"discounted_cash":82.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.28,"standard_charge_algorithm": "Lesser of $10.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"standard_charge_algorithm": "Lesser of $6.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.43,"standard_charge_algorithm": "Lesser of $6.43 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.19,"standard_charge_algorithm": "Lesser of $6.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.31,"standard_charge_algorithm": "Lesser of $6.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.61,"standard_charge_algorithm": "Lesser of $6.61 or 110 Percent of Billed Charges","median_amount":6.01,"10th_percentile":6.01,"90th_percentile":6.01,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.37,"standard_charge_algorithm": "Lesser of $6.37 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PTT","code_information":[{"code":"85730","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":225.18,"maximum":225.18,"gross_charge":278,"discounted_cash":82.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.18,"methodology":"fee schedule"}]}]},{"description":"HC LAB PTT","code_information":[{"code":"85730","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.01,"maximum":225.18,"gross_charge":278,"discounted_cash":82.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.28,"standard_charge_algorithm": "Lesser of $10.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.01,"standard_charge_algorithm": "Lesser of $6.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.43,"standard_charge_algorithm": "Lesser of $6.43 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.19,"standard_charge_algorithm": "Lesser of $6.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.31,"standard_charge_algorithm": "Lesser of $6.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.61,"standard_charge_algorithm": "Lesser of $6.61 or 110 Percent of Billed Charges","median_amount":6.01,"10th_percentile":6.01,"90th_percentile":6.01,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.37,"standard_charge_algorithm": "Lesser of $6.37 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 1/1 MIX PTT","code_information":[{"code":"85732","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.19,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB 1/1 MIX PTT","code_information":[{"code":"85732","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.47,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.92,"standard_charge_algorithm": "Lesser of $6.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.66,"standard_charge_algorithm": "Lesser of $6.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.79,"standard_charge_algorithm": "Lesser of $6.79 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.12,"standard_charge_algorithm": "Lesser of $7.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.86,"standard_charge_algorithm": "Lesser of $6.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"minimum":7291,"maximum":20493.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11581,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10949,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7291,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20231,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18968,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19468.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15290,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18230,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13550,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20493.56,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19134,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11880,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11880,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9294,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11385.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12182.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11726.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11954.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12068.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11954.58,"methodology":"case rate"}]}]},{"description":"HC LAB VISCOSITY SERUM","code_information":[{"code":"85810","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"HC LAB VISCOSITY SERUM","code_information":[{"code":"85810","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.67,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.96,"standard_charge_algorithm": "Lesser of $19.96 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.67,"standard_charge_algorithm": "Lesser of $11.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.49,"standard_charge_algorithm": "Lesser of $12.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.02,"standard_charge_algorithm": "Lesser of $12.02 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.25,"standard_charge_algorithm": "Lesser of $12.25 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.37,"standard_charge_algorithm": "Lesser of $12.37 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CACAO IGG","code_information":[{"code":"86001","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.77,"maximum":13.77,"gross_charge":17,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.77,"methodology":"fee schedule"}]}]},{"description":"HC CACAO IGG","code_information":[{"code":"86001","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":17.45,"gross_charge":17,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.82,"standard_charge_algorithm": "Lesser of $7.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.37,"standard_charge_algorithm": "Lesser of $8.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.05,"standard_charge_algorithm": "Lesser of $8.05 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.21,"standard_charge_algorithm": "Lesser of $8.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.29,"standard_charge_algorithm": "Lesser of $8.29 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"F081-IGE CHEESE CHEDDAR TYPE","code_information":[{"code":"86003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"F081-IGE CHEESE CHEDDAR TYPE","code_information":[{"code":"86003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.22,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.53,"standard_charge_algorithm": "Lesser of $5.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ALTERNARIA TENUIS","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"HC ALTERNARIA TENUIS","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.22,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.53,"standard_charge_algorithm": "Lesser of $5.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC GOOSE FEATHER (E70) IGE","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":19.44,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"}]}]},{"description":"HC GOOSE FEATHER (E70) IGE","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.22,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.53,"standard_charge_algorithm": "Lesser of $5.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IGE ABY TO ALLERGIC SUBSTANCE","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.63,"maximum":18.63,"gross_charge":23,"discounted_cash":6.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"}]}]},{"description":"IGE ABY TO ALLERGIC SUBSTANCE","code_information":[{"code":"86003","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.22,"maximum":18.63,"gross_charge":23,"discounted_cash":6.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.53,"standard_charge_algorithm": "Lesser of $5.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"M207-IGG ASPERGILLUS NIGER","code_information":[{"code":"86003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"M207-IGG ASPERGILLUS NIGER","code_information":[{"code":"86003","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.22,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.59,"standard_charge_algorithm": "Lesser of $5.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.38,"standard_charge_algorithm": "Lesser of $5.38 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.48,"standard_charge_algorithm": "Lesser of $5.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.74,"standard_charge_algorithm": "Lesser of $5.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.53,"standard_charge_algorithm": "Lesser of $5.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ALLERGEN SPEC. IGE RECOMB EA","code_information":[{"code":"86008","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"ALLERGEN SPEC. IGE RECOMB EA","code_information":[{"code":"86008","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.82,"maximum":49.15,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.66,"standard_charge_algorithm": "Lesser of $30.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"standard_charge_algorithm": "Lesser of $17.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.19,"standard_charge_algorithm": "Lesser of $19.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.47,"standard_charge_algorithm": "Lesser of $18.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.83,"standard_charge_algorithm": "Lesser of $18.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.01,"standard_charge_algorithm": "Lesser of $19.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REHABILITATION","code_information":[{"code":"8601","type":"APR-DRG"}],"standard_charges":[{"minimum":8049,"maximum":8049,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8049,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8049,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8049,"methodology":"case rate"}]}]},{"description":"ACTIN SM MUSCLE ABY","code_information":[{"code":"86015","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"ACTIN SM MUSCLE ABY","code_information":[{"code":"86015","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.7,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"REHABILITATION","code_information":[{"code":"8602","type":"APR-DRG"}],"standard_charges":[{"minimum":10461,"maximum":10461,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10461,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10461,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10461,"methodology":"case rate"}]}]},{"description":"HC LAB AB ID LEUKOCYTE ID","code_information":[{"code":"86021","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":286.74,"maximum":286.74,"gross_charge":354,"discounted_cash":104.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.74,"methodology":"fee schedule"}]}]},{"description":"HC LAB AB ID LEUKOCYTE ID","code_information":[{"code":"86021","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.52,"maximum":286.74,"gross_charge":354,"discounted_cash":104.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.74,"standard_charge_algorithm": "Lesser of $25.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.1,"standard_charge_algorithm": "Lesser of $16.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.5,"standard_charge_algorithm": "Lesser of $15.50 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.8,"standard_charge_algorithm": "Lesser of $15.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.95,"standard_charge_algorithm": "Lesser of $15.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AB ID PLATELET AB","code_information":[{"code":"86022","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":120.69,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB AB ID PLATELET AB","code_information":[{"code":"86022","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.37,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.41,"standard_charge_algorithm": "Lesser of $31.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"standard_charge_algorithm": "Lesser of $18.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.66,"standard_charge_algorithm": "Lesser of $19.66 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.92,"standard_charge_algorithm": "Lesser of $18.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.29,"standard_charge_algorithm": "Lesser of $19.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.21,"standard_charge_algorithm": "Lesser of $20.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.47,"standard_charge_algorithm": "Lesser of $19.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SEROTONIN RELEASE ASSAY","code_information":[{"code":"86022","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":120.69,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB SEROTONIN RELEASE ASSAY","code_information":[{"code":"86022","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.37,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.41,"standard_charge_algorithm": "Lesser of $31.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.37,"standard_charge_algorithm": "Lesser of $18.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.66,"standard_charge_algorithm": "Lesser of $19.66 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.92,"standard_charge_algorithm": "Lesser of $18.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.29,"standard_charge_algorithm": "Lesser of $19.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.21,"standard_charge_algorithm": "Lesser of $20.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.47,"standard_charge_algorithm": "Lesser of $19.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEPARIN ANTIBODY","code_information":[{"code":"86023","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":119.88,"maximum":119.88,"gross_charge":148,"discounted_cash":43.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.88,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEPARIN ANTIBODY","code_information":[{"code":"86023","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.46,"maximum":119.88,"gross_charge":148,"discounted_cash":43.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.31,"standard_charge_algorithm": "Lesser of $21.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"standard_charge_algorithm": "Lesser of $12.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"standard_charge_algorithm": "Lesser of $13.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.83,"standard_charge_algorithm": "Lesser of $12.83 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.08,"standard_charge_algorithm": "Lesser of $13.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.71,"standard_charge_algorithm": "Lesser of $13.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.21,"standard_charge_algorithm": "Lesser of $13.21 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PLATELET ANTIBODY DIR","code_information":[{"code":"86023","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLATELET ANTIBODY DIR","code_information":[{"code":"86023","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.46,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.31,"standard_charge_algorithm": "Lesser of $21.31 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.46,"standard_charge_algorithm": "Lesser of $12.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.33,"standard_charge_algorithm": "Lesser of $13.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.83,"standard_charge_algorithm": "Lesser of $12.83 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.08,"standard_charge_algorithm": "Lesser of $13.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.71,"standard_charge_algorithm": "Lesser of $13.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.21,"standard_charge_algorithm": "Lesser of $13.21 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REHABILITATION","code_information":[{"code":"8603","type":"APR-DRG"}],"standard_charges":[{"minimum":14977,"maximum":14977,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14977,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14977,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14977,"methodology":"case rate"}]}]},{"description":"ANCA SCREEN EACH ABY","code_information":[{"code":"86036","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"ANCA SCREEN EACH ABY","code_information":[{"code":"86036","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.7,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"ANCA TITER EACH ANTIBODY","code_information":[{"code":"86037","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"ANCA TITER EACH ANTIBODY","code_information":[{"code":"86037","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":8.7,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"ANTI-NUCLEAR ANTIBODIES","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":66.42,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"}]}]},{"description":"ANTI-NUCLEAR ANTIBODIES","code_information":[{"code":"86038","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.09,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.02,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.67,"standard_charge_algorithm": "Lesser of $20.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.09,"standard_charge_algorithm": "Lesser of $12.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.94,"standard_charge_algorithm": "Lesser of $12.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.45,"standard_charge_algorithm": "Lesser of $12.45 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.69,"standard_charge_algorithm": "Lesser of $12.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.3,"standard_charge_algorithm": "Lesser of $13.30 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANA TITER & PATTERN","code_information":[{"code":"86039","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":230.85,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANA TITER & PATTERN","code_information":[{"code":"86039","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.16,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.08,"standard_charge_algorithm": "Lesser of $19.08 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.16,"standard_charge_algorithm": "Lesser of $11.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.94,"standard_charge_algorithm": "Lesser of $11.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.49,"standard_charge_algorithm": "Lesser of $11.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.72,"standard_charge_algorithm": "Lesser of $11.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.28,"standard_charge_algorithm": "Lesser of $12.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.83,"standard_charge_algorithm": "Lesser of $11.83 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"REHABILITATION","code_information":[{"code":"8604","type":"APR-DRG"}],"standard_charges":[{"minimum":16025,"maximum":16025,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16025,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16025,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16025,"methodology":"case rate"}]}]},{"description":"ACETYLCHOLN RCPTR BNDNG ANTB","code_information":[{"code":"86041","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"ACETYLCHOLN RCPTR BNDNG ANTB","code_information":[{"code":"86041","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.25,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"}]}]},{"description":"ACETYLCHOLN RCPTR BLCKG ANTB","code_information":[{"code":"86042","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"ACETYLCHOLN RCPTR BLCKG ANTB","code_information":[{"code":"86042","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.25,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"}]}]},{"description":"ACETYLCHOLN RCPTR MODLG ANTB","code_information":[{"code":"86043","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"ACETYLCHOLN RCPTR MODLG ANTB","code_information":[{"code":"86043","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"}]}]},{"description":"NMO ANTIBODY (ELISA)","code_information":[{"code":"86051","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":267.3,"maximum":267.3,"gross_charge":330,"discounted_cash":97.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"}]}]},{"description":"NMO ANTIBODY (ELISA)","code_information":[{"code":"86051","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":49.5,"maximum":267.3,"gross_charge":330,"discounted_cash":97.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"}]}]},{"description":"AQUAPORIN-4 ANTB CBA EACH","code_information":[{"code":"86052","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":465.75,"maximum":465.75,"gross_charge":575,"discounted_cash":170.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.75,"methodology":"fee schedule"}]}]},{"description":"AQUAPORIN-4 ANTB CBA EACH","code_information":[{"code":"86052","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":86.25,"maximum":465.75,"gross_charge":575,"discounted_cash":170.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":115,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115,"methodology":"fee schedule"}]}]},{"description":"NMO/AQP4 (CSF) FLOW CYT","code_information":[{"code":"86053","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":550.8,"maximum":550.8,"gross_charge":680,"discounted_cash":201.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":550.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":550.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":550.8,"methodology":"fee schedule"}]}]},{"description":"NMO/AQP4 (CSF) FLOW CYT","code_information":[{"code":"86053","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":102,"maximum":550.8,"gross_charge":680,"discounted_cash":201.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":550.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":550.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":550.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":136,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":136,"methodology":"fee schedule"}]}]},{"description":"NMO/AQP4 (FACS)","code_information":[{"code":"86053","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"NMO/AQP4 (FACS)","code_information":[{"code":"86053","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":105,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTISTREPTOZYME (ASO)","code_information":[{"code":"86060","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":93.96,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTISTREPTOZYME (ASO)","code_information":[{"code":"86060","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.3,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.48,"standard_charge_algorithm": "Lesser of $12.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.81,"standard_charge_algorithm": "Lesser of $7.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.52,"standard_charge_algorithm": "Lesser of $7.52 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.67,"standard_charge_algorithm": "Lesser of $7.67 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.03,"standard_charge_algorithm": "Lesser of $8.03 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.74,"standard_charge_algorithm": "Lesser of $7.74 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8611","type":"APR-DRG"}],"standard_charges":[{"minimum":4272,"maximum":4272,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4272,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4272,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4272,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8612","type":"APR-DRG"}],"standard_charges":[{"minimum":5903,"maximum":5903,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5903,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5903,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5903,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8613","type":"APR-DRG"}],"standard_charges":[{"minimum":10275,"maximum":10275,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10275,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10275,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10275,"methodology":"case rate"}]}]},{"description":"SIGNS SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"8614","type":"APR-DRG"}],"standard_charges":[{"minimum":11039,"maximum":11039,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11039,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11039,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11039,"methodology":"case rate"}]}]},{"description":"HC LAB CRP (C-REACTPROTEIN)","code_information":[{"code":"86140","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":238.14,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB CRP (C-REACTPROTEIN)","code_information":[{"code":"86140","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB C-REACTIVE PROTEIN HS","code_information":[{"code":"86141","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB C-REACTIVE PROTEIN HS","code_information":[{"code":"86141","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.95,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.14,"standard_charge_algorithm": "Lesser of $22.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"standard_charge_algorithm": "Lesser of $12.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.86,"standard_charge_algorithm": "Lesser of $13.86 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.34,"standard_charge_algorithm": "Lesser of $13.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.6,"standard_charge_algorithm": "Lesser of $13.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.24,"standard_charge_algorithm": "Lesser of $14.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB B2-GLYCOPROTEIN I AB","code_information":[{"code":"86146","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":139.32,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB B2-GLYCOPROTEIN I AB","code_information":[{"code":"86146","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.45,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.52,"standard_charge_algorithm": "Lesser of $43.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"standard_charge_algorithm": "Lesser of $25.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.23,"standard_charge_algorithm": "Lesser of $27.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.21,"standard_charge_algorithm": "Lesser of $26.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.72,"standard_charge_algorithm": "Lesser of $26.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28,"standard_charge_algorithm": "Lesser of $28.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.98,"standard_charge_algorithm": "Lesser of $26.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BETA-2-GPI IGG","code_information":[{"code":"86146","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":139.32,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB BETA-2-GPI IGG","code_information":[{"code":"86146","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":25.45,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.52,"standard_charge_algorithm": "Lesser of $43.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"standard_charge_algorithm": "Lesser of $25.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.23,"standard_charge_algorithm": "Lesser of $27.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.21,"standard_charge_algorithm": "Lesser of $26.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.72,"standard_charge_algorithm": "Lesser of $26.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28,"standard_charge_algorithm": "Lesser of $28.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.98,"standard_charge_algorithm": "Lesser of $26.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANTICARDIOLIPIN EA IG","code_information":[{"code":"86147","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":376.65,"maximum":376.65,"gross_charge":465,"discounted_cash":137.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTICARDIOLIPIN EA IG","code_information":[{"code":"86147","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.45,"maximum":376.65,"gross_charge":465,"discounted_cash":137.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.52,"standard_charge_algorithm": "Lesser of $43.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.45,"standard_charge_algorithm": "Lesser of $25.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.23,"standard_charge_algorithm": "Lesser of $27.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.21,"standard_charge_algorithm": "Lesser of $26.21 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.72,"standard_charge_algorithm": "Lesser of $26.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28,"standard_charge_algorithm": "Lesser of $28.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.98,"standard_charge_algorithm": "Lesser of $26.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PHOSPHOLIPIDS AB","code_information":[{"code":"86148","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":276.21,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB PHOSPHOLIPIDS AB","code_information":[{"code":"86148","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.07,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.48,"standard_charge_algorithm": "Lesser of $27.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"standard_charge_algorithm": "Lesser of $17.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.87,"standard_charge_algorithm": "Lesser of $16.87 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.68,"standard_charge_algorithm": "Lesser of $17.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COLD AGGLUTININ TITER","code_information":[{"code":"86157","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":203.31,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"}]}]},{"description":"HC LAB COLD AGGLUTININ TITER","code_information":[{"code":"86157","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.06,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.06,"standard_charge_algorithm": "Lesser of $8.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"standard_charge_algorithm": "Lesser of $8.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.3,"standard_charge_algorithm": "Lesser of $8.30 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.46,"standard_charge_algorithm": "Lesser of $8.46 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.87,"standard_charge_algorithm": "Lesser of $8.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.54,"standard_charge_algorithm": "Lesser of $8.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB C-3 C-4 COMPLEMENT","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":140.94,"maximum":140.94,"gross_charge":174,"discounted_cash":51.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB C-3 C-4 COMPLEMENT","code_information":[{"code":"86160","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12,"maximum":140.94,"gross_charge":174,"discounted_cash":51.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.52,"standard_charge_algorithm": "Lesser of $20.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"standard_charge_algorithm": "Lesser of $12.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.36,"standard_charge_algorithm": "Lesser of $12.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.6,"standard_charge_algorithm": "Lesser of $12.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.2,"standard_charge_algorithm": "Lesser of $13.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.72,"standard_charge_algorithm": "Lesser of $12.72 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COMPLEMENT AG EA","code_information":[{"code":"86160","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":140.94,"maximum":140.94,"gross_charge":174,"discounted_cash":51.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB COMPLEMENT AG EA","code_information":[{"code":"86160","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12,"maximum":140.94,"gross_charge":174,"discounted_cash":51.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.52,"standard_charge_algorithm": "Lesser of $20.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"standard_charge_algorithm": "Lesser of $12.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.36,"standard_charge_algorithm": "Lesser of $12.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.6,"standard_charge_algorithm": "Lesser of $12.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.2,"standard_charge_algorithm": "Lesser of $13.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.72,"standard_charge_algorithm": "Lesser of $12.72 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC C1 EST INHIB ELISAFUNCTIONAL","code_information":[{"code":"86161","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":200.07,"maximum":200.07,"gross_charge":247,"discounted_cash":73.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.07,"methodology":"fee schedule"}]}]},{"description":"HC C1 EST INHIB ELISAFUNCTIONAL","code_information":[{"code":"86161","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12,"maximum":200.07,"gross_charge":247,"discounted_cash":73.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.52,"standard_charge_algorithm": "Lesser of $20.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12,"standard_charge_algorithm": "Lesser of $12.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.36,"standard_charge_algorithm": "Lesser of $12.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.6,"standard_charge_algorithm": "Lesser of $12.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.2,"standard_charge_algorithm": "Lesser of $13.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.72,"standard_charge_algorithm": "Lesser of $12.72 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COMPLEMENT (CH50)","code_information":[{"code":"86162","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":129.6,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"}]}]},{"description":"HC LAB COMPLEMENT (CH50)","code_information":[{"code":"86162","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.32,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.75,"standard_charge_algorithm": "Lesser of $34.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.74,"standard_charge_algorithm": "Lesser of $21.74 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.93,"standard_charge_algorithm": "Lesser of $20.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.34,"standard_charge_algorithm": "Lesser of $21.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.35,"standard_charge_algorithm": "Lesser of $22.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.54,"standard_charge_algorithm": "Lesser of $21.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":9332,"maximum":27307,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16528,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15625,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10465,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22623,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21210,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25513.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19771,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23572,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19448,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26856.83,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27307,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9332,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14920.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15964.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15368.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15666.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15815.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15666.49,"methodology":"case rate"}]}]},{"description":"HC LAB CYCLIC CITRULINATD PEP IGG","code_information":[{"code":"86200","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":457.65,"maximum":457.65,"gross_charge":565,"discounted_cash":167.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":457.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYCLIC CITRULINATD PEP IGG","code_information":[{"code":"86200","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.95,"maximum":457.65,"gross_charge":565,"discounted_cash":167.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.14,"standard_charge_algorithm": "Lesser of $22.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"standard_charge_algorithm": "Lesser of $12.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.86,"standard_charge_algorithm": "Lesser of $13.86 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.34,"standard_charge_algorithm": "Lesser of $13.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.6,"standard_charge_algorithm": "Lesser of $13.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.24,"standard_charge_algorithm": "Lesser of $14.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CYCLIC CITRULLINATED PEPTIDE","code_information":[{"code":"86200","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":457.65,"maximum":457.65,"gross_charge":565,"discounted_cash":167.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":457.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYCLIC CITRULLINATED PEPTIDE","code_information":[{"code":"86200","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.95,"maximum":457.65,"gross_charge":565,"discounted_cash":167.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":457.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.14,"standard_charge_algorithm": "Lesser of $22.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.95,"standard_charge_algorithm": "Lesser of $12.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.86,"standard_charge_algorithm": "Lesser of $13.86 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.34,"standard_charge_algorithm": "Lesser of $13.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.6,"standard_charge_algorithm": "Lesser of $13.60 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.24,"standard_charge_algorithm": "Lesser of $14.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.73,"standard_charge_algorithm": "Lesser of $13.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8621","type":"APR-DRG"}],"standard_charges":[{"minimum":5920,"maximum":5920,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"}]}]},{"description":"HC STREPTOCOCCAL DNASE B AB","code_information":[{"code":"86215","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC STREPTOCOCCAL DNASE B AB","code_information":[{"code":"86215","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8622","type":"APR-DRG"}],"standard_charges":[{"minimum":5920,"maximum":5920,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"}]}]},{"description":"DSDNA CRITHIDIA LUCILIAE IFA","code_information":[{"code":"86225","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":53.46,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"}]}]},{"description":"DSDNA CRITHIDIA LUCILIAE IFA","code_information":[{"code":"86225","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.74,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.5,"standard_charge_algorithm": "Lesser of $23.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"standard_charge_algorithm": "Lesser of $13.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"standard_charge_algorithm": "Lesser of $14.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.15,"standard_charge_algorithm": "Lesser of $14.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ANTI-DNA","code_information":[{"code":"86225","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTI-DNA","code_information":[{"code":"86225","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.74,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.5,"standard_charge_algorithm": "Lesser of $23.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.74,"standard_charge_algorithm": "Lesser of $13.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.7,"standard_charge_algorithm": "Lesser of $14.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.15,"standard_charge_algorithm": "Lesser of $14.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ANTI DNA SINGLESTRAND*","code_information":[{"code":"86226","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":548.37,"maximum":548.37,"gross_charge":677,"discounted_cash":200.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":548.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":548.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":548.37,"methodology":"fee schedule"}]}]},{"description":"HC ANTI DNA SINGLESTRAND*","code_information":[{"code":"86226","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.11,"maximum":548.37,"gross_charge":677,"discounted_cash":200.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":548.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":548.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":548.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.71,"standard_charge_algorithm": "Lesser of $20.71 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.96,"standard_charge_algorithm": "Lesser of $12.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.47,"standard_charge_algorithm": "Lesser of $12.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.72,"standard_charge_algorithm": "Lesser of $12.72 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.32,"standard_charge_algorithm": "Lesser of $13.32 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.84,"standard_charge_algorithm": "Lesser of $12.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8623","type":"APR-DRG"}],"standard_charges":[{"minimum":5920,"maximum":5920,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"}]}]},{"description":"ENDOMYSIAL ANTIBODY IGA","code_information":[{"code":"86231","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"ENDOMYSIAL ANTIBODY IGA","code_information":[{"code":"86231","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB ENA ANY METHOD","code_information":[{"code":"86235","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":379.08,"maximum":379.08,"gross_charge":468,"discounted_cash":138.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB ENA ANY METHOD","code_information":[{"code":"86235","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.93,"maximum":379.08,"gross_charge":468,"discounted_cash":138.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.66,"standard_charge_algorithm": "Lesser of $30.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"standard_charge_algorithm": "Lesser of $17.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.19,"standard_charge_algorithm": "Lesser of $19.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.47,"standard_charge_algorithm": "Lesser of $18.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.83,"standard_charge_algorithm": "Lesser of $18.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.01,"standard_charge_algorithm": "Lesser of $19.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PM-SCL ANTIBODY","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":379.08,"maximum":379.08,"gross_charge":468,"discounted_cash":138.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB PM-SCL ANTIBODY","code_information":[{"code":"86235","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":17.93,"maximum":379.08,"gross_charge":468,"discounted_cash":138.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.66,"standard_charge_algorithm": "Lesser of $30.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.93,"standard_charge_algorithm": "Lesser of $17.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.19,"standard_charge_algorithm": "Lesser of $19.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.47,"standard_charge_algorithm": "Lesser of $18.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.83,"standard_charge_algorithm": "Lesser of $18.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.01,"standard_charge_algorithm": "Lesser of $19.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER AFTERCARE AND CONVALESCENCE","code_information":[{"code":"8624","type":"APR-DRG"}],"standard_charges":[{"minimum":5920,"maximum":5920,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5920,"methodology":"case rate"}]}]},{"description":"HC LAB ANTI-CENTROMERE ANTIBODY","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":375.03,"maximum":375.03,"gross_charge":463,"discounted_cash":137.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTI-CENTROMERE ANTIBODY","code_information":[{"code":"86255","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.05,"maximum":375.03,"gross_charge":463,"discounted_cash":137.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"standard_charge_algorithm": "Lesser of $12.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FLUORESC AB SCRN EA AB","code_information":[{"code":"86255","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":375.03,"maximum":375.03,"gross_charge":463,"discounted_cash":137.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLUORESC AB SCRN EA AB","code_information":[{"code":"86255","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.05,"maximum":375.03,"gross_charge":463,"discounted_cash":137.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"standard_charge_algorithm": "Lesser of $12.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTI-HU ANTIBODIES","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":76.95,"maximum":76.95,"gross_charge":95,"discounted_cash":28.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.95,"methodology":"fee schedule"}]}]},{"description":"ANTI-HU ANTIBODIES","code_information":[{"code":"86256","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.05,"maximum":76.95,"gross_charge":95,"discounted_cash":28.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"standard_charge_algorithm": "Lesser of $12.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FLUORESC AB TITER EA AB","code_information":[{"code":"86256","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":76.95,"maximum":76.95,"gross_charge":95,"discounted_cash":28.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.95,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLUORESC AB TITER EA AB","code_information":[{"code":"86256","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.05,"maximum":76.95,"gross_charge":95,"discounted_cash":28.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"standard_charge_algorithm": "Lesser of $12.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DET OF GLIADIN (DGP) EACH IG CLS","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"DET OF GLIADIN (DGP) EACH IG CLS","code_information":[{"code":"86258","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"minimum":5120,"maximum":17157.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8988,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8497,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5713,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10986,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10300,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16299.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10873,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12963,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10616,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17157.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14850,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9220,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9220,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5120,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9531.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10199.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9817.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10008.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10103.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10008.57,"methodology":"case rate"}]}]},{"description":"HC LAB CANCER ANTIGEN","code_information":[{"code":"86300","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB CANCER ANTIGEN","code_information":[{"code":"86300","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":63.03,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CANCER ANTIGEN 27.29","code_information":[{"code":"86300","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB CANCER ANTIGEN 27.29","code_information":[{"code":"86300","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":63.03,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CARBOHYDRATE ANTI 19-9","code_information":[{"code":"86301","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":106.92,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"}]}]},{"description":"HC LAB CARBOHYDRATE ANTI 19-9","code_information":[{"code":"86301","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CANCER ANTIGEN 125","code_information":[{"code":"86304","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":166.05,"maximum":166.05,"gross_charge":205,"discounted_cash":60.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB CANCER ANTIGEN 125","code_information":[{"code":"86304","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":166.05,"gross_charge":205,"discounted_cash":60.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HUMAN EPIDIDYMIS PROTEIN 4","code_information":[{"code":"86305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":383.13,"maximum":383.13,"gross_charge":473,"discounted_cash":140.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.13,"methodology":"fee schedule"}]}]},{"description":"HC HUMAN EPIDIDYMIS PROTEIN 4","code_information":[{"code":"86305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":383.13,"gross_charge":473,"discounted_cash":140.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INFECT MONO SCREEN","code_information":[{"code":"86308","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":337.77,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB INFECT MONO SCREEN","code_information":[{"code":"86308","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":337.77,"gross_charge":417,"discounted_cash":123.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.86,"standard_charge_algorithm": "Lesser of $8.86 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.18,"standard_charge_algorithm": "Lesser of $5.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.54,"standard_charge_algorithm": "Lesser of $5.54 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.34,"standard_charge_algorithm": "Lesser of $5.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.44,"standard_charge_algorithm": "Lesser of $5.44 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.7,"standard_charge_algorithm": "Lesser of $5.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.49,"standard_charge_algorithm": "Lesser of $5.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8631","type":"APR-DRG"}],"standard_charges":[{"minimum":3605,"maximum":3605,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3605,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3605,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3605,"methodology":"case rate"}]}]},{"description":"HC LAB IA OTH TUMOR AG QUAN","code_information":[{"code":"86316","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":100.44,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"}]}]},{"description":"HC LAB IA OTH TUMOR AG QUAN","code_information":[{"code":"86316","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB NEURON SPECIFIC ENOLASE SERUM","code_information":[{"code":"86316","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":392.85,"maximum":392.85,"gross_charge":485,"discounted_cash":143.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":392.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":392.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":392.85,"methodology":"fee schedule"}]}]},{"description":"HC LAB NEURON SPECIFIC ENOLASE SERUM","code_information":[{"code":"86316","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.81,"maximum":392.85,"gross_charge":485,"discounted_cash":143.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":392.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":392.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":392.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.59,"standard_charge_algorithm": "Lesser of $35.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.27,"standard_charge_algorithm": "Lesser of $22.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.43,"standard_charge_algorithm": "Lesser of $21.43 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.85,"standard_charge_algorithm": "Lesser of $21.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.89,"standard_charge_algorithm": "Lesser of $22.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB 1433 PROTEIN CSF (PRION)","code_information":[{"code":"86317","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":412.29,"maximum":412.29,"gross_charge":509,"discounted_cash":150.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB 1433 PROTEIN CSF (PRION)","code_information":[{"code":"86317","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.99,"maximum":412.29,"gross_charge":509,"discounted_cash":150.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.63,"standard_charge_algorithm": "Lesser of $25.63 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.04,"standard_charge_algorithm": "Lesser of $16.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.49,"standard_charge_algorithm": "Lesser of $16.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DIPTHERIA AB","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB DIPTHERIA AB","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.99,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.63,"standard_charge_algorithm": "Lesser of $25.63 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.04,"standard_charge_algorithm": "Lesser of $16.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.49,"standard_charge_algorithm": "Lesser of $16.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DIPTHERIA AB IGG","code_information":[{"code":"86317","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"HC LAB DIPTHERIA AB IGG","code_information":[{"code":"86317","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.99,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.63,"standard_charge_algorithm": "Lesser of $25.63 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.04,"standard_charge_algorithm": "Lesser of $16.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.49,"standard_charge_algorithm": "Lesser of $16.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INFECTIOUS AGENT AB QNT","code_information":[{"code":"86317","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB INFECTIOUS AGENT AB QNT","code_information":[{"code":"86317","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.99,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.63,"standard_charge_algorithm": "Lesser of $25.63 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.04,"standard_charge_algorithm": "Lesser of $16.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.49,"standard_charge_algorithm": "Lesser of $16.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TOXOPLASMA AB IGG S/CSF","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOXOPLASMA AB IGG S/CSF","code_information":[{"code":"86317","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.99,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.63,"standard_charge_algorithm": "Lesser of $25.63 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.04,"standard_charge_algorithm": "Lesser of $16.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.44,"standard_charge_algorithm": "Lesser of $15.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.74,"standard_charge_algorithm": "Lesser of $15.74 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.49,"standard_charge_algorithm": "Lesser of $16.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8632","type":"APR-DRG"}],"standard_charges":[{"minimum":16394,"maximum":16394,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16394,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16394,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16394,"methodology":"case rate"}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8633","type":"APR-DRG"}],"standard_charges":[{"minimum":31952,"maximum":31952,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31952,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31952,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31952,"methodology":"case rate"}]}]},{"description":"IMMUNODIFFUSION OUCHTERLONY","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"IMMUNODIFFUSION OUCHTERLONY","code_information":[{"code":"86331","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC IMMUNE COMPLEX C1Q BINDI*","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":461.7,"maximum":461.7,"gross_charge":570,"discounted_cash":168.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":461.7,"methodology":"fee schedule"}]}]},{"description":"HC IMMUNE COMPLEX C1Q BINDI*","code_information":[{"code":"86332","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24.37,"maximum":461.7,"gross_charge":570,"discounted_cash":168.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.67,"standard_charge_algorithm": "Lesser of $41.67 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.37,"standard_charge_algorithm": "Lesser of $24.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.08,"standard_charge_algorithm": "Lesser of $26.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.1,"standard_charge_algorithm": "Lesser of $25.10 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.59,"standard_charge_algorithm": "Lesser of $25.59 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.81,"standard_charge_algorithm": "Lesser of $26.81 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.83,"standard_charge_algorithm": "Lesser of $25.83 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SERUM IFE ID","code_information":[{"code":"86334","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":220.32,"maximum":220.32,"gross_charge":272,"discounted_cash":80.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB SERUM IFE ID","code_information":[{"code":"86334","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":22.34,"maximum":220.32,"gross_charge":272,"discounted_cash":80.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.2,"standard_charge_algorithm": "Lesser of $38.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.34,"standard_charge_algorithm": "Lesser of $22.34 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.9,"standard_charge_algorithm": "Lesser of $23.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.01,"standard_charge_algorithm": "Lesser of $23.01 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.46,"standard_charge_algorithm": "Lesser of $23.46 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.57,"standard_charge_algorithm": "Lesser of $24.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.68,"standard_charge_algorithm": "Lesser of $23.68 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BETA 2 TRANSFERRIN","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":276.21,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"}]}]},{"description":"BETA 2 TRANSFERRIN","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":29.35,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.19,"standard_charge_algorithm": "Lesser of $50.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"standard_charge_algorithm": "Lesser of $29.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.4,"standard_charge_algorithm": "Lesser of $31.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.23,"standard_charge_algorithm": "Lesser of $30.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.82,"standard_charge_algorithm": "Lesser of $30.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.28,"standard_charge_algorithm": "Lesser of $32.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.11,"standard_charge_algorithm": "Lesser of $31.11 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URINE IFE","code_information":[{"code":"86335","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":276.21,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINE IFE","code_information":[{"code":"86335","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":29.35,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.19,"standard_charge_algorithm": "Lesser of $50.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"standard_charge_algorithm": "Lesser of $29.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.4,"standard_charge_algorithm": "Lesser of $31.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.23,"standard_charge_algorithm": "Lesser of $30.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.82,"standard_charge_algorithm": "Lesser of $30.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.28,"standard_charge_algorithm": "Lesser of $32.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.11,"standard_charge_algorithm": "Lesser of $31.11 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMMUNOFIXATION RFLEX CSF","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":240.57,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"}]}]},{"description":"IMMUNOFIXATION RFLEX CSF","code_information":[{"code":"86335","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":29.35,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.19,"standard_charge_algorithm": "Lesser of $50.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.35,"standard_charge_algorithm": "Lesser of $29.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.4,"standard_charge_algorithm": "Lesser of $31.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.23,"standard_charge_algorithm": "Lesser of $30.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.82,"standard_charge_algorithm": "Lesser of $30.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.28,"standard_charge_algorithm": "Lesser of $32.28 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.11,"standard_charge_algorithm": "Lesser of $31.11 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INHIBIN A","code_information":[{"code":"86336","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB INHIBIN A","code_information":[{"code":"86336","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.59,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.66,"standard_charge_algorithm": "Lesser of $26.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"standard_charge_algorithm": "Lesser of $15.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.68,"standard_charge_algorithm": "Lesser of $16.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.06,"standard_charge_algorithm": "Lesser of $16.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.37,"standard_charge_algorithm": "Lesser of $16.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.15,"standard_charge_algorithm": "Lesser of $17.15 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.53,"standard_charge_algorithm": "Lesser of $16.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INSULIN AUTOANTIBODY","code_information":[{"code":"86337","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":51.03,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"}]}]},{"description":"HC LAB INSULIN AUTOANTIBODY","code_information":[{"code":"86337","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.41,"maximum":64.85,"gross_charge":63,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":36.61,"standard_charge_algorithm": "Lesser of $36.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.41,"standard_charge_algorithm": "Lesser of $21.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.91,"standard_charge_algorithm": "Lesser of $22.91 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.05,"standard_charge_algorithm": "Lesser of $22.05 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":22.48,"standard_charge_algorithm": "Lesser of $22.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23.55,"standard_charge_algorithm": "Lesser of $23.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.69,"standard_charge_algorithm": "Lesser of $22.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NEONATAL AFTERCARE","code_information":[{"code":"8634","type":"APR-DRG"}],"standard_charges":[{"minimum":49799,"maximum":49799,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49799,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49799,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49799,"methodology":"case rate"}]}]},{"description":"HC LAB INTRINSIC FACT BLOCKAB","code_information":[{"code":"86340","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":303.75,"maximum":303.75,"gross_charge":375,"discounted_cash":111,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.75,"methodology":"fee schedule"}]}]},{"description":"HC LAB INTRINSIC FACT BLOCKAB","code_information":[{"code":"86340","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.08,"maximum":303.75,"gross_charge":375,"discounted_cash":111,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.79,"standard_charge_algorithm": "Lesser of $25.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.08,"standard_charge_algorithm": "Lesser of $15.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.53,"standard_charge_algorithm": "Lesser of $15.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.59,"standard_charge_algorithm": "Lesser of $16.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.98,"standard_charge_algorithm": "Lesser of $15.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ISLET CELL AB","code_information":[{"code":"86341","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB ISLET CELL AB","code_information":[{"code":"86341","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.57,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40.3,"standard_charge_algorithm": "Lesser of $40.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23.57,"standard_charge_algorithm": "Lesser of $23.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.22,"standard_charge_algorithm": "Lesser of $25.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.28,"standard_charge_algorithm": "Lesser of $24.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.75,"standard_charge_algorithm": "Lesser of $24.75 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.93,"standard_charge_algorithm": "Lesser of $25.93 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.98,"standard_charge_algorithm": "Lesser of $24.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CU INDEX","code_information":[{"code":"86352","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":719.28,"maximum":719.28,"gross_charge":888,"discounted_cash":262.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":719.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":719.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":719.28,"methodology":"fee schedule"}]}]},{"description":"HC CU INDEX","code_information":[{"code":"86352","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":133.2,"maximum":719.28,"gross_charge":888,"discounted_cash":262.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":719.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":719.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":719.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":411.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":326.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":232.32,"standard_charge_algorithm": "Lesser of $232.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":297.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":331.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":203.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"standard_charge_algorithm": "Lesser of $135.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":145.37,"standard_charge_algorithm": "Lesser of $145.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":139.94,"standard_charge_algorithm": "Lesser of $139.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":142.65,"standard_charge_algorithm": "Lesser of $142.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":149.45,"standard_charge_algorithm": "Lesser of $149.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":144.01,"standard_charge_algorithm": "Lesser of $144.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"IMMUKNOW","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":475.47,"maximum":475.47,"gross_charge":587,"discounted_cash":173.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":475.47,"methodology":"fee schedule"}]}]},{"description":"IMMUKNOW","code_information":[{"code":"86352","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":88.05,"maximum":475.47,"gross_charge":587,"discounted_cash":173.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":411.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":326.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":232.32,"standard_charge_algorithm": "Lesser of $232.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":297.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":331.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":203.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":135.86,"standard_charge_algorithm": "Lesser of $135.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":145.37,"standard_charge_algorithm": "Lesser of $145.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":139.94,"standard_charge_algorithm": "Lesser of $139.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":142.65,"standard_charge_algorithm": "Lesser of $142.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":149.45,"standard_charge_algorithm": "Lesser of $149.45 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":144.01,"standard_charge_algorithm": "Lesser of $144.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB B CELLS TOTAL COUNT","code_information":[{"code":"86355","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB B CELLS TOTAL COUNT","code_information":[{"code":"86355","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":33.14,"maximum":114.24,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64.52,"standard_charge_algorithm": "Lesser of $64.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":82.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"standard_charge_algorithm": "Lesser of $37.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40.37,"standard_charge_algorithm": "Lesser of $40.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38.86,"standard_charge_algorithm": "Lesser of $38.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39.62,"standard_charge_algorithm": "Lesser of $39.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":41.5,"standard_charge_algorithm": "Lesser of $41.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39.99,"standard_charge_algorithm": "Lesser of $39.99 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC MOLECULAR CELL ANTIGEN QUANT","code_information":[{"code":"86356","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC MOLECULAR CELL ANTIGEN QUANT","code_information":[{"code":"86356","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.78,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":81.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.79,"standard_charge_algorithm": "Lesser of $45.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"standard_charge_algorithm": "Lesser of $26.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.65,"standard_charge_algorithm": "Lesser of $28.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.58,"standard_charge_algorithm": "Lesser of $27.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.12,"standard_charge_algorithm": "Lesser of $28.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.46,"standard_charge_algorithm": "Lesser of $29.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.39,"standard_charge_algorithm": "Lesser of $28.39 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NATURAL KILLER (NK) CELLS","code_information":[{"code":"86357","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"NATURAL KILLER (NK) CELLS","code_information":[{"code":"86357","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":33.14,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64.52,"standard_charge_algorithm": "Lesser of $64.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":82.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"standard_charge_algorithm": "Lesser of $37.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40.37,"standard_charge_algorithm": "Lesser of $40.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38.86,"standard_charge_algorithm": "Lesser of $38.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39.62,"standard_charge_algorithm": "Lesser of $39.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":41.5,"standard_charge_algorithm": "Lesser of $41.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39.99,"standard_charge_algorithm": "Lesser of $39.99 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"T CELLS TOTAL COUNT","code_information":[{"code":"86359","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":121.5,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"}]}]},{"description":"T CELLS TOTAL COUNT","code_information":[{"code":"86359","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":33.14,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":64.52,"standard_charge_algorithm": "Lesser of $64.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":82.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37.73,"standard_charge_algorithm": "Lesser of $37.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40.37,"standard_charge_algorithm": "Lesser of $40.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38.86,"standard_charge_algorithm": "Lesser of $38.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39.62,"standard_charge_algorithm": "Lesser of $39.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":41.5,"standard_charge_algorithm": "Lesser of $41.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39.99,"standard_charge_algorithm": "Lesser of $39.99 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T CELLS ABSOL CD4 & CD8 INCL RATIO","code_information":[{"code":"86360","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":191.16,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB T CELLS ABSOL CD4 & CD8 INCL RATIO","code_information":[{"code":"86360","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":142.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":112.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":80.34,"standard_charge_algorithm": "Lesser of $80.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":103.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":115,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46.98,"standard_charge_algorithm": "Lesser of $46.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":50.27,"standard_charge_algorithm": "Lesser of $50.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":48.39,"standard_charge_algorithm": "Lesser of $48.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":49.33,"standard_charge_algorithm": "Lesser of $49.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":51.68,"standard_charge_algorithm": "Lesser of $51.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":49.8,"standard_charge_algorithm": "Lesser of $49.80 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB T CELLS ABSOLUTE CD4 COUNT","code_information":[{"code":"86361","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB T CELLS ABSOLUTE CD4 COUNT","code_information":[{"code":"86361","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.78,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":81.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.79,"standard_charge_algorithm": "Lesser of $45.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.78,"standard_charge_algorithm": "Lesser of $26.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.65,"standard_charge_algorithm": "Lesser of $28.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.58,"standard_charge_algorithm": "Lesser of $27.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.12,"standard_charge_algorithm": "Lesser of $28.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.46,"standard_charge_algorithm": "Lesser of $29.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.39,"standard_charge_algorithm": "Lesser of $28.39 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANTI- MOG (CBA) EACH","code_information":[{"code":"86362","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"ANTI- MOG (CBA) EACH","code_information":[{"code":"86362","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":105,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"}]}]},{"description":"MOG (MYELIN OLIG GLYCOPROT)","code_information":[{"code":"86363","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":578.34,"maximum":578.34,"gross_charge":714,"discounted_cash":211.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.34,"methodology":"fee schedule"}]}]},{"description":"MOG (MYELIN OLIG GLYCOPROT)","code_information":[{"code":"86363","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":107.1,"maximum":578.34,"gross_charge":714,"discounted_cash":211.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.8,"methodology":"fee schedule"}]}]},{"description":"TISSUE TG EACH IG CLASS","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"TISSUE TG EACH IG CLASS","code_information":[{"code":"86364","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":6.75,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"}]}]},{"description":"MUSCLE-SPECIFIC KINASE ANTB","code_information":[{"code":"86366","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"MUSCLE-SPECIFIC KINASE ANTB","code_information":[{"code":"86366","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.25,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"}]}]},{"description":"HC LAB MICROSOMAL AB EA","code_information":[{"code":"86376","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":463.32,"maximum":463.32,"gross_charge":572,"discounted_cash":169.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":463.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB MICROSOMAL AB EA","code_information":[{"code":"86376","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.55,"maximum":463.32,"gross_charge":572,"discounted_cash":169.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.88,"standard_charge_algorithm": "Lesser of $24.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.57,"standard_charge_algorithm": "Lesser of $15.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.28,"standard_charge_algorithm": "Lesser of $15.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16,"standard_charge_algorithm": "Lesser of $16.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.42,"standard_charge_algorithm": "Lesser of $15.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THYROID PEROXIDASE AB","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":463.32,"maximum":463.32,"gross_charge":572,"discounted_cash":169.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":463.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB THYROID PEROXIDASE AB","code_information":[{"code":"86376","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.55,"maximum":463.32,"gross_charge":572,"discounted_cash":169.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":463.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.88,"standard_charge_algorithm": "Lesser of $24.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.55,"standard_charge_algorithm": "Lesser of $14.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.57,"standard_charge_algorithm": "Lesser of $15.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.99,"standard_charge_algorithm": "Lesser of $14.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.28,"standard_charge_algorithm": "Lesser of $15.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16,"standard_charge_algorithm": "Lesser of $16.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.42,"standard_charge_algorithm": "Lesser of $15.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MITOCHONDRIAL ABY EACH","code_information":[{"code":"86381","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":97.2,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"}]}]},{"description":"MITOCHONDRIAL ABY EACH","code_information":[{"code":"86381","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"}]}]},{"description":"HC RABIES ANTIBODY ENDPOINT","code_information":[{"code":"86382","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":150.66,"maximum":150.66,"gross_charge":186,"discounted_cash":55.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.66,"methodology":"fee schedule"}]}]},{"description":"HC RABIES ANTIBODY ENDPOINT","code_information":[{"code":"86382","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.91,"maximum":150.66,"gross_charge":186,"discounted_cash":55.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.92,"standard_charge_algorithm": "Lesser of $28.92 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.91,"standard_charge_algorithm": "Lesser of $16.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.09,"standard_charge_algorithm": "Lesser of $18.09 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.42,"standard_charge_algorithm": "Lesser of $17.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.76,"standard_charge_algorithm": "Lesser of $17.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.6,"standard_charge_algorithm": "Lesser of $18.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"minimum":4799,"maximum":15979.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8072,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7631,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5015,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7588,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7114,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15180.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9168,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10931,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9321,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15979.25,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13336,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8280,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8280,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4799,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8877.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9498.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9143.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9321.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9410.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9321.23,"methodology":"case rate"}]}]},{"description":"HC LAB PA SCREEN EA AB","code_information":[{"code":"86403","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":77.76,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"}]}]},{"description":"HC LAB PA SCREEN EA AB","code_information":[{"code":"86403","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.19,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.73,"standard_charge_algorithm": "Lesser of $19.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"standard_charge_algorithm": "Lesser of $11.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.35,"standard_charge_algorithm": "Lesser of $12.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.89,"standard_charge_algorithm": "Lesser of $11.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.12,"standard_charge_algorithm": "Lesser of $12.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.69,"standard_charge_algorithm": "Lesser of $12.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.23,"standard_charge_algorithm": "Lesser of $12.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB STREP GROUP B","code_information":[{"code":"86403","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":77.76,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"}]}]},{"description":"HC LAB STREP GROUP B","code_information":[{"code":"86403","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.19,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.73,"standard_charge_algorithm": "Lesser of $19.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.54,"standard_charge_algorithm": "Lesser of $11.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.35,"standard_charge_algorithm": "Lesser of $12.35 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.89,"standard_charge_algorithm": "Lesser of $11.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.12,"standard_charge_algorithm": "Lesser of $12.12 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.69,"standard_charge_algorithm": "Lesser of $12.69 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.23,"standard_charge_algorithm": "Lesser of $12.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CRYPTOCOCCAL ANTIGEN TITER","code_information":[{"code":"86406","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC LAB CRYPTOCOCCAL ANTIGEN TITER","code_information":[{"code":"86406","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.64,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.19,"standard_charge_algorithm": "Lesser of $18.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.64,"standard_charge_algorithm": "Lesser of $10.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.38,"standard_charge_algorithm": "Lesser of $11.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.96,"standard_charge_algorithm": "Lesser of $10.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.17,"standard_charge_algorithm": "Lesser of $11.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.7,"standard_charge_algorithm": "Lesser of $11.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.28,"standard_charge_algorithm": "Lesser of $11.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RA SYNOVIAL FLUID","code_information":[{"code":"86431","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":240.57,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"}]}]},{"description":"HC LAB RA SYNOVIAL FLUID","code_information":[{"code":"86431","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":5.67,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.7,"standard_charge_algorithm": "Lesser of $9.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.67,"standard_charge_algorithm": "Lesser of $5.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.07,"standard_charge_algorithm": "Lesser of $6.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.84,"standard_charge_algorithm": "Lesser of $5.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.24,"standard_charge_algorithm": "Lesser of $6.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.01,"standard_charge_algorithm": "Lesser of $6.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RHEUMATOID ARTH TTR","code_information":[{"code":"86431","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":240.57,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"}]}]},{"description":"HC LAB RHEUMATOID ARTH TTR","code_information":[{"code":"86431","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.67,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.7,"standard_charge_algorithm": "Lesser of $9.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.67,"standard_charge_algorithm": "Lesser of $5.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.07,"standard_charge_algorithm": "Lesser of $6.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.84,"standard_charge_algorithm": "Lesser of $5.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.95,"standard_charge_algorithm": "Lesser of $5.95 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.24,"standard_charge_algorithm": "Lesser of $6.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.01,"standard_charge_algorithm": "Lesser of $6.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB QUANTIFERON-TB","code_information":[{"code":"86480","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"HC LAB QUANTIFERON-TB","code_information":[{"code":"86480","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":61.98,"maximum":187.72,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":187.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":148.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":105.99,"standard_charge_algorithm": "Lesser of $105.99 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":136.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":151.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":92.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":61.98,"standard_charge_algorithm": "Lesser of $61.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":66.32,"standard_charge_algorithm": "Lesser of $66.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":63.84,"standard_charge_algorithm": "Lesser of $63.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":65.08,"standard_charge_algorithm": "Lesser of $65.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":68.18,"standard_charge_algorithm": "Lesser of $68.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":65.7,"standard_charge_algorithm": "Lesser of $65.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VIRAL ILLNESS WITH MCC","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"minimum":4662,"maximum":22661.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13267,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12542,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9317,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11855,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11114,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21528.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18081,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21557,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17314,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22661.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21919,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13609,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13609,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4662,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12589.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13471.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12967.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13219.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13345.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13219.32,"methodology":"case rate"}]}]},{"description":"HC LAB TUBERCULOSIS INTRADML TEST","code_information":[{"code":"86580","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB TUBERCULOSIS INTRADML TEST","code_information":[{"code":"86580","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.1,"maximum":53.63,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"STREP PNEUM ANTB SEROT IA QUAN","code_information":[{"code":"86581","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"STREP PNEUM ANTB SEROT IA QUAN","code_information":[{"code":"86581","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.05,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB RPR","code_information":[{"code":"86592","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":23.49,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB RPR","code_information":[{"code":"86592","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","median_amount":6.87,"10th_percentile":6.87,"90th_percentile":6.87,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","median_amount":4.4,"10th_percentile":4.4,"90th_percentile":4.4,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SYPHILIS TEST NONTRP QL","code_information":[{"code":"86592","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.49,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB SYPHILIS TEST NONTRP QL","code_information":[{"code":"86592","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","median_amount":6.87,"10th_percentile":6.87,"90th_percentile":6.87,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","median_amount":4.4,"10th_percentile":4.4,"90th_percentile":4.4,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SYPHILIS TEST NONTRP QN","code_information":[{"code":"86593","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":98.01,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"}]}]},{"description":"HC LAB SYPHILIS TEST NONTRP QN","code_information":[{"code":"86593","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.4,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.52,"standard_charge_algorithm": "Lesser of $7.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.71,"standard_charge_algorithm": "Lesser of $4.71 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.62,"standard_charge_algorithm": "Lesser of $4.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.84,"standard_charge_algorithm": "Lesser of $4.84 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.66,"standard_charge_algorithm": "Lesser of $4.66 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VGCC ABY ASSAY","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":129.6,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"}]}]},{"description":"VGCC ABY ASSAY","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":24,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"}]}]},{"description":"VOLTAGE-GATED CA CHAN ABY EA","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"VOLTAGE-GATED CA CHAN ABY EA","code_information":[{"code":"86596","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"}]}]},{"description":"VIRAL ILLNESS WITHOUT MCC","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":4272,"maximum":15826.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7953,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7519,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5214,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5959,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5587,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15035.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9725,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11594,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9689,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15826.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13140,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8159,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8159,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4272,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8792.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9408.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9056.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9232.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9320.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9232.2,"methodology":"case rate"}]}]},{"description":"ANTINOMYCES ANTIBODY","code_information":[{"code":"86602","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":45.36,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"}]}]},{"description":"ANTINOMYCES ANTIBODY","code_information":[{"code":"86602","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.18,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.41,"standard_charge_algorithm": "Lesser of $17.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"standard_charge_algorithm": "Lesser of $10.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.89,"standard_charge_algorithm": "Lesser of $10.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.2,"standard_charge_algorithm": "Lesser of $11.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.79,"standard_charge_algorithm": "Lesser of $10.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ADENOVIRUS ANTIBODY","code_information":[{"code":"86603","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB ADENOVIRUS ANTIBODY","code_information":[{"code":"86603","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.87,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.01,"standard_charge_algorithm": "Lesser of $22.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"standard_charge_algorithm": "Lesser of $12.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.51,"standard_charge_algorithm": "Lesser of $13.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.16,"standard_charge_algorithm": "Lesser of $14.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ASPERGILLUS ANTIBODY","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":132.84,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"}]}]},{"description":"ASPERGILLUS ANTIBODY","code_information":[{"code":"86606","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.05,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.74,"standard_charge_algorithm": "Lesser of $25.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.1,"standard_charge_algorithm": "Lesser of $16.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.5,"standard_charge_algorithm": "Lesser of $15.50 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.8,"standard_charge_algorithm": "Lesser of $15.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.95,"standard_charge_algorithm": "Lesser of $15.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ASPERGILLUS","code_information":[{"code":"86606","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":132.84,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"}]}]},{"description":"HC LAB ASPERGILLUS","code_information":[{"code":"86606","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.05,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.74,"standard_charge_algorithm": "Lesser of $25.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.1,"standard_charge_algorithm": "Lesser of $16.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.5,"standard_charge_algorithm": "Lesser of $15.50 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.8,"standard_charge_algorithm": "Lesser of $15.80 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.95,"standard_charge_algorithm": "Lesser of $15.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BACTERIUM ANTIBODY","code_information":[{"code":"86609","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"BACTERIUM ANTIBODY","code_information":[{"code":"86609","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.02,"standard_charge_algorithm": "Lesser of $22.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"standard_charge_algorithm": "Lesser of $12.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.27,"standard_charge_algorithm": "Lesser of $13.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PNEUMOCOCCAL IM (14 SEROTYPE)","code_information":[{"code":"86609","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC PNEUMOCOCCAL IM (14 SEROTYPE)","code_information":[{"code":"86609","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.02,"standard_charge_algorithm": "Lesser of $22.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"standard_charge_algorithm": "Lesser of $12.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.27,"standard_charge_algorithm": "Lesser of $13.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BARTONELLA ANTIBODY","code_information":[{"code":"86611","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":39.69,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB BARTONELLA ANTIBODY","code_information":[{"code":"86611","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.18,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.41,"standard_charge_algorithm": "Lesser of $17.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"standard_charge_algorithm": "Lesser of $10.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.89,"standard_charge_algorithm": "Lesser of $10.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.2,"standard_charge_algorithm": "Lesser of $11.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.79,"standard_charge_algorithm": "Lesser of $10.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BLASTOMYCES AB ID","code_information":[{"code":"86612","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLASTOMYCES AB ID","code_information":[{"code":"86612","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.9,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.06,"standard_charge_algorithm": "Lesser of $22.06 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.9,"standard_charge_algorithm": "Lesser of $12.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.8,"standard_charge_algorithm": "Lesser of $13.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.29,"standard_charge_algorithm": "Lesser of $13.29 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.54,"standard_charge_algorithm": "Lesser of $13.54 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.19,"standard_charge_algorithm": "Lesser of $14.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.67,"standard_charge_algorithm": "Lesser of $13.67 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC B PERT IGA","code_information":[{"code":"86615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"HC B PERT IGA","code_information":[{"code":"86615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC B PERTUSSIS AB IGG","code_information":[{"code":"86615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":186.3,"maximum":186.3,"gross_charge":230,"discounted_cash":68.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"}]}]},{"description":"HC B PERTUSSIS AB IGG","code_information":[{"code":"86615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":186.3,"gross_charge":230,"discounted_cash":68.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC B. PERTUSSIS AB IGA","code_information":[{"code":"86615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC B. PERTUSSIS AB IGA","code_information":[{"code":"86615","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYME DISEASE CONFIRMATORY TEST","code_information":[{"code":"86617","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"LYME DISEASE CONFIRMATORY TEST","code_information":[{"code":"86617","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.49,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.49,"standard_charge_algorithm": "Lesser of $26.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.49,"standard_charge_algorithm": "Lesser of $15.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.57,"standard_charge_algorithm": "Lesser of $16.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.95,"standard_charge_algorithm": "Lesser of $15.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.26,"standard_charge_algorithm": "Lesser of $16.26 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.04,"standard_charge_algorithm": "Lesser of $17.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.42,"standard_charge_algorithm": "Lesser of $16.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LYME DISEASE AB TOTAL","code_information":[{"code":"86618","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB LYME DISEASE AB TOTAL","code_information":[{"code":"86618","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.03,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.12,"standard_charge_algorithm": "Lesser of $29.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.22,"standard_charge_algorithm": "Lesser of $18.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.54,"standard_charge_algorithm": "Lesser of $17.54 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.88,"standard_charge_algorithm": "Lesser of $17.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.73,"standard_charge_algorithm": "Lesser of $18.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.05,"standard_charge_algorithm": "Lesser of $18.05 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BRUCELLA ABORTUS","code_information":[{"code":"86622","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":147.42,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"}]}]},{"description":"HC LAB BRUCELLA ABORTUS","code_information":[{"code":"86622","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.93,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.27,"standard_charge_algorithm": "Lesser of $15.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.56,"standard_charge_algorithm": "Lesser of $9.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.2,"standard_charge_algorithm": "Lesser of $9.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.38,"standard_charge_algorithm": "Lesser of $9.38 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.82,"standard_charge_algorithm": "Lesser of $9.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.47,"standard_charge_algorithm": "Lesser of $9.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BRUCELLA IGG IGM","code_information":[{"code":"86622","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":73.71,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"}]}]},{"description":"HC LAB BRUCELLA IGG IGM","code_information":[{"code":"86622","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.93,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.27,"standard_charge_algorithm": "Lesser of $15.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.93,"standard_charge_algorithm": "Lesser of $8.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.56,"standard_charge_algorithm": "Lesser of $9.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.2,"standard_charge_algorithm": "Lesser of $9.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.38,"standard_charge_algorithm": "Lesser of $9.38 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.82,"standard_charge_algorithm": "Lesser of $9.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.47,"standard_charge_algorithm": "Lesser of $9.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CANDIDA AB IGM","code_information":[{"code":"86628","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":71.28,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"}]}]},{"description":"HC CANDIDA AB IGM","code_information":[{"code":"86628","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.01,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.54,"standard_charge_algorithm": "Lesser of $20.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"standard_charge_algorithm": "Lesser of $12.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.85,"standard_charge_algorithm": "Lesser of $12.85 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.37,"standard_charge_algorithm": "Lesser of $12.37 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.61,"standard_charge_algorithm": "Lesser of $12.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.21,"standard_charge_algorithm": "Lesser of $13.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CANDIDA IGG","code_information":[{"code":"86628","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC CANDIDA IGG","code_information":[{"code":"86628","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.01,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.54,"standard_charge_algorithm": "Lesser of $20.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.01,"standard_charge_algorithm": "Lesser of $12.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.85,"standard_charge_algorithm": "Lesser of $12.85 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.37,"standard_charge_algorithm": "Lesser of $12.37 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.61,"standard_charge_algorithm": "Lesser of $12.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.21,"standard_charge_algorithm": "Lesser of $13.21 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC C. PNEUMONIAE IGG SERUM","code_information":[{"code":"86631","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC C. PNEUMONIAE IGG SERUM","code_information":[{"code":"86631","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.82,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.21,"standard_charge_algorithm": "Lesser of $20.21 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"standard_charge_algorithm": "Lesser of $11.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.17,"standard_charge_algorithm": "Lesser of $12.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13,"standard_charge_algorithm": "Lesser of $13.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.53,"standard_charge_algorithm": "Lesser of $12.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC C. PNEUMONIAE IGG TITER","code_information":[{"code":"86631","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC C. PNEUMONIAE IGG TITER","code_information":[{"code":"86631","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.82,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.21,"standard_charge_algorithm": "Lesser of $20.21 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.82,"standard_charge_algorithm": "Lesser of $11.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.17,"standard_charge_algorithm": "Lesser of $12.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13,"standard_charge_algorithm": "Lesser of $13.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.53,"standard_charge_algorithm": "Lesser of $12.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC C PNEUMONIAE IGM TITER","code_information":[{"code":"86632","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC C PNEUMONIAE IGM TITER","code_information":[{"code":"86632","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.68,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.68,"standard_charge_algorithm": "Lesser of $21.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.57,"standard_charge_algorithm": "Lesser of $13.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.06,"standard_charge_algorithm": "Lesser of $13.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.31,"standard_charge_algorithm": "Lesser of $13.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.95,"standard_charge_algorithm": "Lesser of $13.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COCCIDIOIDES AB","code_information":[{"code":"86635","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC LAB COCCIDIOIDES AB","code_information":[{"code":"86635","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.47,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.61,"standard_charge_algorithm": "Lesser of $19.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"standard_charge_algorithm": "Lesser of $11.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.27,"standard_charge_algorithm": "Lesser of $12.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.81,"standard_charge_algorithm": "Lesser of $11.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.04,"standard_charge_algorithm": "Lesser of $12.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.62,"standard_charge_algorithm": "Lesser of $12.62 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.16,"standard_charge_algorithm": "Lesser of $12.16 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB COCCIDIOIDES AB COMP FIXATION","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC LAB COCCIDIOIDES AB COMP FIXATION","code_information":[{"code":"86635","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.47,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.61,"standard_charge_algorithm": "Lesser of $19.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.47,"standard_charge_algorithm": "Lesser of $11.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.27,"standard_charge_algorithm": "Lesser of $12.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.81,"standard_charge_algorithm": "Lesser of $11.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.04,"standard_charge_algorithm": "Lesser of $12.04 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.62,"standard_charge_algorithm": "Lesser of $12.62 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.16,"standard_charge_algorithm": "Lesser of $12.16 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB Q FEVER","code_information":[{"code":"86638","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC LAB Q FEVER","code_information":[{"code":"86638","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.12,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.73,"standard_charge_algorithm": "Lesser of $20.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.12,"standard_charge_algorithm": "Lesser of $12.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.97,"standard_charge_algorithm": "Lesser of $12.97 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.48,"standard_charge_algorithm": "Lesser of $12.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.33,"standard_charge_algorithm": "Lesser of $13.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.85,"standard_charge_algorithm": "Lesser of $12.85 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CRYPTOCOCCAL AB","code_information":[{"code":"86641","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":181.44,"maximum":181.44,"gross_charge":224,"discounted_cash":66.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.44,"methodology":"fee schedule"}]}]},{"description":"HC CRYPTOCOCCAL AB","code_information":[{"code":"86641","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.41,"maximum":181.44,"gross_charge":224,"discounted_cash":66.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.64,"standard_charge_algorithm": "Lesser of $24.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"standard_charge_algorithm": "Lesser of $14.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.42,"standard_charge_algorithm": "Lesser of $15.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.84,"standard_charge_algorithm": "Lesser of $14.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.13,"standard_charge_algorithm": "Lesser of $15.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.85,"standard_charge_algorithm": "Lesser of $15.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.27,"standard_charge_algorithm": "Lesser of $15.27 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CMV-IGG","code_information":[{"code":"86644","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":70.47,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"}]}]},{"description":"HC LAB CMV-IGG","code_information":[{"code":"86644","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.39,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.61,"standard_charge_algorithm": "Lesser of $24.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"standard_charge_algorithm": "Lesser of $14.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.4,"standard_charge_algorithm": "Lesser of $15.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.82,"standard_charge_algorithm": "Lesser of $14.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.25,"standard_charge_algorithm": "Lesser of $15.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CMV-IGM","code_information":[{"code":"86645","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":70.47,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"}]}]},{"description":"HC LAB CMV-IGM","code_information":[{"code":"86645","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.85,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.81,"standard_charge_algorithm": "Lesser of $28.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.03,"standard_charge_algorithm": "Lesser of $18.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.86,"standard_charge_algorithm": "Lesser of $17.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CALIFORNIA AB IGG","code_information":[{"code":"86651","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC CALIFORNIA AB IGG","code_information":[{"code":"86651","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC EASTERN EQUINE AB IGG","code_information":[{"code":"86652","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC EASTERN EQUINE AB IGG","code_information":[{"code":"86652","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ENCEPH SCREEN SERUM","code_information":[{"code":"86653","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB ENCEPH SCREEN SERUM","code_information":[{"code":"86653","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC WESTERN EQUINE AB IGG","code_information":[{"code":"86654","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC WESTERN EQUINE AB IGG","code_information":[{"code":"86654","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC COXSACKIE A TYPE A7 IGG","code_information":[{"code":"86658","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC COXSACKIE A TYPE A7 IGG","code_information":[{"code":"86658","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.03,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.28,"standard_charge_algorithm": "Lesser of $22.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"standard_charge_algorithm": "Lesser of $13.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.94,"standard_charge_algorithm": "Lesser of $13.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.42,"standard_charge_algorithm": "Lesser of $13.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.68,"standard_charge_algorithm": "Lesser of $13.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.81,"standard_charge_algorithm": "Lesser of $13.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ECHOVIRUS TYPE 4","code_information":[{"code":"86658","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC ECHOVIRUS TYPE 4","code_information":[{"code":"86658","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.03,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.28,"standard_charge_algorithm": "Lesser of $22.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.03,"standard_charge_algorithm": "Lesser of $13.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.94,"standard_charge_algorithm": "Lesser of $13.94 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.42,"standard_charge_algorithm": "Lesser of $13.42 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.68,"standard_charge_algorithm": "Lesser of $13.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.81,"standard_charge_algorithm": "Lesser of $13.81 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC EBV NUCLEAR AG","code_information":[{"code":"86664","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":196.02,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"}]}]},{"description":"HC EBV NUCLEAR AG","code_information":[{"code":"86664","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.29,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.15,"standard_charge_algorithm": "Lesser of $26.15 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.29,"standard_charge_algorithm": "Lesser of $15.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.36,"standard_charge_algorithm": "Lesser of $16.36 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.75,"standard_charge_algorithm": "Lesser of $15.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.05,"standard_charge_algorithm": "Lesser of $16.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.82,"standard_charge_algorithm": "Lesser of $16.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.21,"standard_charge_algorithm": "Lesser of $16.21 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EBV AB VCA IGG IGM","code_information":[{"code":"86665","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":153.09,"maximum":153.09,"gross_charge":189,"discounted_cash":55.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.09,"methodology":"fee schedule"}]}]},{"description":"EBV AB VCA IGG IGM","code_information":[{"code":"86665","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":18.14,"maximum":153.09,"gross_charge":189,"discounted_cash":55.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.02,"standard_charge_algorithm": "Lesser of $31.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"standard_charge_algorithm": "Lesser of $18.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.41,"standard_charge_algorithm": "Lesser of $19.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.05,"standard_charge_algorithm": "Lesser of $19.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.95,"standard_charge_algorithm": "Lesser of $19.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.23,"standard_charge_algorithm": "Lesser of $19.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB EBV-VCA","code_information":[{"code":"86665","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":153.09,"maximum":153.09,"gross_charge":189,"discounted_cash":55.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB EBV-VCA","code_information":[{"code":"86665","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":18.14,"maximum":153.09,"gross_charge":189,"discounted_cash":55.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.02,"standard_charge_algorithm": "Lesser of $31.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.14,"standard_charge_algorithm": "Lesser of $18.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.41,"standard_charge_algorithm": "Lesser of $19.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.05,"standard_charge_algorithm": "Lesser of $19.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.95,"standard_charge_algorithm": "Lesser of $19.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.23,"standard_charge_algorithm": "Lesser of $19.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ANAPLAMA IGG","code_information":[{"code":"86666","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC ANAPLAMA IGG","code_information":[{"code":"86666","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.18,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.41,"standard_charge_algorithm": "Lesser of $17.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"standard_charge_algorithm": "Lesser of $10.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.89,"standard_charge_algorithm": "Lesser of $10.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.2,"standard_charge_algorithm": "Lesser of $11.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.79,"standard_charge_algorithm": "Lesser of $10.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB EHRICHIA IGM","code_information":[{"code":"86666","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB EHRICHIA IGM","code_information":[{"code":"86666","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.18,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.41,"standard_charge_algorithm": "Lesser of $17.41 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.18,"standard_charge_algorithm": "Lesser of $10.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.89,"standard_charge_algorithm": "Lesser of $10.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.69,"standard_charge_algorithm": "Lesser of $10.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.2,"standard_charge_algorithm": "Lesser of $11.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.79,"standard_charge_algorithm": "Lesser of $10.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC FRANCISELLA TULARENSIS AB IGG","code_information":[{"code":"86668","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC FRANCISELLA TULARENSIS AB IGG","code_information":[{"code":"86668","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.16,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.21,"standard_charge_algorithm": "Lesser of $24.21 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.16,"standard_charge_algorithm": "Lesser of $14.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.15,"standard_charge_algorithm": "Lesser of $15.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.58,"standard_charge_algorithm": "Lesser of $14.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.87,"standard_charge_algorithm": "Lesser of $14.87 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.58,"standard_charge_algorithm": "Lesser of $15.58 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.01,"standard_charge_algorithm": "Lesser of $15.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GASCA","code_information":[{"code":"86671","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"GASCA","code_information":[{"code":"86671","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.25,"maximum":37.12,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.95,"standard_charge_algorithm": "Lesser of $20.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"standard_charge_algorithm": "Lesser of $12.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.11,"standard_charge_algorithm": "Lesser of $13.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.62,"standard_charge_algorithm": "Lesser of $12.62 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.86,"standard_charge_algorithm": "Lesser of $12.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.47,"standard_charge_algorithm": "Lesser of $13.47 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.98,"standard_charge_algorithm": "Lesser of $12.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SACCHROMYCES ABS IGG/A","code_information":[{"code":"86671","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"HC LAB SACCHROMYCES ABS IGG/A","code_information":[{"code":"86671","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.25,"maximum":37.12,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.95,"standard_charge_algorithm": "Lesser of $20.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.25,"standard_charge_algorithm": "Lesser of $12.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.11,"standard_charge_algorithm": "Lesser of $13.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.62,"standard_charge_algorithm": "Lesser of $12.62 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.86,"standard_charge_algorithm": "Lesser of $12.86 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.47,"standard_charge_algorithm": "Lesser of $13.47 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.98,"standard_charge_algorithm": "Lesser of $12.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB H.PYLORI ANTIBODIES","code_information":[{"code":"86677","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC LAB H.PYLORI ANTIBODIES","code_information":[{"code":"86677","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.85,"maximum":43.96,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.81,"standard_charge_algorithm": "Lesser of $28.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.03,"standard_charge_algorithm": "Lesser of $18.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.86,"standard_charge_algorithm": "Lesser of $17.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HELICOBACTER PYLORI IGG QUANT","code_information":[{"code":"86677","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC LAB HELICOBACTER PYLORI IGG QUANT","code_information":[{"code":"86677","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.85,"maximum":43.96,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.81,"standard_charge_algorithm": "Lesser of $28.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.03,"standard_charge_algorithm": "Lesser of $18.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.86,"standard_charge_algorithm": "Lesser of $17.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CYSTICERCOSIS ANTIBODY","code_information":[{"code":"86682","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYSTICERCOSIS ANTIBODY","code_information":[{"code":"86682","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.01,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.25,"standard_charge_algorithm": "Lesser of $22.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"standard_charge_algorithm": "Lesser of $13.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.92,"standard_charge_algorithm": "Lesser of $13.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.4,"standard_charge_algorithm": "Lesser of $13.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.66,"standard_charge_algorithm": "Lesser of $13.66 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.31,"standard_charge_algorithm": "Lesser of $14.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CYSTICERCOSIS ENZ-LINK IMMUNO","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYSTICERCOSIS ENZ-LINK IMMUNO","code_information":[{"code":"86682","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.01,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.25,"standard_charge_algorithm": "Lesser of $22.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.01,"standard_charge_algorithm": "Lesser of $13.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.92,"standard_charge_algorithm": "Lesser of $13.92 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.4,"standard_charge_algorithm": "Lesser of $13.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.66,"standard_charge_algorithm": "Lesser of $13.66 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.31,"standard_charge_algorithm": "Lesser of $14.31 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC H. INFLUENZAE B ANTIBODY IGG","code_information":[{"code":"86684","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":159.57,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"}]}]},{"description":"HC H. INFLUENZAE B ANTIBODY IGG","code_information":[{"code":"86684","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.84,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.09,"standard_charge_algorithm": "Lesser of $27.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.84,"standard_charge_algorithm": "Lesser of $15.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.95,"standard_charge_algorithm": "Lesser of $16.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.32,"standard_charge_algorithm": "Lesser of $16.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.63,"standard_charge_algorithm": "Lesser of $16.63 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.42,"standard_charge_algorithm": "Lesser of $17.42 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.79,"standard_charge_algorithm": "Lesser of $16.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HTLVL I/II ABY CONFIRMATION","code_information":[{"code":"86689","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":396.09,"maximum":396.09,"gross_charge":489,"discounted_cash":144.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.09,"methodology":"fee schedule"}]}]},{"description":"HTLVL I/II ABY CONFIRMATION","code_information":[{"code":"86689","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":396.09,"gross_charge":489,"discounted_cash":144.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.09,"standard_charge_algorithm": "Lesser of $33.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.7,"standard_charge_algorithm": "Lesser of $20.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.93,"standard_charge_algorithm": "Lesser of $19.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.51,"standard_charge_algorithm": "Lesser of $20.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AB HEPATITIS D DELTA","code_information":[{"code":"86692","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":77.76,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"}]}]},{"description":"HC LAB AB HEPATITIS D DELTA","code_information":[{"code":"86692","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.16,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.34,"standard_charge_algorithm": "Lesser of $29.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.16,"standard_charge_algorithm": "Lesser of $17.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.36,"standard_charge_algorithm": "Lesser of $18.36 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.67,"standard_charge_algorithm": "Lesser of $17.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.02,"standard_charge_algorithm": "Lesser of $18.02 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.88,"standard_charge_algorithm": "Lesser of $18.88 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.19,"standard_charge_algorithm": "Lesser of $18.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HERPES","code_information":[{"code":"86694","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB HERPES","code_information":[{"code":"86694","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.39,"maximum":43.6,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.61,"standard_charge_algorithm": "Lesser of $24.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"standard_charge_algorithm": "Lesser of $14.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.4,"standard_charge_algorithm": "Lesser of $15.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.82,"standard_charge_algorithm": "Lesser of $14.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.25,"standard_charge_algorithm": "Lesser of $15.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HERPES SIMPL TYPE I","code_information":[{"code":"86695","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB HERPES SIMPL TYPE I","code_information":[{"code":"86695","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC HSV TYPE 2 AB IGG","code_information":[{"code":"86696","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC HSV TYPE 2 AB IGG","code_information":[{"code":"86696","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.09,"standard_charge_algorithm": "Lesser of $33.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.7,"standard_charge_algorithm": "Lesser of $20.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.93,"standard_charge_algorithm": "Lesser of $19.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.51,"standard_charge_algorithm": "Lesser of $20.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HERPES SIMPL TYPE 2","code_information":[{"code":"86696","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB HERPES SIMPL TYPE 2","code_information":[{"code":"86696","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.09,"standard_charge_algorithm": "Lesser of $33.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.7,"standard_charge_algorithm": "Lesser of $20.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.93,"standard_charge_algorithm": "Lesser of $19.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.51,"standard_charge_algorithm": "Lesser of $20.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HISTOPLASMA","code_information":[{"code":"86698","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HC LAB HISTOPLASMA","code_information":[{"code":"86698","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.79,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.58,"standard_charge_algorithm": "Lesser of $23.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.76,"standard_charge_algorithm": "Lesser of $14.76 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.2,"standard_charge_algorithm": "Lesser of $14.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.48,"standard_charge_algorithm": "Lesser of $14.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.62,"standard_charge_algorithm": "Lesser of $14.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HISTOPLASMA CAPSULATUM ABS","code_information":[{"code":"86698","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HISTOPLASMA CAPSULATUM ABS","code_information":[{"code":"86698","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.79,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.58,"standard_charge_algorithm": "Lesser of $23.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.79,"standard_charge_algorithm": "Lesser of $13.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.76,"standard_charge_algorithm": "Lesser of $14.76 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.2,"standard_charge_algorithm": "Lesser of $14.20 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.48,"standard_charge_algorithm": "Lesser of $14.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.17,"standard_charge_algorithm": "Lesser of $15.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.62,"standard_charge_algorithm": "Lesser of $14.62 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"minimum":10521,"maximum":31845,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19275,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18222,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11887,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":29168,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27347,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28871.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22844,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27235,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22090,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30390.56,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31845,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19773,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19773,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10521,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16883.64,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18065.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17390.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17727.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17896.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17727.83,"methodology":"case rate"}]}]},{"description":"HC LAB RAPID HIV-1 ANTIBODY","code_information":[{"code":"86701","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":65.61,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"HC LAB RAPID HIV-1 ANTIBODY","code_information":[{"code":"86701","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.89,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.2,"standard_charge_algorithm": "Lesser of $15.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.89,"standard_charge_algorithm": "Lesser of $8.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.51,"standard_charge_algorithm": "Lesser of $9.51 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.16,"standard_charge_algorithm": "Lesser of $9.16 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.33,"standard_charge_algorithm": "Lesser of $9.33 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.78,"standard_charge_algorithm": "Lesser of $9.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.42,"standard_charge_algorithm": "Lesser of $9.42 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RAPID HIV-2 ANTIBODY","code_information":[{"code":"86702","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":47.79,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB RAPID HIV-2 ANTIBODY","code_information":[{"code":"86702","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.52,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.12,"standard_charge_algorithm": "Lesser of $23.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.47,"standard_charge_algorithm": "Lesser of $14.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.93,"standard_charge_algorithm": "Lesser of $13.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.2,"standard_charge_algorithm": "Lesser of $14.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.87,"standard_charge_algorithm": "Lesser of $14.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HIV-1/HIV-2 AB SNGL RES","code_information":[{"code":"86703","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB HIV-1/HIV-2 AB SNGL RES","code_information":[{"code":"86703","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.71,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.44,"standard_charge_algorithm": "Lesser of $23.44 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.71,"standard_charge_algorithm": "Lesser of $13.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.67,"standard_charge_algorithm": "Lesser of $14.67 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.12,"standard_charge_algorithm": "Lesser of $14.12 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.4,"standard_charge_algorithm": "Lesser of $14.40 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.08,"standard_charge_algorithm": "Lesser of $15.08 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.53,"standard_charge_algorithm": "Lesser of $14.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP B CORE AB TOTAL","code_information":[{"code":"86704","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP B CORE AB TOTAL","code_information":[{"code":"86704","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.05,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"standard_charge_algorithm": "Lesser of $12.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP B CORE AB (IGM)","code_information":[{"code":"86705","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP B CORE AB (IGM)","code_information":[{"code":"86705","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.77,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.13,"standard_charge_algorithm": "Lesser of $20.13 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"standard_charge_algorithm": "Lesser of $11.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.59,"standard_charge_algorithm": "Lesser of $12.59 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.12,"standard_charge_algorithm": "Lesser of $12.12 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.36,"standard_charge_algorithm": "Lesser of $12.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.95,"standard_charge_algorithm": "Lesser of $12.95 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.48,"standard_charge_algorithm": "Lesser of $12.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP BS AB (ANTI-HBS)","code_information":[{"code":"86706","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":137.7,"maximum":137.7,"gross_charge":170,"discounted_cash":50.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP BS AB (ANTI-HBS)","code_information":[{"code":"86706","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":137.7,"gross_charge":170,"discounted_cash":50.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.37,"standard_charge_algorithm": "Lesser of $18.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"standard_charge_algorithm": "Lesser of $10.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"standard_charge_algorithm": "Lesser of $11.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.28,"standard_charge_algorithm": "Lesser of $11.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.81,"standard_charge_algorithm": "Lesser of $11.81 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.38,"standard_charge_algorithm": "Lesser of $11.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEPATITIS B SURFACE ANTIBODY","code_information":[{"code":"86706","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":137.7,"maximum":137.7,"gross_charge":170,"discounted_cash":50.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEPATITIS B SURFACE ANTIBODY","code_information":[{"code":"86706","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":10.74,"maximum":137.7,"gross_charge":170,"discounted_cash":50.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.37,"standard_charge_algorithm": "Lesser of $18.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.74,"standard_charge_algorithm": "Lesser of $10.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.49,"standard_charge_algorithm": "Lesser of $11.49 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.06,"standard_charge_algorithm": "Lesser of $11.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.28,"standard_charge_algorithm": "Lesser of $11.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.81,"standard_charge_algorithm": "Lesser of $11.81 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.38,"standard_charge_algorithm": "Lesser of $11.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP BE AB (ANTI-HBE)","code_information":[{"code":"86707","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":49.41,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP BE AB (ANTI-HBE)","code_information":[{"code":"86707","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.57,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.78,"standard_charge_algorithm": "Lesser of $19.78 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.57,"standard_charge_algorithm": "Lesser of $11.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.38,"standard_charge_algorithm": "Lesser of $12.38 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.92,"standard_charge_algorithm": "Lesser of $11.92 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.15,"standard_charge_algorithm": "Lesser of $12.15 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.26,"standard_charge_algorithm": "Lesser of $12.26 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP A AB","code_information":[{"code":"86708","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP A AB","code_information":[{"code":"86708","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.39,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.19,"standard_charge_algorithm": "Lesser of $21.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"standard_charge_algorithm": "Lesser of $12.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.76,"standard_charge_algorithm": "Lesser of $12.76 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.01,"standard_charge_algorithm": "Lesser of $13.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.63,"standard_charge_algorithm": "Lesser of $13.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.13,"standard_charge_algorithm": "Lesser of $13.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP A AB (IGM)","code_information":[{"code":"86709","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":143.37,"maximum":143.37,"gross_charge":177,"discounted_cash":52.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.37,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP A AB (IGM)","code_information":[{"code":"86709","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.26,"maximum":143.37,"gross_charge":177,"discounted_cash":52.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.25,"standard_charge_algorithm": "Lesser of $19.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.26,"standard_charge_algorithm": "Lesser of $11.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.6,"standard_charge_algorithm": "Lesser of $11.60 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.82,"standard_charge_algorithm": "Lesser of $11.82 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.39,"standard_charge_algorithm": "Lesser of $12.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.94,"standard_charge_algorithm": "Lesser of $11.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC INFLUENZA A AB*","code_information":[{"code":"86710","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":79.38,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"}]}]},{"description":"HC INFLUENZA A AB*","code_information":[{"code":"86710","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.55,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.17,"standard_charge_algorithm": "Lesser of $23.17 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.55,"standard_charge_algorithm": "Lesser of $13.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.5,"standard_charge_algorithm": "Lesser of $14.50 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.96,"standard_charge_algorithm": "Lesser of $13.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.23,"standard_charge_algorithm": "Lesser of $14.23 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.9,"standard_charge_algorithm": "Lesser of $14.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.36,"standard_charge_algorithm": "Lesser of $14.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC STRATIFY JCV AB WITH INDEX","code_information":[{"code":"86711","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":181.44,"maximum":181.44,"gross_charge":224,"discounted_cash":66.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.44,"methodology":"fee schedule"}]}]},{"description":"HC STRATIFY JCV AB WITH INDEX","code_information":[{"code":"86711","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.32,"maximum":181.44,"gross_charge":224,"discounted_cash":66.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.88,"standard_charge_algorithm": "Lesser of $28.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.89,"standard_charge_algorithm": "Lesser of $16.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.07,"standard_charge_algorithm": "Lesser of $18.07 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.4,"standard_charge_algorithm": "Lesser of $17.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.73,"standard_charge_algorithm": "Lesser of $17.73 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.58,"standard_charge_algorithm": "Lesser of $18.58 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.9,"standard_charge_algorithm": "Lesser of $17.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LEGIONELLA AB TITER","code_information":[{"code":"86713","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB LEGIONELLA AB TITER","code_information":[{"code":"86713","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.16,"standard_charge_algorithm": "Lesser of $26.16 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.37,"standard_charge_algorithm": "Lesser of $16.37 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.76,"standard_charge_algorithm": "Lesser of $15.76 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.83,"standard_charge_algorithm": "Lesser of $16.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.22,"standard_charge_algorithm": "Lesser of $16.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB LEPTOSPIRA AB","code_information":[{"code":"86720","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"HC LAB LEPTOSPIRA AB","code_information":[{"code":"86720","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.7,"standard_charge_algorithm": "Lesser of $27.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.2,"standard_charge_algorithm": "Lesser of $16.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.33,"standard_charge_algorithm": "Lesser of $17.33 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.69,"standard_charge_algorithm": "Lesser of $16.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.01,"standard_charge_algorithm": "Lesser of $17.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.82,"standard_charge_algorithm": "Lesser of $17.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.17,"standard_charge_algorithm": "Lesser of $17.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LYMPH CHORIOMENINGITIS AB","code_information":[{"code":"86727","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"LYMPH CHORIOMENINGITIS AB","code_information":[{"code":"86727","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.87,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.01,"standard_charge_algorithm": "Lesser of $22.01 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.87,"standard_charge_algorithm": "Lesser of $12.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.51,"standard_charge_algorithm": "Lesser of $13.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.16,"standard_charge_algorithm": "Lesser of $14.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MUMPS AB IGG","code_information":[{"code":"86735","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":89.91,"maximum":89.91,"gross_charge":111,"discounted_cash":32.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.91,"methodology":"fee schedule"}]}]},{"description":"HC LAB MUMPS AB IGG","code_information":[{"code":"86735","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.05,"maximum":89.91,"gross_charge":111,"discounted_cash":32.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.32,"standard_charge_algorithm": "Lesser of $22.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"standard_charge_algorithm": "Lesser of $13.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.96,"standard_charge_algorithm": "Lesser of $13.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.7,"standard_charge_algorithm": "Lesser of $13.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.36,"standard_charge_algorithm": "Lesser of $14.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.83,"standard_charge_algorithm": "Lesser of $13.83 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MUMPS VIRUS IGM AB","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":89.91,"maximum":89.91,"gross_charge":111,"discounted_cash":32.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.91,"methodology":"fee schedule"}]}]},{"description":"HC LAB MUMPS VIRUS IGM AB","code_information":[{"code":"86735","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.05,"maximum":89.91,"gross_charge":111,"discounted_cash":32.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.32,"standard_charge_algorithm": "Lesser of $22.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.05,"standard_charge_algorithm": "Lesser of $13.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.96,"standard_charge_algorithm": "Lesser of $13.96 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.7,"standard_charge_algorithm": "Lesser of $13.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.36,"standard_charge_algorithm": "Lesser of $14.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.83,"standard_charge_algorithm": "Lesser of $13.83 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AB MYCOPLASMA","code_information":[{"code":"86738","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB AB MYCOPLASMA","code_information":[{"code":"86738","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.24,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.64,"standard_charge_algorithm": "Lesser of $22.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"standard_charge_algorithm": "Lesser of $13.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.9,"standard_charge_algorithm": "Lesser of $13.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.03,"standard_charge_algorithm": "Lesser of $14.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MYCOPLASMA PNEUMON IGM AB","code_information":[{"code":"86738","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYCOPLASMA PNEUMON IGM AB","code_information":[{"code":"86738","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.24,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.64,"standard_charge_algorithm": "Lesser of $22.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"standard_charge_algorithm": "Lesser of $13.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.9,"standard_charge_algorithm": "Lesser of $13.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.03,"standard_charge_algorithm": "Lesser of $14.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HUMAN PARVOVIRUS IGM IGG","code_information":[{"code":"86747","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB HUMAN PARVOVIRUS IGM IGG","code_information":[{"code":"86747","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.03,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.7,"standard_charge_algorithm": "Lesser of $25.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.08,"standard_charge_algorithm": "Lesser of $16.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.48,"standard_charge_algorithm": "Lesser of $15.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.78,"standard_charge_algorithm": "Lesser of $15.78 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.53,"standard_charge_algorithm": "Lesser of $16.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.93,"standard_charge_algorithm": "Lesser of $15.93 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB PARVOVIRUS","code_information":[{"code":"86747","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB PARVOVIRUS","code_information":[{"code":"86747","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.03,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.7,"standard_charge_algorithm": "Lesser of $25.70 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.03,"standard_charge_algorithm": "Lesser of $15.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.08,"standard_charge_algorithm": "Lesser of $16.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.48,"standard_charge_algorithm": "Lesser of $15.48 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.78,"standard_charge_algorithm": "Lesser of $15.78 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.53,"standard_charge_algorithm": "Lesser of $16.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.93,"standard_charge_algorithm": "Lesser of $15.93 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMOEBA ANTIBODY","code_information":[{"code":"86753","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":57.51,"maximum":57.51,"gross_charge":71,"discounted_cash":21.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMOEBA ANTIBODY","code_information":[{"code":"86753","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.39,"maximum":57.51,"gross_charge":71,"discounted_cash":21.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.19,"standard_charge_algorithm": "Lesser of $21.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.39,"standard_charge_algorithm": "Lesser of $12.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.76,"standard_charge_algorithm": "Lesser of $12.76 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.01,"standard_charge_algorithm": "Lesser of $13.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.63,"standard_charge_algorithm": "Lesser of $13.63 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.13,"standard_charge_algorithm": "Lesser of $13.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC RSV IGG","code_information":[{"code":"86756","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC RSV IGG","code_information":[{"code":"86756","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.89,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.17,"standard_charge_algorithm": "Lesser of $27.17 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.89,"standard_charge_algorithm": "Lesser of $15.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17,"standard_charge_algorithm": "Lesser of $17.00 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.37,"standard_charge_algorithm": "Lesser of $16.37 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.68,"standard_charge_algorithm": "Lesser of $16.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.48,"standard_charge_algorithm": "Lesser of $17.48 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.84,"standard_charge_algorithm": "Lesser of $16.84 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RICKETTSIA AB","code_information":[{"code":"86757","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC LAB RICKETTSIA AB","code_information":[{"code":"86757","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.09,"standard_charge_algorithm": "Lesser of $33.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.7,"standard_charge_algorithm": "Lesser of $20.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.93,"standard_charge_algorithm": "Lesser of $19.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.51,"standard_charge_algorithm": "Lesser of $20.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ROCKY MOUNTAIN IGG IGM AB","code_information":[{"code":"86757","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC LAB ROCKY MOUNTAIN IGG IGM AB","code_information":[{"code":"86757","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.09,"standard_charge_algorithm": "Lesser of $33.09 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.35,"standard_charge_algorithm": "Lesser of $19.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.7,"standard_charge_algorithm": "Lesser of $20.70 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.93,"standard_charge_algorithm": "Lesser of $19.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.32,"standard_charge_algorithm": "Lesser of $20.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.29,"standard_charge_algorithm": "Lesser of $21.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.51,"standard_charge_algorithm": "Lesser of $20.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RUBELLA AB","code_information":[{"code":"86762","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":89.1,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"}]}]},{"description":"HC LAB RUBELLA AB","code_information":[{"code":"86762","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.39,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.61,"standard_charge_algorithm": "Lesser of $24.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"standard_charge_algorithm": "Lesser of $14.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.4,"standard_charge_algorithm": "Lesser of $15.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.82,"standard_charge_algorithm": "Lesser of $14.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.25,"standard_charge_algorithm": "Lesser of $15.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RUBEOLA AB","code_information":[{"code":"86765","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":80.19,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB RUBEOLA AB","code_information":[{"code":"86765","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":80.19,"gross_charge":99,"discounted_cash":29.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.02,"standard_charge_algorithm": "Lesser of $22.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"standard_charge_algorithm": "Lesser of $12.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.27,"standard_charge_algorithm": "Lesser of $13.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SALMONELL O TYPE D","code_information":[{"code":"86768","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"HC SALMONELL O TYPE D","code_information":[{"code":"86768","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.19,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.55,"standard_charge_algorithm": "Lesser of $22.55 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.11,"standard_charge_algorithm": "Lesser of $14.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.85,"standard_charge_algorithm": "Lesser of $13.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.98,"standard_charge_algorithm": "Lesser of $13.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SARS-COV-2 ANTIBODY IGG","code_information":[{"code":"86769","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"SARS-COV-2 ANTIBODY IGG","code_information":[{"code":"86769","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.13,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":74.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":72.04,"standard_charge_algorithm": "Lesser of $72.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.13,"standard_charge_algorithm": "Lesser of $42.13 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.08,"standard_charge_algorithm": "Lesser of $45.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43.39,"standard_charge_algorithm": "Lesser of $43.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.24,"standard_charge_algorithm": "Lesser of $44.24 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":46.34,"standard_charge_algorithm": "Lesser of $46.34 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44.66,"standard_charge_algorithm": "Lesser of $44.66 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TOXOPLASMA AB IGG","code_information":[{"code":"86777","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":33.21,"maximum":33.21,"gross_charge":41,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOXOPLASMA AB IGG","code_information":[{"code":"86777","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.39,"maximum":43.6,"gross_charge":41,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.61,"standard_charge_algorithm": "Lesser of $24.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"standard_charge_algorithm": "Lesser of $14.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.4,"standard_charge_algorithm": "Lesser of $15.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.82,"standard_charge_algorithm": "Lesser of $14.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.25,"standard_charge_algorithm": "Lesser of $15.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TOXOPLASMA AB IGM","code_information":[{"code":"86778","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOXOPLASMA AB IGM","code_information":[{"code":"86778","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.41,"maximum":43.62,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.64,"standard_charge_algorithm": "Lesser of $24.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.41,"standard_charge_algorithm": "Lesser of $14.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.42,"standard_charge_algorithm": "Lesser of $15.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.84,"standard_charge_algorithm": "Lesser of $14.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.13,"standard_charge_algorithm": "Lesser of $15.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.85,"standard_charge_algorithm": "Lesser of $15.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.27,"standard_charge_algorithm": "Lesser of $15.27 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TPA CONFIRMATION","code_information":[{"code":"86780","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":98.82,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB TPA CONFIRMATION","code_information":[{"code":"86780","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.24,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.64,"standard_charge_algorithm": "Lesser of $22.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"standard_charge_algorithm": "Lesser of $13.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.9,"standard_charge_algorithm": "Lesser of $13.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.03,"standard_charge_algorithm": "Lesser of $14.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TREPONEMA PALLIDUM AB CSF","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":98.82,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB TREPONEMA PALLIDUM AB CSF","code_information":[{"code":"86780","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.24,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.64,"standard_charge_algorithm": "Lesser of $22.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.24,"standard_charge_algorithm": "Lesser of $13.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.64,"standard_charge_algorithm": "Lesser of $13.64 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.9,"standard_charge_algorithm": "Lesser of $13.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.56,"standard_charge_algorithm": "Lesser of $14.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.03,"standard_charge_algorithm": "Lesser of $14.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC TRICHINELLA IGG AB","code_information":[{"code":"86784","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"HC TRICHINELLA IGG AB","code_information":[{"code":"86784","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.56,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":38.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.48,"standard_charge_algorithm": "Lesser of $21.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.56,"standard_charge_algorithm": "Lesser of $12.56 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.44,"standard_charge_algorithm": "Lesser of $13.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.94,"standard_charge_algorithm": "Lesser of $12.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.19,"standard_charge_algorithm": "Lesser of $13.19 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.31,"standard_charge_algorithm": "Lesser of $13.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VARICELLA ZOSTER","code_information":[{"code":"86787","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB VARICELLA ZOSTER","code_information":[{"code":"86787","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.02,"standard_charge_algorithm": "Lesser of $22.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"standard_charge_algorithm": "Lesser of $12.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.27,"standard_charge_algorithm": "Lesser of $13.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WEST NILE VIRUS AB IGM","code_information":[{"code":"86788","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB WEST NILE VIRUS AB IGM","code_information":[{"code":"86788","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.85,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.81,"standard_charge_algorithm": "Lesser of $28.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.03,"standard_charge_algorithm": "Lesser of $18.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.86,"standard_charge_algorithm": "Lesser of $17.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WEST NILE VIRUS IGM","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB WEST NILE VIRUS IGM","code_information":[{"code":"86788","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":16.85,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.81,"standard_charge_algorithm": "Lesser of $28.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.03,"standard_charge_algorithm": "Lesser of $18.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.86,"standard_charge_algorithm": "Lesser of $17.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WEST NILE VIRUS AB","code_information":[{"code":"86789","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB WEST NILE VIRUS AB","code_information":[{"code":"86789","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.39,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.61,"standard_charge_algorithm": "Lesser of $24.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"standard_charge_algorithm": "Lesser of $14.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.4,"standard_charge_algorithm": "Lesser of $15.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.82,"standard_charge_algorithm": "Lesser of $14.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.25,"standard_charge_algorithm": "Lesser of $15.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WEST NILE VIRUS IGG","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB WEST NILE VIRUS IGG","code_information":[{"code":"86789","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":14.39,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.61,"standard_charge_algorithm": "Lesser of $24.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.39,"standard_charge_algorithm": "Lesser of $14.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.4,"standard_charge_algorithm": "Lesser of $15.40 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.82,"standard_charge_algorithm": "Lesser of $14.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.11,"standard_charge_algorithm": "Lesser of $15.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.83,"standard_charge_algorithm": "Lesser of $15.83 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.25,"standard_charge_algorithm": "Lesser of $15.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HTLV I/II ABS REFLEX","code_information":[{"code":"86790","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":111.78,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB HTLV I/II ABS REFLEX","code_information":[{"code":"86790","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.02,"standard_charge_algorithm": "Lesser of $22.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"standard_charge_algorithm": "Lesser of $12.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.27,"standard_charge_algorithm": "Lesser of $13.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB VIRUS AB NES","code_information":[{"code":"86790","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":111.78,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB VIRUS AB NES","code_information":[{"code":"86790","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.02,"standard_charge_algorithm": "Lesser of $22.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.88,"standard_charge_algorithm": "Lesser of $12.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.78,"standard_charge_algorithm": "Lesser of $13.78 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.27,"standard_charge_algorithm": "Lesser of $13.27 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.52,"standard_charge_algorithm": "Lesser of $13.52 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.17,"standard_charge_algorithm": "Lesser of $14.17 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ZIKA VIRUS IGM SERUM","code_information":[{"code":"86794","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC ZIKA VIRUS IGM SERUM","code_information":[{"code":"86794","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.85,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.81,"standard_charge_algorithm": "Lesser of $28.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.85,"standard_charge_algorithm": "Lesser of $16.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.03,"standard_charge_algorithm": "Lesser of $18.03 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.86,"standard_charge_algorithm": "Lesser of $17.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"minimum":4610,"maximum":17738.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9439,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8924,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6167,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12532,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11750,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16851.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11411,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13605,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11461,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17738.03,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15595,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9683,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9683,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4610,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9854.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10544.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10150.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10347.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10445.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10347.19,"methodology":"case rate"}]}]},{"description":"HC LAB THYROGLOBULIN AB","code_information":[{"code":"86800","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":110.16,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB THYROGLOBULIN AB","code_information":[{"code":"86800","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.91,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.21,"standard_charge_algorithm": "Lesser of $27.21 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"standard_charge_algorithm": "Lesser of $15.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"standard_charge_algorithm": "Lesser of $17.02 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.39,"standard_charge_algorithm": "Lesser of $16.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.71,"standard_charge_algorithm": "Lesser of $16.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.5,"standard_charge_algorithm": "Lesser of $17.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.86,"standard_charge_algorithm": "Lesser of $16.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB THYROGLOBULING QN","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":110.16,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB THYROGLOBULING QN","code_information":[{"code":"86800","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":15.91,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.21,"standard_charge_algorithm": "Lesser of $27.21 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.91,"standard_charge_algorithm": "Lesser of $15.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.02,"standard_charge_algorithm": "Lesser of $17.02 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.39,"standard_charge_algorithm": "Lesser of $16.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.71,"standard_charge_algorithm": "Lesser of $16.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.5,"standard_charge_algorithm": "Lesser of $17.50 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.86,"standard_charge_algorithm": "Lesser of $16.86 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP C AB (ANTI-HCV) DONOR","code_information":[{"code":"86803","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":45.36,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP C AB (ANTI-HCV) DONOR","code_information":[{"code":"86803","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.19,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.4,"standard_charge_algorithm": "Lesser of $24.40 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.27,"standard_charge_algorithm": "Lesser of $14.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.27,"standard_charge_algorithm": "Lesser of $15.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.7,"standard_charge_algorithm": "Lesser of $14.70 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.98,"standard_charge_algorithm": "Lesser of $14.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.7,"standard_charge_algorithm": "Lesser of $15.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.13,"standard_charge_algorithm": "Lesser of $15.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HLA B27 SNGL AG","code_information":[{"code":"86812","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC LAB HLA B27 SNGL AG","code_information":[{"code":"86812","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.81,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44.14,"standard_charge_algorithm": "Lesser of $44.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"standard_charge_algorithm": "Lesser of $25.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.62,"standard_charge_algorithm": "Lesser of $27.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.58,"standard_charge_algorithm": "Lesser of $26.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.1,"standard_charge_algorithm": "Lesser of $27.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.39,"standard_charge_algorithm": "Lesser of $28.39 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.36,"standard_charge_algorithm": "Lesser of $27.36 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HLA A B C","code_information":[{"code":"86813","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":706.32,"maximum":706.32,"gross_charge":872,"discounted_cash":258.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":706.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":706.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":706.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB HLA A B C","code_information":[{"code":"86813","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":58,"maximum":706.32,"gross_charge":872,"discounted_cash":258.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":706.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":706.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":706.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":175.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":139.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":99.18,"standard_charge_algorithm": "Lesser of $99.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":127.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":58,"standard_charge_algorithm": "Lesser of $58.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":62.06,"standard_charge_algorithm": "Lesser of $62.06 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":59.74,"standard_charge_algorithm": "Lesser of $59.74 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":60.9,"standard_charge_algorithm": "Lesser of $60.90 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":63.8,"standard_charge_algorithm": "Lesser of $63.80 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":61.48,"standard_charge_algorithm": "Lesser of $61.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HLA DR/DQ MULT AG","code_information":[{"code":"86817","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1080.54,"maximum":1080.54,"gross_charge":1334,"discounted_cash":394.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1080.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1080.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1080.54,"methodology":"fee schedule"}]}]},{"description":"HC LAB HLA DR/DQ MULT AG","code_information":[{"code":"86817","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":90.58,"maximum":1080.54,"gross_charge":1334,"discounted_cash":394.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1080.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1080.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1080.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":195,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":154.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":181.5,"standard_charge_algorithm": "Lesser of $181.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":209.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":233.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":159.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":106.14,"standard_charge_algorithm": "Lesser of $106.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":113.57,"standard_charge_algorithm": "Lesser of $113.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":109.32,"standard_charge_algorithm": "Lesser of $109.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":111.45,"standard_charge_algorithm": "Lesser of $111.45 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":116.75,"standard_charge_algorithm": "Lesser of $116.75 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":112.51,"standard_charge_algorithm": "Lesser of $112.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DRAWN SAMPLE STORAGE","code_information":[{"code":"86849","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC LAB DRAWN SAMPLE STORAGE","code_information":[{"code":"86849","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":50.58,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":52.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":52.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB INDIRECT COOMBS","code_information":[{"code":"86850","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":228.42,"maximum":228.42,"gross_charge":282,"discounted_cash":83.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.42,"methodology":"fee schedule"}]}]},{"description":"HC LAB INDIRECT COOMBS","code_information":[{"code":"86850","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.77,"maximum":228.42,"gross_charge":282,"discounted_cash":83.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB ANTIBODY ELUTION","code_information":[{"code":"86860","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTIBODY ELUTION","code_information":[{"code":"86860","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.85,"maximum":375.17,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB ANTIBODY ID SERUM","code_information":[{"code":"86870","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":358.83,"maximum":358.83,"gross_charge":443,"discounted_cash":131.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":358.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":358.83,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTIBODY ID SERUM","code_information":[{"code":"86870","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.85,"maximum":787.54,"gross_charge":443,"discounted_cash":131.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":358.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":358.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":89.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB COOMBS DIRECT AHG","code_information":[{"code":"86880","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"HC LAB COOMBS DIRECT AHG","code_information":[{"code":"86880","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.39,"maximum":130.04,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"INDIRECT EACH ANTIBODY TITER","code_information":[{"code":"86886","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":97.2,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"}]}]},{"description":"INDIRECT EACH ANTIBODY TITER","code_information":[{"code":"86886","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.18,"maximum":375.17,"gross_charge":120,"discounted_cash":35.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB AUTOLOGOUS COLL/PRCS","code_information":[{"code":"86890","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":251.1,"maximum":251.1,"gross_charge":310,"discounted_cash":91.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":251.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":251.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":251.1,"methodology":"fee schedule"}]}]},{"description":"HC LAB AUTOLOGOUS COLL/PRCS","code_information":[{"code":"86890","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":46.5,"maximum":375.17,"gross_charge":310,"discounted_cash":91.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":251.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":251.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":251.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":203.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":226.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"minimum":3924,"maximum":13916.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6468,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6115,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3924,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7050,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6610,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13220.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8007,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9547,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7292,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13916.36,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10687,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6635,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6635,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4610,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7731.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8272.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7963.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8117.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8195.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8117.88,"methodology":"case rate"}]}]},{"description":"HC LAB BLOOD TYPING ABO SEROLOGIC","code_information":[{"code":"86900","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.49,"maximum":23.49,"gross_charge":29,"discounted_cash":8.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD TYPING ABO SEROLOGIC","code_information":[{"code":"86900","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.99,"maximum":282.21,"gross_charge":29,"discounted_cash":8.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC LAB BLOOD TYPING RHD SEROLOGIC","code_information":[{"code":"86901","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":106.11,"maximum":106.11,"gross_charge":131,"discounted_cash":38.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD TYPING RHD SEROLOGIC","code_information":[{"code":"86901","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.99,"maximum":106.11,"gross_charge":131,"discounted_cash":38.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"HC LAB SPECIAL AG TESTING SEROLOGIC","code_information":[{"code":"86902","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":73.71,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"}]}]},{"description":"HC LAB SPECIAL AG TESTING SEROLOGIC","code_information":[{"code":"86902","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.81,"maximum":787.54,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB AG SCR W PT SERUM SEROLOGIC","code_information":[{"code":"86904","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":39.69,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"}]}]},{"description":"HC LAB AG SCR W PT SERUM SEROLOGIC","code_information":[{"code":"86904","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.37,"maximum":130.04,"gross_charge":49,"discounted_cash":14.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC LAB RBC AG-PATIENT SEROLOGIC","code_information":[{"code":"86905","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB RBC AG-PATIENT SEROLOGIC","code_information":[{"code":"86905","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.83,"maximum":787.54,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB CROSSMATCH IS","code_information":[{"code":"86920","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":276.21,"maximum":276.21,"gross_charge":341,"discounted_cash":100.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB CROSSMATCH IS","code_information":[{"code":"86920","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":39.07,"maximum":375.17,"gross_charge":341,"discounted_cash":100.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":80.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB CROSSMATCH AHG","code_information":[{"code":"86922","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":325.62,"maximum":325.62,"gross_charge":402,"discounted_cash":119,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB CROSSMATCH AHG","code_information":[{"code":"86922","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":41.32,"maximum":375.17,"gross_charge":402,"discounted_cash":119,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":52.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB CROSSMATCH-ELECTRONIC","code_information":[{"code":"86923","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":259.2,"maximum":259.2,"gross_charge":320,"discounted_cash":94.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"}]}]},{"description":"HC LAB CROSSMATCH-ELECTRONIC","code_information":[{"code":"86923","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":31.13,"maximum":375.17,"gross_charge":320,"discounted_cash":94.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC PROC FEE IRRADIATION PLATELET","code_information":[{"code":"86945","type":"CPT"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":234.09,"maximum":234.09,"gross_charge":289,"discounted_cash":85.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.09,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE IRRADIATION PLATELET","code_information":[{"code":"86945","type":"CPT"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":32.28,"maximum":234.09,"gross_charge":289,"discounted_cash":85.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"HC LAB POOLING BLOOD PRODUCTS","code_information":[{"code":"86965","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":673.11,"maximum":673.11,"gross_charge":831,"discounted_cash":245.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":673.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":673.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":673.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB POOLING BLOOD PRODUCTS","code_information":[{"code":"86965","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.24,"maximum":673.11,"gross_charge":831,"discounted_cash":245.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":673.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":673.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":673.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":66.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB PRETREAT RBC CHLOROQUIN","code_information":[{"code":"86970","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":81,"maximum":81,"gross_charge":100,"discounted_cash":29.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81,"methodology":"fee schedule"}]}]},{"description":"HC LAB PRETREAT RBC CHLOROQUIN","code_information":[{"code":"86970","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15,"maximum":130.04,"gross_charge":100,"discounted_cash":29.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC LAB ANTIBODY ABSORPTION","code_information":[{"code":"86978","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"}]}]},{"description":"HC LAB ANTIBODY ABSORPTION","code_information":[{"code":"86978","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.85,"maximum":130.04,"gross_charge":159,"discounted_cash":47.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":71.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":80.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"minimum":35522,"maximum":125541,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62532,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":59116,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39570,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":125541,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":117703,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81733.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":73403,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":87514,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73535,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":86035.34,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103311,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":64146,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64146,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35522,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47797.41,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51143.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49231.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50187.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":50665.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50187.29,"methodology":"case rate"}]}]},{"description":"CONC FOR INFECTIOUS AGENTS","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":34.83,"maximum":34.83,"gross_charge":43,"discounted_cash":12.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.83,"methodology":"fee schedule"}]}]},{"description":"CONC FOR INFECTIOUS AGENTS","code_information":[{"code":"87015","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.68,"maximum":34.83,"gross_charge":43,"discounted_cash":12.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.42,"standard_charge_algorithm": "Lesser of $11.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"standard_charge_algorithm": "Lesser of $6.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.15,"standard_charge_algorithm": "Lesser of $7.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.88,"standard_charge_algorithm": "Lesser of $6.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.01,"standard_charge_algorithm": "Lesser of $7.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.35,"standard_charge_algorithm": "Lesser of $7.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.08,"standard_charge_algorithm": "Lesser of $7.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CONCENTRATION;INF AGNT","code_information":[{"code":"87015","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":34.83,"maximum":34.83,"gross_charge":43,"discounted_cash":12.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.83,"methodology":"fee schedule"}]}]},{"description":"HC LAB CONCENTRATION;INF AGNT","code_information":[{"code":"87015","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.68,"maximum":34.83,"gross_charge":43,"discounted_cash":12.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.42,"standard_charge_algorithm": "Lesser of $11.42 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.68,"standard_charge_algorithm": "Lesser of $6.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.15,"standard_charge_algorithm": "Lesser of $7.15 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.88,"standard_charge_algorithm": "Lesser of $6.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.01,"standard_charge_algorithm": "Lesser of $7.01 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.35,"standard_charge_algorithm": "Lesser of $7.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.08,"standard_charge_algorithm": "Lesser of $7.08 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-BLOOD","code_information":[{"code":"87040","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-BLOOD","code_information":[{"code":"87040","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.32,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"standard_charge_algorithm": "Lesser of $10.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.04,"standard_charge_algorithm": "Lesser of $11.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.63,"standard_charge_algorithm": "Lesser of $10.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.84,"standard_charge_algorithm": "Lesser of $10.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.35,"standard_charge_algorithm": "Lesser of $11.35 or 110 Percent of Billed Charges","median_amount":10.32,"10th_percentile":4.1,"90th_percentile":10.32,"count":"11","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.94,"standard_charge_algorithm": "Lesser of $10.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-STOOL","code_information":[{"code":"87045","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-STOOL","code_information":[{"code":"87045","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.44,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"standard_charge_algorithm": "Lesser of $9.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.1,"standard_charge_algorithm": "Lesser of $10.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.72,"standard_charge_algorithm": "Lesser of $9.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.91,"standard_charge_algorithm": "Lesser of $9.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.38,"standard_charge_algorithm": "Lesser of $10.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.01,"standard_charge_algorithm": "Lesser of $10.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-STOOL ADDL PATHOG","code_information":[{"code":"87046","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-STOOL ADDL PATHOG","code_information":[{"code":"87046","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.32,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"standard_charge_algorithm": "Lesser of $9.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.1,"standard_charge_algorithm": "Lesser of $10.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.72,"standard_charge_algorithm": "Lesser of $9.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.91,"standard_charge_algorithm": "Lesser of $9.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.38,"standard_charge_algorithm": "Lesser of $10.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.01,"standard_charge_algorithm": "Lesser of $10.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"STOOL AEROBIC ADDITIONAL PATHOGENS","code_information":[{"code":"87046","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"STOOL AEROBIC ADDITIONAL PATHOGENS","code_information":[{"code":"87046","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":3.32,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.14,"standard_charge_algorithm": "Lesser of $16.14 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.44,"standard_charge_algorithm": "Lesser of $9.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.1,"standard_charge_algorithm": "Lesser of $10.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.72,"standard_charge_algorithm": "Lesser of $9.72 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.91,"standard_charge_algorithm": "Lesser of $9.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.38,"standard_charge_algorithm": "Lesser of $10.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.01,"standard_charge_algorithm": "Lesser of $10.01 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-BACT OTH SOURCE","code_information":[{"code":"87070","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":53.46,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-BACT OTH SOURCE","code_information":[{"code":"87070","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.62,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.74,"standard_charge_algorithm": "Lesser of $14.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"standard_charge_algorithm": "Lesser of $8.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"standard_charge_algorithm": "Lesser of $9.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.88,"standard_charge_algorithm": "Lesser of $8.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.05,"standard_charge_algorithm": "Lesser of $9.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.48,"standard_charge_algorithm": "Lesser of $9.48 or 110 Percent of Billed Charges","median_amount":8.62,"10th_percentile":8.62,"90th_percentile":8.62,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.14,"standard_charge_algorithm": "Lesser of $9.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULTURE UPPER RESPIRATORY","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULTURE UPPER RESPIRATORY","code_information":[{"code":"87070","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.62,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.74,"standard_charge_algorithm": "Lesser of $14.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.62,"standard_charge_algorithm": "Lesser of $8.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.22,"standard_charge_algorithm": "Lesser of $9.22 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.88,"standard_charge_algorithm": "Lesser of $8.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.05,"standard_charge_algorithm": "Lesser of $9.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.48,"standard_charge_algorithm": "Lesser of $9.48 or 110 Percent of Billed Charges","median_amount":8.62,"10th_percentile":8.62,"90th_percentile":8.62,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.14,"standard_charge_algorithm": "Lesser of $9.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-QUAN AEROBIC","code_information":[{"code":"87071","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-QUAN AEROBIC","code_information":[{"code":"87071","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.63,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.91,"standard_charge_algorithm": "Lesser of $16.91 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.89,"standard_charge_algorithm": "Lesser of $9.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.58,"standard_charge_algorithm": "Lesser of $10.58 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.19,"standard_charge_algorithm": "Lesser of $10.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.38,"standard_charge_algorithm": "Lesser of $10.38 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.88,"standard_charge_algorithm": "Lesser of $10.88 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.48,"standard_charge_algorithm": "Lesser of $10.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-ANAEROBIC W ISOL","code_information":[{"code":"87075","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-ANAEROBIC W ISOL","code_information":[{"code":"87075","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":9.47,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.19,"standard_charge_algorithm": "Lesser of $16.19 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.47,"standard_charge_algorithm": "Lesser of $9.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.13,"standard_charge_algorithm": "Lesser of $10.13 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.75,"standard_charge_algorithm": "Lesser of $9.75 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.94,"standard_charge_algorithm": "Lesser of $9.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.42,"standard_charge_algorithm": "Lesser of $10.42 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.04,"standard_charge_algorithm": "Lesser of $10.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-ANAEROBE ID ADDL","code_information":[{"code":"87076","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-ANAEROBE ID ADDL","code_information":[{"code":"87076","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.08,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"standard_charge_algorithm": "Lesser of $8.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.32,"standard_charge_algorithm": "Lesser of $8.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.48,"standard_charge_algorithm": "Lesser of $8.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.89,"standard_charge_algorithm": "Lesser of $8.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.56,"standard_charge_algorithm": "Lesser of $8.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"AEROBIC ID BY MALDI","code_information":[{"code":"87077","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":307.8,"maximum":307.8,"gross_charge":380,"discounted_cash":112.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.8,"methodology":"fee schedule"}]}]},{"description":"AEROBIC ID BY MALDI","code_information":[{"code":"87077","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.08,"maximum":307.8,"gross_charge":380,"discounted_cash":112.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"standard_charge_algorithm": "Lesser of $8.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.32,"standard_charge_algorithm": "Lesser of $8.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.48,"standard_charge_algorithm": "Lesser of $8.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.89,"standard_charge_algorithm": "Lesser of $8.89 or 110 Percent of Billed Charges","median_amount":8.08,"10th_percentile":8.08,"90th_percentile":8.08,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.56,"standard_charge_algorithm": "Lesser of $8.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-AEROBE ID ADDL","code_information":[{"code":"87077","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-AEROBE ID ADDL","code_information":[{"code":"87077","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.08,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.08,"standard_charge_algorithm": "Lesser of $8.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.32,"standard_charge_algorithm": "Lesser of $8.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.48,"standard_charge_algorithm": "Lesser of $8.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.89,"standard_charge_algorithm": "Lesser of $8.89 or 110 Percent of Billed Charges","median_amount":8.08,"10th_percentile":8.08,"90th_percentile":8.08,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.56,"standard_charge_algorithm": "Lesser of $8.56 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-P PATHOG SCREEN","code_information":[{"code":"87081","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-P PATHOG SCREEN","code_information":[{"code":"87081","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.63,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.34,"standard_charge_algorithm": "Lesser of $11.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"standard_charge_algorithm": "Lesser of $6.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.09,"standard_charge_algorithm": "Lesser of $7.09 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.83,"standard_charge_algorithm": "Lesser of $6.83 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.96,"standard_charge_algorithm": "Lesser of $6.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.29,"standard_charge_algorithm": "Lesser of $7.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.03,"standard_charge_algorithm": "Lesser of $7.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULTURE BORDETELLA PERTUSSIS","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULTURE BORDETELLA PERTUSSIS","code_information":[{"code":"87081","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.63,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.34,"standard_charge_algorithm": "Lesser of $11.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.63,"standard_charge_algorithm": "Lesser of $6.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.09,"standard_charge_algorithm": "Lesser of $7.09 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.83,"standard_charge_algorithm": "Lesser of $6.83 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.96,"standard_charge_algorithm": "Lesser of $6.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.29,"standard_charge_algorithm": "Lesser of $7.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.03,"standard_charge_algorithm": "Lesser of $7.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-URINE","code_information":[{"code":"87086","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-URINE","code_information":[{"code":"87086","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.07,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.8,"standard_charge_algorithm": "Lesser of $13.80 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"standard_charge_algorithm": "Lesser of $8.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.63,"standard_charge_algorithm": "Lesser of $8.63 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.31,"standard_charge_algorithm": "Lesser of $8.31 or 103 Percent of Billed Charges","median_amount":8.31,"10th_percentile":8.31,"90th_percentile":8.31,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.47,"standard_charge_algorithm": "Lesser of $8.47 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.88,"standard_charge_algorithm": "Lesser of $8.88 or 110 Percent of Billed Charges","median_amount":8.07,"10th_percentile":8.07,"90th_percentile":8.07,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.55,"standard_charge_algorithm": "Lesser of $8.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URINE CULTURE SPECIAL","code_information":[{"code":"87086","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINE CULTURE SPECIAL","code_information":[{"code":"87086","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.07,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.8,"standard_charge_algorithm": "Lesser of $13.80 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.07,"standard_charge_algorithm": "Lesser of $8.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.63,"standard_charge_algorithm": "Lesser of $8.63 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.31,"standard_charge_algorithm": "Lesser of $8.31 or 103 Percent of Billed Charges","median_amount":8.31,"10th_percentile":8.31,"90th_percentile":8.31,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.47,"standard_charge_algorithm": "Lesser of $8.47 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.88,"standard_charge_algorithm": "Lesser of $8.88 or 110 Percent of Billed Charges","median_amount":8.07,"10th_percentile":8.07,"90th_percentile":8.07,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.55,"standard_charge_algorithm": "Lesser of $8.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB URINE BACTERIA CULTURE","code_information":[{"code":"87088","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC LAB URINE BACTERIA CULTURE","code_information":[{"code":"87088","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.09,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.83,"standard_charge_algorithm": "Lesser of $13.83 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.09,"standard_charge_algorithm": "Lesser of $8.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.66,"standard_charge_algorithm": "Lesser of $8.66 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.33,"standard_charge_algorithm": "Lesser of $8.33 or 103 Percent of Billed Charges","median_amount":8.33,"10th_percentile":8.33,"90th_percentile":8.33,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.49,"standard_charge_algorithm": "Lesser of $8.49 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.9,"standard_charge_algorithm": "Lesser of $8.90 or 110 Percent of Billed Charges","median_amount":8.09,"10th_percentile":8.09,"90th_percentile":8.09,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.58,"standard_charge_algorithm": "Lesser of $8.58 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":11004,"maximum":29139,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17637,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16674,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11264,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22763,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21342,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26869.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21155,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25222,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20932,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28283.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29139,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18093,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18093,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11004,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15713.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16813.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16184.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16498.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16655.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16498.84,"methodology":"case rate"}]}]},{"description":"HC FUNGUS CULTURESKINHRNAIL","code_information":[{"code":"87101","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC FUNGUS CULTURESKINHRNAIL","code_information":[{"code":"87101","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":7.71,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.71,"standard_charge_algorithm": "Lesser of $7.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.25,"standard_charge_algorithm": "Lesser of $8.25 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.94,"standard_charge_algorithm": "Lesser of $7.94 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.1,"standard_charge_algorithm": "Lesser of $8.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.48,"standard_charge_algorithm": "Lesser of $8.48 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-FUNGUS","code_information":[{"code":"87102","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-FUNGUS","code_information":[{"code":"87102","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.41,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.38,"standard_charge_algorithm": "Lesser of $14.38 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.41,"standard_charge_algorithm": "Lesser of $8.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9,"standard_charge_algorithm": "Lesser of $9.00 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.66,"standard_charge_algorithm": "Lesser of $8.66 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.83,"standard_charge_algorithm": "Lesser of $8.83 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.25,"standard_charge_algorithm": "Lesser of $9.25 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.91,"standard_charge_algorithm": "Lesser of $8.91 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-FUNGUS BLOOD","code_information":[{"code":"87103","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":285.12,"maximum":285.12,"gross_charge":352,"discounted_cash":104.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-FUNGUS BLOOD","code_information":[{"code":"87103","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.69,"maximum":285.12,"gross_charge":352,"discounted_cash":104.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.99,"standard_charge_algorithm": "Lesser of $34.99 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.46,"standard_charge_algorithm": "Lesser of $20.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.89,"standard_charge_algorithm": "Lesser of $21.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.07,"standard_charge_algorithm": "Lesser of $21.07 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.48,"standard_charge_algorithm": "Lesser of $21.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.51,"standard_charge_algorithm": "Lesser of $22.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.69,"standard_charge_algorithm": "Lesser of $21.69 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-FUNGAL ID YEAST","code_information":[{"code":"87106","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-FUNGAL ID YEAST","code_information":[{"code":"87106","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.32,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"standard_charge_algorithm": "Lesser of $10.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.04,"standard_charge_algorithm": "Lesser of $11.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.63,"standard_charge_algorithm": "Lesser of $10.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.84,"standard_charge_algorithm": "Lesser of $10.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.35,"standard_charge_algorithm": "Lesser of $11.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.94,"standard_charge_algorithm": "Lesser of $10.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"YEAST ID BY MALDI","code_information":[{"code":"87106","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":308.61,"maximum":308.61,"gross_charge":381,"discounted_cash":112.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":308.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.61,"methodology":"fee schedule"}]}]},{"description":"YEAST ID BY MALDI","code_information":[{"code":"87106","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.32,"maximum":308.61,"gross_charge":381,"discounted_cash":112.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":308.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"standard_charge_algorithm": "Lesser of $10.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.04,"standard_charge_algorithm": "Lesser of $11.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.63,"standard_charge_algorithm": "Lesser of $10.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.84,"standard_charge_algorithm": "Lesser of $10.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.35,"standard_charge_algorithm": "Lesser of $11.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.94,"standard_charge_algorithm": "Lesser of $10.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-FUNGAL ID MOLD","code_information":[{"code":"87107","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":86.67,"maximum":86.67,"gross_charge":107,"discounted_cash":31.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.67,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-FUNGAL ID MOLD","code_information":[{"code":"87107","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.32,"maximum":86.67,"gross_charge":107,"discounted_cash":31.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.65,"standard_charge_algorithm": "Lesser of $17.65 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.32,"standard_charge_algorithm": "Lesser of $10.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.04,"standard_charge_algorithm": "Lesser of $11.04 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.63,"standard_charge_algorithm": "Lesser of $10.63 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.84,"standard_charge_algorithm": "Lesser of $10.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.35,"standard_charge_algorithm": "Lesser of $11.35 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.94,"standard_charge_algorithm": "Lesser of $10.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-MYCOPLASMA","code_information":[{"code":"87109","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":318.33,"maximum":318.33,"gross_charge":393,"discounted_cash":116.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.33,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-MYCOPLASMA","code_information":[{"code":"87109","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":15.39,"maximum":318.33,"gross_charge":393,"discounted_cash":116.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.32,"standard_charge_algorithm": "Lesser of $26.32 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"standard_charge_algorithm": "Lesser of $15.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.47,"standard_charge_algorithm": "Lesser of $16.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.85,"standard_charge_algorithm": "Lesser of $15.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.16,"standard_charge_algorithm": "Lesser of $16.16 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.93,"standard_charge_algorithm": "Lesser of $16.93 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.31,"standard_charge_algorithm": "Lesser of $16.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-CHLAMYDIA TRCHMTS","code_information":[{"code":"87110","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":125.55,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-CHLAMYDIA TRCHMTS","code_information":[{"code":"87110","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.6,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.52,"standard_charge_algorithm": "Lesser of $33.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.6,"standard_charge_algorithm": "Lesser of $19.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.97,"standard_charge_algorithm": "Lesser of $20.97 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.58,"standard_charge_algorithm": "Lesser of $20.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.56,"standard_charge_algorithm": "Lesser of $21.56 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.78,"standard_charge_algorithm": "Lesser of $20.78 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-AFB ISOL & ID","code_information":[{"code":"87116","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":376.65,"maximum":376.65,"gross_charge":465,"discounted_cash":137.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-AFB ISOL & ID","code_information":[{"code":"87116","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.8,"maximum":376.65,"gross_charge":465,"discounted_cash":137.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":376.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.47,"standard_charge_algorithm": "Lesser of $18.47 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.8,"standard_charge_algorithm": "Lesser of $10.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.56,"standard_charge_algorithm": "Lesser of $11.56 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.12,"standard_charge_algorithm": "Lesser of $11.12 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.34,"standard_charge_algorithm": "Lesser of $11.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.45,"standard_charge_algorithm": "Lesser of $11.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NORCARDIA ID BY MALDI","code_information":[{"code":"87118","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":208.98,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"}]}]},{"description":"NORCARDIA ID BY MALDI","code_information":[{"code":"87118","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":14.61,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.98,"standard_charge_algorithm": "Lesser of $24.98 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.63,"standard_charge_algorithm": "Lesser of $15.63 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.05,"standard_charge_algorithm": "Lesser of $15.05 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.34,"standard_charge_algorithm": "Lesser of $15.34 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.49,"standard_charge_algorithm": "Lesser of $15.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-AFB ID","code_information":[{"code":"87149","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-AFB ID","code_information":[{"code":"87149","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.05,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.29,"standard_charge_algorithm": "Lesser of $34.29 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"standard_charge_algorithm": "Lesser of $20.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.45,"standard_charge_algorithm": "Lesser of $21.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.65,"standard_charge_algorithm": "Lesser of $20.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.05,"standard_charge_algorithm": "Lesser of $21.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.05,"standard_charge_algorithm": "Lesser of $22.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.25,"standard_charge_algorithm": "Lesser of $21.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DNA/RNA AMPLIFIED PROBE","code_information":[{"code":"87150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":136.08,"maximum":136.08,"gross_charge":168,"discounted_cash":49.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.08,"methodology":"fee schedule"}]}]},{"description":"DNA/RNA AMPLIFIED PROBE","code_information":[{"code":"87150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":25.2,"maximum":136.08,"gross_charge":168,"discounted_cash":49.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPANDED BLOOD CULT ID PANEL","code_information":[{"code":"87150","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":238.14,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"}]}]},{"description":"EXPANDED BLOOD CULT ID PANEL","code_information":[{"code":"87150","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":35.09,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BLOOD CULTURE ID PANEL","code_information":[{"code":"87150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":141.75,"maximum":141.75,"gross_charge":175,"discounted_cash":51.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.75,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLOOD CULTURE ID PANEL","code_information":[{"code":"87150","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.25,"maximum":141.75,"gross_charge":175,"discounted_cash":51.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC SEQUENCING IF REFLEXED","code_information":[{"code":"87153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":451.17,"maximum":451.17,"gross_charge":557,"discounted_cash":164.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.17,"methodology":"fee schedule"}]}]},{"description":"HC SEQUENCING IF REFLEXED","code_information":[{"code":"87153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.55,"maximum":451.17,"gross_charge":557,"discounted_cash":164.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":349.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":276.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.27,"standard_charge_algorithm": "Lesser of $197.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":252.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":281.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":173.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"standard_charge_algorithm": "Lesser of $115.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.44,"standard_charge_algorithm": "Lesser of $123.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.82,"standard_charge_algorithm": "Lesser of $118.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121.13,"standard_charge_algorithm": "Lesser of $121.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.9,"standard_charge_algorithm": "Lesser of $126.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.28,"standard_charge_algorithm": "Lesser of $122.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORG ID BY SEQ RFLX AST","code_information":[{"code":"87153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":422.82,"maximum":422.82,"gross_charge":522,"discounted_cash":154.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.82,"methodology":"fee schedule"}]}]},{"description":"ORG ID BY SEQ RFLX AST","code_information":[{"code":"87153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":78.3,"maximum":422.82,"gross_charge":522,"discounted_cash":154.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":349.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":276.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.27,"standard_charge_algorithm": "Lesser of $197.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":252.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":281.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":173.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"standard_charge_algorithm": "Lesser of $115.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.44,"standard_charge_algorithm": "Lesser of $123.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.82,"standard_charge_algorithm": "Lesser of $118.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121.13,"standard_charge_algorithm": "Lesser of $121.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.9,"standard_charge_algorithm": "Lesser of $126.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.28,"standard_charge_algorithm": "Lesser of $122.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORGANISM ID BY SEQUENCING","code_information":[{"code":"87153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":383.94,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"}]}]},{"description":"ORGANISM ID BY SEQUENCING","code_information":[{"code":"87153","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":71.1,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":349.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":276.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.27,"standard_charge_algorithm": "Lesser of $197.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":252.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":281.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":173.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.36,"standard_charge_algorithm": "Lesser of $115.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.44,"standard_charge_algorithm": "Lesser of $123.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.82,"standard_charge_algorithm": "Lesser of $118.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121.13,"standard_charge_algorithm": "Lesser of $121.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.9,"standard_charge_algorithm": "Lesser of $126.90 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.28,"standard_charge_algorithm": "Lesser of $122.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ORGANISM IDENTIFICATION","code_information":[{"code":"87158","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":208.98,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"}]}]},{"description":"ORGANISM IDENTIFICATION","code_information":[{"code":"87158","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.36,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":13.24,"standard_charge_algorithm": "Lesser of $13.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.74,"standard_charge_algorithm": "Lesser of $7.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8.28,"standard_charge_algorithm": "Lesser of $8.28 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.97,"standard_charge_algorithm": "Lesser of $7.97 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8.13,"standard_charge_algorithm": "Lesser of $8.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.51,"standard_charge_algorithm": "Lesser of $8.51 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8.2,"standard_charge_algorithm": "Lesser of $8.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PARASITE ID ARTHROPOD","code_information":[{"code":"87168","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":12.15,"maximum":12.15,"gross_charge":15,"discounted_cash":4.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.15,"methodology":"fee schedule"}]}]},{"description":"PARASITE ID ARTHROPOD","code_information":[{"code":"87168","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":12.45,"gross_charge":15,"discounted_cash":4.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PARASITE IDENT IN-HOUSE","code_information":[{"code":"87169","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":13.77,"maximum":13.77,"gross_charge":17,"discounted_cash":5.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.77,"methodology":"fee schedule"}]}]},{"description":"HC PARASITE IDENT IN-HOUSE","code_information":[{"code":"87169","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.31,"maximum":13.77,"gross_charge":17,"discounted_cash":5.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.37,"standard_charge_algorithm": "Lesser of $7.37 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.31,"standard_charge_algorithm": "Lesser of $4.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.44,"standard_charge_algorithm": "Lesser of $4.44 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.74,"standard_charge_algorithm": "Lesser of $4.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC PINWORM PREP","code_information":[{"code":"87172","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":108.54,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"}]}]},{"description":"HC PINWORM PREP","code_information":[{"code":"87172","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB O&P DIRECT SMEAR","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB O&P DIRECT SMEAR","code_information":[{"code":"87177","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.9,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"standard_charge_algorithm": "Lesser of $8.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.52,"standard_charge_algorithm": "Lesser of $9.52 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.17,"standard_charge_algorithm": "Lesser of $9.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.35,"standard_charge_algorithm": "Lesser of $9.35 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.79,"standard_charge_algorithm": "Lesser of $9.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.43,"standard_charge_algorithm": "Lesser of $9.43 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB OVA-PARASITE EXAM","code_information":[{"code":"87177","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB OVA-PARASITE EXAM","code_information":[{"code":"87177","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.9,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.22,"standard_charge_algorithm": "Lesser of $15.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.9,"standard_charge_algorithm": "Lesser of $8.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.52,"standard_charge_algorithm": "Lesser of $9.52 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.17,"standard_charge_algorithm": "Lesser of $9.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.35,"standard_charge_algorithm": "Lesser of $9.35 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.79,"standard_charge_algorithm": "Lesser of $9.79 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.43,"standard_charge_algorithm": "Lesser of $9.43 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SUSCEPTIBILITY-KB","code_information":[{"code":"87184","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC LAB SUSCEPTIBILITY-KB","code_information":[{"code":"87184","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.48,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.79,"standard_charge_algorithm": "Lesser of $12.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.48,"standard_charge_algorithm": "Lesser of $7.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8,"standard_charge_algorithm": "Lesser of $8.00 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.7,"standard_charge_algorithm": "Lesser of $7.70 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.85,"standard_charge_algorithm": "Lesser of $7.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.23,"standard_charge_algorithm": "Lesser of $8.23 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.93,"standard_charge_algorithm": "Lesser of $7.93 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MICROBE SUSCEPTIBLE ENZYME","code_information":[{"code":"87185","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"MICROBE SUSCEPTIBLE ENZYME","code_information":[{"code":"87185","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":4.75,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.12,"standard_charge_algorithm": "Lesser of $8.12 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.08,"standard_charge_algorithm": "Lesser of $5.08 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.89,"standard_charge_algorithm": "Lesser of $4.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.99,"standard_charge_algorithm": "Lesser of $4.99 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.22,"standard_charge_algorithm": "Lesser of $5.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.04,"standard_charge_algorithm": "Lesser of $5.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB D-TEST SENSITIVITY","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB D-TEST SENSITIVITY","code_information":[{"code":"87186","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":8.65,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.79,"standard_charge_algorithm": "Lesser of $14.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.26,"standard_charge_algorithm": "Lesser of $9.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.91,"standard_charge_algorithm": "Lesser of $8.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.08,"standard_charge_algorithm": "Lesser of $9.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.52,"standard_charge_algorithm": "Lesser of $9.52 or 110 Percent of Billed Charges","median_amount":8.65,"10th_percentile":6.27,"90th_percentile":8.65,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.17,"standard_charge_algorithm": "Lesser of $9.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SUSCEPTIBILITY-MIC","code_information":[{"code":"87186","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC LAB SUSCEPTIBILITY-MIC","code_information":[{"code":"87186","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":8.65,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14.79,"standard_charge_algorithm": "Lesser of $14.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8.65,"standard_charge_algorithm": "Lesser of $8.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.26,"standard_charge_algorithm": "Lesser of $9.26 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8.91,"standard_charge_algorithm": "Lesser of $8.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.08,"standard_charge_algorithm": "Lesser of $9.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9.52,"standard_charge_algorithm": "Lesser of $9.52 or 110 Percent of Billed Charges","median_amount":8.65,"10th_percentile":6.27,"90th_percentile":8.65,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.17,"standard_charge_algorithm": "Lesser of $9.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MTB SUSCEPTIBILITY BROTH","code_information":[{"code":"87188","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"MTB SUSCEPTIBILITY BROTH","code_information":[{"code":"87188","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":6.64,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.35,"standard_charge_algorithm": "Lesser of $11.35 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.64,"standard_charge_algorithm": "Lesser of $6.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.1,"standard_charge_algorithm": "Lesser of $7.10 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.84,"standard_charge_algorithm": "Lesser of $6.84 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.97,"standard_charge_algorithm": "Lesser of $6.97 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.04,"standard_charge_algorithm": "Lesser of $7.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MTB AST CONFIRMATION","code_information":[{"code":"87190","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"MTB AST CONFIRMATION","code_information":[{"code":"87190","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1.8,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.5,"standard_charge_algorithm": "Lesser of $12.50 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.31,"standard_charge_algorithm": "Lesser of $7.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.82,"standard_charge_algorithm": "Lesser of $7.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.53,"standard_charge_algorithm": "Lesser of $7.53 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.68,"standard_charge_algorithm": "Lesser of $7.68 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.04,"standard_charge_algorithm": "Lesser of $8.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.75,"standard_charge_algorithm": "Lesser of $7.75 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":5851,"maximum":17517.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9268,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8761,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5851,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11771,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11036,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16641.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11112,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13248,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10874,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17517.17,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15311,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9507,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9507,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5915,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9731.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10412.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10023.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10218.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10315.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10218.35,"methodology":"case rate"}]}]},{"description":"HC LAB SMEAR-GRAM STAIN","code_information":[{"code":"87205","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":152.28,"maximum":152.28,"gross_charge":188,"discounted_cash":55.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.28,"methodology":"fee schedule"}]}]},{"description":"HC LAB SMEAR-GRAM STAIN","code_information":[{"code":"87205","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.3,"maximum":152.28,"gross_charge":188,"discounted_cash":55.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","median_amount":3.3,"10th_percentile":3.3,"90th_percentile":3.3,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AFB(TB) SMEAR","code_information":[{"code":"87206","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB AFB(TB) SMEAR","code_information":[{"code":"87206","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":5.39,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.22,"standard_charge_algorithm": "Lesser of $9.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"standard_charge_algorithm": "Lesser of $5.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"standard_charge_algorithm": "Lesser of $5.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.55,"standard_charge_algorithm": "Lesser of $5.55 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.66,"standard_charge_algorithm": "Lesser of $5.66 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.93,"standard_charge_algorithm": "Lesser of $5.93 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.71,"standard_charge_algorithm": "Lesser of $5.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SMEAR RAPID FLR/AF STN","code_information":[{"code":"87206","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB SMEAR RAPID FLR/AF STN","code_information":[{"code":"87206","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.39,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.22,"standard_charge_algorithm": "Lesser of $9.22 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.39,"standard_charge_algorithm": "Lesser of $5.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.77,"standard_charge_algorithm": "Lesser of $5.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.55,"standard_charge_algorithm": "Lesser of $5.55 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.66,"standard_charge_algorithm": "Lesser of $5.66 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.93,"standard_charge_algorithm": "Lesser of $5.93 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.71,"standard_charge_algorithm": "Lesser of $5.71 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SMEAR-SPECIAL STAIN","code_information":[{"code":"87207","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB SMEAR-SPECIAL STAIN","code_information":[{"code":"87207","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.99,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.24,"standard_charge_algorithm": "Lesser of $10.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"standard_charge_algorithm": "Lesser of $5.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.41,"standard_charge_algorithm": "Lesser of $6.41 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.17,"standard_charge_algorithm": "Lesser of $6.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.29,"standard_charge_algorithm": "Lesser of $6.29 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.59,"standard_charge_algorithm": "Lesser of $6.59 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.35,"standard_charge_algorithm": "Lesser of $6.35 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB O&P PERMANENT STAIN","code_information":[{"code":"87209","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":106.11,"maximum":106.11,"gross_charge":131,"discounted_cash":38.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB O&P PERMANENT STAIN","code_information":[{"code":"87209","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":17.98,"maximum":106.11,"gross_charge":131,"discounted_cash":38.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.75,"standard_charge_algorithm": "Lesser of $30.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"standard_charge_algorithm": "Lesser of $17.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.24,"standard_charge_algorithm": "Lesser of $19.24 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.52,"standard_charge_algorithm": "Lesser of $18.52 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.88,"standard_charge_algorithm": "Lesser of $18.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.78,"standard_charge_algorithm": "Lesser of $19.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.06,"standard_charge_algorithm": "Lesser of $19.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SMEAR-COMPLX STAIN","code_information":[{"code":"87209","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":106.11,"maximum":106.11,"gross_charge":131,"discounted_cash":38.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.11,"methodology":"fee schedule"}]}]},{"description":"HC LAB SMEAR-COMPLX STAIN","code_information":[{"code":"87209","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":17.98,"maximum":106.11,"gross_charge":131,"discounted_cash":38.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":30.75,"standard_charge_algorithm": "Lesser of $30.75 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.98,"standard_charge_algorithm": "Lesser of $17.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.24,"standard_charge_algorithm": "Lesser of $19.24 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.52,"standard_charge_algorithm": "Lesser of $18.52 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.88,"standard_charge_algorithm": "Lesser of $18.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19.78,"standard_charge_algorithm": "Lesser of $19.78 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.06,"standard_charge_algorithm": "Lesser of $19.06 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SMEAR-WET PREP","code_information":[{"code":"87210","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":184.68,"maximum":184.68,"gross_charge":228,"discounted_cash":67.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.68,"methodology":"fee schedule"}]}]},{"description":"HC LAB SMEAR-WET PREP","code_information":[{"code":"87210","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.82,"maximum":184.68,"gross_charge":228,"discounted_cash":67.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.95,"standard_charge_algorithm": "Lesser of $9.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.82,"standard_charge_algorithm": "Lesser of $5.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.23,"standard_charge_algorithm": "Lesser of $6.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.99,"standard_charge_algorithm": "Lesser of $5.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.11,"standard_charge_algorithm": "Lesser of $6.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.4,"standard_charge_algorithm": "Lesser of $6.40 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.17,"standard_charge_algorithm": "Lesser of $6.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB KOH PREP","code_information":[{"code":"87220","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.15,"maximum":12.15,"gross_charge":15,"discounted_cash":4.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.15,"methodology":"fee schedule"}]}]},{"description":"HC LAB KOH PREP","code_information":[{"code":"87220","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.27,"maximum":12.45,"gross_charge":15,"discounted_cash":4.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB C DIFFICILE TOXIN","code_information":[{"code":"87230","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":392.04,"maximum":392.04,"gross_charge":484,"discounted_cash":143.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":392.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":392.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":392.04,"methodology":"fee schedule"}]}]},{"description":"HC LAB C DIFFICILE TOXIN","code_information":[{"code":"87230","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":19.74,"maximum":392.04,"gross_charge":484,"discounted_cash":143.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":392.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":392.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":392.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.76,"standard_charge_algorithm": "Lesser of $33.76 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.74,"standard_charge_algorithm": "Lesser of $19.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.12,"standard_charge_algorithm": "Lesser of $21.12 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.33,"standard_charge_algorithm": "Lesser of $20.33 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.73,"standard_charge_algorithm": "Lesser of $20.73 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.71,"standard_charge_algorithm": "Lesser of $21.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.92,"standard_charge_algorithm": "Lesser of $20.92 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CULT-VIRUS","code_information":[{"code":"87252","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"HC LAB CULT-VIRUS","code_information":[{"code":"87252","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":26.07,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":44.58,"standard_charge_algorithm": "Lesser of $44.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.07,"standard_charge_algorithm": "Lesser of $26.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.89,"standard_charge_algorithm": "Lesser of $27.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.85,"standard_charge_algorithm": "Lesser of $26.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.37,"standard_charge_algorithm": "Lesser of $27.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.68,"standard_charge_algorithm": "Lesser of $28.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.63,"standard_charge_algorithm": "Lesser of $27.63 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"VIRUS INOCULATE TISSUE ADDL","code_information":[{"code":"87253","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"VIRUS INOCULATE TISSUE ADDL","code_information":[{"code":"87253","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.2,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.54,"standard_charge_algorithm": "Lesser of $34.54 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.2,"standard_charge_algorithm": "Lesser of $20.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.61,"standard_charge_algorithm": "Lesser of $21.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.81,"standard_charge_algorithm": "Lesser of $20.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.21,"standard_charge_algorithm": "Lesser of $21.21 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.22,"standard_charge_algorithm": "Lesser of $22.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.41,"standard_charge_algorithm": "Lesser of $21.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TISSUE CULT- RAPID VIRAL EA","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"TISSUE CULT- RAPID VIRAL EA","code_information":[{"code":"87254","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.45,"standard_charge_algorithm": "Lesser of $33.45 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.56,"standard_charge_algorithm": "Lesser of $19.56 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.93,"standard_charge_algorithm": "Lesser of $20.93 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.15,"standard_charge_algorithm": "Lesser of $20.15 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.54,"standard_charge_algorithm": "Lesser of $20.54 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.52,"standard_charge_algorithm": "Lesser of $21.52 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.73,"standard_charge_algorithm": "Lesser of $20.73 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GENET VIRUS ISOLATE HSV","code_information":[{"code":"87255","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":109.35,"maximum":109.35,"gross_charge":135,"discounted_cash":39.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.35,"methodology":"fee schedule"}]}]},{"description":"GENET VIRUS ISOLATE HSV","code_information":[{"code":"87255","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":33.86,"maximum":109.35,"gross_charge":135,"discounted_cash":39.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.9,"standard_charge_algorithm": "Lesser of $57.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":74.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":82.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.86,"standard_charge_algorithm": "Lesser of $33.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36.23,"standard_charge_algorithm": "Lesser of $36.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.88,"standard_charge_algorithm": "Lesser of $34.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.55,"standard_charge_algorithm": "Lesser of $35.55 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37.25,"standard_charge_algorithm": "Lesser of $37.25 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.89,"standard_charge_algorithm": "Lesser of $35.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"LEGIONELLA PNEUMO (DIR FL ABY)","code_information":[{"code":"87278","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"LEGIONELLA PNEUMO (DIR FL ABY)","code_information":[{"code":"87278","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":15.6,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.68,"standard_charge_algorithm": "Lesser of $26.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.6,"standard_charge_algorithm": "Lesser of $15.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.69,"standard_charge_algorithm": "Lesser of $16.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.38,"standard_charge_algorithm": "Lesser of $16.38 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.16,"standard_charge_algorithm": "Lesser of $17.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.54,"standard_charge_algorithm": "Lesser of $16.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CYTOMEGALOVIRUS ANTIGENEMIA","code_information":[{"code":"87299","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":366.12,"maximum":366.12,"gross_charge":452,"discounted_cash":133.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.12,"methodology":"fee schedule"}]}]},{"description":"HC CYTOMEGALOVIRUS ANTIGENEMIA","code_information":[{"code":"87299","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":16.1,"maximum":366.12,"gross_charge":452,"discounted_cash":133.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.53,"standard_charge_algorithm": "Lesser of $27.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.1,"standard_charge_algorithm": "Lesser of $16.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.23,"standard_charge_algorithm": "Lesser of $17.23 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.58,"standard_charge_algorithm": "Lesser of $16.58 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.91,"standard_charge_algorithm": "Lesser of $16.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.07,"standard_charge_algorithm": "Lesser of $17.07 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ASPERGILLUS ANTIGEN","code_information":[{"code":"87305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":214.65,"maximum":214.65,"gross_charge":265,"discounted_cash":78.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.65,"methodology":"fee schedule"}]}]},{"description":"HC LAB ASPERGILLUS ANTIGEN","code_information":[{"code":"87305","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":214.65,"gross_charge":265,"discounted_cash":78.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CLOSTRIDIUM AG IA","code_information":[{"code":"87324","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB CLOSTRIDIUM AG IA","code_information":[{"code":"87324","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CRYPTOCOCCAL ANTIGEN","code_information":[{"code":"87327","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":264.87,"maximum":264.87,"gross_charge":327,"discounted_cash":96.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.87,"methodology":"fee schedule"}]}]},{"description":"HC CRYPTOCOCCAL ANTIGEN","code_information":[{"code":"87327","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":13.42,"maximum":264.87,"gross_charge":327,"discounted_cash":96.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.95,"standard_charge_algorithm": "Lesser of $22.95 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.42,"standard_charge_algorithm": "Lesser of $13.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.36,"standard_charge_algorithm": "Lesser of $14.36 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.09,"standard_charge_algorithm": "Lesser of $14.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.76,"standard_charge_algorithm": "Lesser of $14.76 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.23,"standard_charge_algorithm": "Lesser of $14.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN STOO","code_information":[{"code":"87328","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":317.52,"maximum":317.52,"gross_charge":392,"discounted_cash":116.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.52,"methodology":"fee schedule"}]}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN STOO","code_information":[{"code":"87328","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":13.82,"maximum":317.52,"gross_charge":392,"discounted_cash":116.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.63,"standard_charge_algorithm": "Lesser of $23.63 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.82,"standard_charge_algorithm": "Lesser of $13.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.79,"standard_charge_algorithm": "Lesser of $14.79 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.23,"standard_charge_algorithm": "Lesser of $14.23 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.51,"standard_charge_algorithm": "Lesser of $14.51 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.2,"standard_charge_algorithm": "Lesser of $15.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.65,"standard_charge_algorithm": "Lesser of $14.65 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GIARDIA ANTIGEN","code_information":[{"code":"87329","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":324.81,"maximum":324.81,"gross_charge":401,"discounted_cash":118.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":324.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":324.81,"methodology":"fee schedule"}]}]},{"description":"HC LAB GIARDIA ANTIGEN","code_information":[{"code":"87329","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":324.81,"gross_charge":401,"discounted_cash":118.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":324.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":324.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC H. PYLORI STOOL ANTIGEN","code_information":[{"code":"87338","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":106.92,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"}]}]},{"description":"HC H. PYLORI STOOL ANTIGEN","code_information":[{"code":"87338","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":14.38,"maximum":106.92,"gross_charge":132,"discounted_cash":39.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.59,"standard_charge_algorithm": "Lesser of $24.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.38,"standard_charge_algorithm": "Lesser of $14.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.39,"standard_charge_algorithm": "Lesser of $15.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.81,"standard_charge_algorithm": "Lesser of $14.81 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.1,"standard_charge_algorithm": "Lesser of $15.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.82,"standard_charge_algorithm": "Lesser of $15.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.24,"standard_charge_algorithm": "Lesser of $15.24 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP BS AG (HBSAG)","code_information":[{"code":"87340","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP BS AG (HBSAG)","code_information":[{"code":"87340","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.33,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17.66,"standard_charge_algorithm": "Lesser of $17.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.33,"standard_charge_algorithm": "Lesser of $10.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.05,"standard_charge_algorithm": "Lesser of $11.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.64,"standard_charge_algorithm": "Lesser of $10.64 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.85,"standard_charge_algorithm": "Lesser of $10.85 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.36,"standard_charge_algorithm": "Lesser of $11.36 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.95,"standard_charge_algorithm": "Lesser of $10.95 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP BE AG (ANTIGEN)","code_information":[{"code":"87350","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP BE AG (ANTIGEN)","code_information":[{"code":"87350","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.53,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.72,"standard_charge_algorithm": "Lesser of $19.72 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.53,"standard_charge_algorithm": "Lesser of $11.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.88,"standard_charge_algorithm": "Lesser of $11.88 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.11,"standard_charge_algorithm": "Lesser of $12.11 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.68,"standard_charge_algorithm": "Lesser of $12.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.22,"standard_charge_algorithm": "Lesser of $12.22 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HISTOPLASMA ANTIGENUR","code_information":[{"code":"87385","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":118.26,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"}]}]},{"description":"HC LAB HISTOPLASMA ANTIGENUR","code_information":[{"code":"87385","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.25,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.66,"standard_charge_algorithm": "Lesser of $22.66 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.25,"standard_charge_algorithm": "Lesser of $13.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.18,"standard_charge_algorithm": "Lesser of $14.18 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.65,"standard_charge_algorithm": "Lesser of $13.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.57,"standard_charge_algorithm": "Lesser of $14.57 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.04,"standard_charge_algorithm": "Lesser of $14.04 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HIV-1 AG W/HIV-1&2 AB","code_information":[{"code":"87389","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC LAB HIV-1 AG W/HIV-1&2 AB","code_information":[{"code":"87389","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":24.08,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.18,"standard_charge_algorithm": "Lesser of $41.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"standard_charge_algorithm": "Lesser of $24.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.77,"standard_charge_algorithm": "Lesser of $25.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.8,"standard_charge_algorithm": "Lesser of $24.80 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.28,"standard_charge_algorithm": "Lesser of $25.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.49,"standard_charge_algorithm": "Lesser of $26.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.52,"standard_charge_algorithm": "Lesser of $25.52 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HIV ABY/P24 AGN WITH REFLEX","code_information":[{"code":"87389","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HIV ABY/P24 AGN WITH REFLEX","code_information":[{"code":"87389","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":24.08,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.18,"standard_charge_algorithm": "Lesser of $41.18 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.08,"standard_charge_algorithm": "Lesser of $24.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.77,"standard_charge_algorithm": "Lesser of $25.77 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.8,"standard_charge_algorithm": "Lesser of $24.80 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.28,"standard_charge_algorithm": "Lesser of $25.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.49,"standard_charge_algorithm": "Lesser of $26.49 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.52,"standard_charge_algorithm": "Lesser of $25.52 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RSVEIA","code_information":[{"code":"87420","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"HC LAB RSVEIA","code_information":[{"code":"87420","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.91,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.79,"standard_charge_algorithm": "Lesser of $23.79 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.91,"standard_charge_algorithm": "Lesser of $13.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.88,"standard_charge_algorithm": "Lesser of $14.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.33,"standard_charge_algorithm": "Lesser of $14.33 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.61,"standard_charge_algorithm": "Lesser of $14.61 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.3,"standard_charge_algorithm": "Lesser of $15.30 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.74,"standard_charge_algorithm": "Lesser of $14.74 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ROTAVIRUS ANTIGEN","code_information":[{"code":"87425","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC ROTAVIRUS ANTIGEN","code_information":[{"code":"87425","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CORONAVIRUS AG IA","code_information":[{"code":"87426","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB CORONAVIRUS AG IA","code_information":[{"code":"87426","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":35.33,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60.41,"standard_charge_algorithm": "Lesser of $60.41 or 171 Percent of Billed Charges","median_amount":60.41,"10th_percentile":60.41,"90th_percentile":60.41,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":45.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":45.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.33,"standard_charge_algorithm": "Lesser of $35.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.8,"standard_charge_algorithm": "Lesser of $37.80 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.39,"standard_charge_algorithm": "Lesser of $36.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37.1,"standard_charge_algorithm": "Lesser of $37.10 or 105 Percent of Billed Charges","median_amount":37.1,"10th_percentile":37.1,"90th_percentile":37.1,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.86,"standard_charge_algorithm": "Lesser of $38.86 or 110 Percent of Billed Charges","median_amount":38.86,"10th_percentile":38.86,"90th_percentile":38.86,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.45,"standard_charge_algorithm": "Lesser of $37.45 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SHIGA TOXIN 1 2","code_information":[{"code":"87427","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB SHIGA TOXIN 1 2","code_information":[{"code":"87427","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ACUTE RESP SYND COV H FLU A & B","code_information":[{"code":"87428","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":226.8,"maximum":226.8,"gross_charge":280,"discounted_cash":82.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":226.8,"methodology":"fee schedule"}]}]},{"description":"ACUTE RESP SYND COV H FLU A & B","code_information":[{"code":"87428","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":70.29,"maximum":226.8,"gross_charge":280,"discounted_cash":82.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":141.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":111.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.2,"standard_charge_algorithm": "Lesser of $120.20 or 171 Percent of Billed Charges","median_amount":120.2,"10th_percentile":118.32,"90th_percentile":125.67,"count":"313","methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":73.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":73.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.29,"standard_charge_algorithm": "Lesser of $70.29 or 100 Percent of Billed Charges","median_amount":70.29,"10th_percentile":70.29,"90th_percentile":70.29,"count":"20","methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.21,"standard_charge_algorithm": "Lesser of $75.21 or 107 Percent of Billed Charges","median_amount":70.29,"10th_percentile":70.29,"90th_percentile":70.29,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.4,"standard_charge_algorithm": "Lesser of $72.40 or 103 Percent of Billed Charges","median_amount":72.4,"10th_percentile":70.29,"90th_percentile":72.4,"count":"77","methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":73.8,"standard_charge_algorithm": "Lesser of $73.80 or 105 Percent of Billed Charges","median_amount":73.8,"10th_percentile":73.8,"90th_percentile":73.8,"count":"39","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.32,"standard_charge_algorithm": "Lesser of $77.32 or 110 Percent of Billed Charges","median_amount":77.32,"10th_percentile":41.48,"90th_percentile":77.32,"count":"61","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.51,"standard_charge_algorithm": "Lesser of $74.51 or 106 Percent of Billed Charges","median_amount":74.51,"10th_percentile":74.51,"90th_percentile":77.32,"count":"1 through 10","methodology":"fee schedule"}]}]},{"description":"COCCIDIOIDES AG QUANT","code_information":[{"code":"87449","type":"CPT"},{"code":"0303","type":"RC"}],"standard_charges":[{"minimum":196.02,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"}]}]},{"description":"COCCIDIOIDES AG QUANT","code_information":[{"code":"87449","type":"CPT"},{"code":"0303","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","median_amount":11.98,"10th_percentile":11.98,"90th_percentile":11.98,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB BLASTOMYCES DERMATITIDIS AG","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":196.02,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"}]}]},{"description":"HC LAB BLASTOMYCES DERMATITIDIS AG","code_information":[{"code":"87449","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","median_amount":11.98,"10th_percentile":11.98,"90th_percentile":11.98,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB IA BY EIA MULTI STEP","code_information":[{"code":"87449","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":196.02,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"}]}]},{"description":"HC LAB IA BY EIA MULTI STEP","code_information":[{"code":"87449","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","median_amount":11.98,"10th_percentile":11.98,"90th_percentile":11.98,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB STREP PNEUMOCOCCUS ANTIGEN UR","code_information":[{"code":"87449","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":196.02,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"}]}]},{"description":"HC LAB STREP PNEUMOCOCCUS ANTIGEN UR","code_information":[{"code":"87449","type":"CPT"},{"code":"0302","type":"RC"}],"standard_charges":[{"minimum":11.98,"maximum":196.02,"gross_charge":242,"discounted_cash":71.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.49,"standard_charge_algorithm": "Lesser of $20.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.98,"standard_charge_algorithm": "Lesser of $11.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.82,"standard_charge_algorithm": "Lesser of $12.82 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.34,"standard_charge_algorithm": "Lesser of $12.34 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.58,"standard_charge_algorithm": "Lesser of $12.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.18,"standard_charge_algorithm": "Lesser of $13.18 or 110 Percent of Billed Charges","median_amount":11.98,"10th_percentile":11.98,"90th_percentile":11.98,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.7,"standard_charge_algorithm": "Lesser of $12.70 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"ANAPLSMA PHGCYTOPHLM AMP PRB","code_information":[{"code":"87468","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"ANAPLSMA PHGCYTOPHLM AMP PRB","code_information":[{"code":"87468","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"}]}]},{"description":"BABESIA MICROTI RT DNA PCR","code_information":[{"code":"87469","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"BABESIA MICROTI RT DNA PCR","code_information":[{"code":"87469","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"}]}]},{"description":"HC BARTONELLA DNA PCR","code_information":[{"code":"87471","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":396.09,"maximum":396.09,"gross_charge":489,"discounted_cash":144.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.09,"methodology":"fee schedule"}]}]},{"description":"HC BARTONELLA DNA PCR","code_information":[{"code":"87471","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":396.09,"gross_charge":489,"discounted_cash":144.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LYME ANTIBODIES CSF","code_information":[{"code":"87476","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":99.63,"maximum":99.63,"gross_charge":123,"discounted_cash":36.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.63,"methodology":"fee schedule"}]}]},{"description":"HC LYME ANTIBODIES CSF","code_information":[{"code":"87476","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":106.27,"gross_charge":123,"discounted_cash":36.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CANDIDA DNA","code_information":[{"code":"87480","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":70.47,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"}]}]},{"description":"CANDIDA DNA","code_information":[{"code":"87480","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.05,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.29,"standard_charge_algorithm": "Lesser of $34.29 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"standard_charge_algorithm": "Lesser of $20.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.45,"standard_charge_algorithm": "Lesser of $21.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.65,"standard_charge_algorithm": "Lesser of $20.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.05,"standard_charge_algorithm": "Lesser of $21.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.05,"standard_charge_algorithm": "Lesser of $22.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.25,"standard_charge_algorithm": "Lesser of $21.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BIOFIRE MENINGITIS PANEL","code_information":[{"code":"87483","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2025,"maximum":2025,"gross_charge":2500,"discounted_cash":740,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2025,"methodology":"fee schedule"}]}]},{"description":"HC BIOFIRE MENINGITIS PANEL","code_information":[{"code":"87483","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":216.49,"maximum":2025,"gross_charge":2500,"discounted_cash":740,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1269.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1006.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":712.69,"standard_charge_algorithm": "Lesser of $712.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":913.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1017.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":625.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":445.95,"standard_charge_algorithm": "Lesser of $445.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":429.28,"standard_charge_algorithm": "Lesser of $429.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":437.62,"standard_charge_algorithm": "Lesser of $437.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":458.46,"standard_charge_algorithm": "Lesser of $458.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":441.79,"standard_charge_algorithm": "Lesser of $441.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"CHLAMYDIA PNEUMONIAPCR","code_information":[{"code":"87486","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":174.15,"maximum":174.15,"gross_charge":215,"discounted_cash":63.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"}]}]},{"description":"CHLAMYDIA PNEUMONIAPCR","code_information":[{"code":"87486","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":174.15,"gross_charge":215,"discounted_cash":63.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB C. TRACHOMATIS RNA","code_information":[{"code":"87491","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":318.33,"maximum":318.33,"gross_charge":393,"discounted_cash":116.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.33,"methodology":"fee schedule"}]}]},{"description":"HC LAB C. TRACHOMATIS RNA","code_information":[{"code":"87491","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":318.33,"gross_charge":393,"discounted_cash":116.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHLAMYDIA RNA TMA THROAT","code_information":[{"code":"87491","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":318.33,"maximum":318.33,"gross_charge":393,"discounted_cash":116.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.33,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHLAMYDIA RNA TMA THROAT","code_information":[{"code":"87491","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":318.33,"gross_charge":393,"discounted_cash":116.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB C DIFFICILE TOXIN PCR","code_information":[{"code":"87493","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":236.52,"maximum":236.52,"gross_charge":292,"discounted_cash":86.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB C DIFFICILE TOXIN PCR","code_information":[{"code":"87493","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":37.27,"maximum":236.52,"gross_charge":292,"discounted_cash":86.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":63.73,"standard_charge_algorithm": "Lesser of $63.73 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37.27,"standard_charge_algorithm": "Lesser of $37.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39.88,"standard_charge_algorithm": "Lesser of $39.88 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38.39,"standard_charge_algorithm": "Lesser of $38.39 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39.13,"standard_charge_algorithm": "Lesser of $39.13 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":41,"standard_charge_algorithm": "Lesser of $41.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39.51,"standard_charge_algorithm": "Lesser of $39.51 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CMV DNA AMPLIFIED PROBE","code_information":[{"code":"87496","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB CMV DNA AMPLIFIED PROBE","code_information":[{"code":"87496","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CMV DNAQNTRT PCR","code_information":[{"code":"87497","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":248.67,"maximum":248.67,"gross_charge":307,"discounted_cash":90.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.67,"methodology":"fee schedule"}]}]},{"description":"HC LAB CMV DNAQNTRT PCR","code_information":[{"code":"87497","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":248.67,"gross_charge":307,"discounted_cash":90.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB ENTEROVIR RNAQL RT PCR","code_information":[{"code":"87498","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":150.66,"maximum":150.66,"gross_charge":186,"discounted_cash":55.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.66,"methodology":"fee schedule"}]}]},{"description":"HC LAB ENTEROVIR RNAQL RT PCR","code_information":[{"code":"87498","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":150.66,"gross_charge":186,"discounted_cash":55.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FLU VIRUS AMP PROB","code_information":[{"code":"87502","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":391.23,"maximum":391.23,"gross_charge":483,"discounted_cash":142.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":391.23,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLU VIRUS AMP PROB","code_information":[{"code":"87502","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":65.37,"maximum":391.23,"gross_charge":483,"discounted_cash":142.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":257.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":204.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":163.82,"standard_charge_algorithm": "Lesser of $163.82 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":210.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":143.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.8,"standard_charge_algorithm": "Lesser of $95.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":102.51,"standard_charge_algorithm": "Lesser of $102.51 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":98.67,"standard_charge_algorithm": "Lesser of $98.67 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":100.59,"standard_charge_algorithm": "Lesser of $100.59 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":105.38,"standard_charge_algorithm": "Lesser of $105.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":101.55,"standard_charge_algorithm": "Lesser of $101.55 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC BACTERIAL STOOL PATHOGENS NAA","code_information":[{"code":"87505","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":565.38,"maximum":565.38,"gross_charge":698,"discounted_cash":206.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.38,"methodology":"fee schedule"}]}]},{"description":"HC BACTERIAL STOOL PATHOGENS NAA","code_information":[{"code":"87505","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":114.82,"maximum":565.38,"gross_charge":698,"discounted_cash":206.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":387.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":307.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":219.38,"standard_charge_algorithm": "Lesser of $219.38 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":281.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":313.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":192.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":128.29,"standard_charge_algorithm": "Lesser of $128.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":137.27,"standard_charge_algorithm": "Lesser of $137.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":132.14,"standard_charge_algorithm": "Lesser of $132.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":134.7,"standard_charge_algorithm": "Lesser of $134.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":141.12,"standard_charge_algorithm": "Lesser of $141.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":135.99,"standard_charge_algorithm": "Lesser of $135.99 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GI PROFILE STOOL PCR","code_information":[{"code":"87507","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1486.35,"maximum":1486.35,"gross_charge":1835,"discounted_cash":543.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1486.35,"methodology":"fee schedule"}]}]},{"description":"GI PROFILE STOOL PCR","code_information":[{"code":"87507","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":373.03,"maximum":1486.35,"gross_charge":1835,"discounted_cash":543.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1259.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":998.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":712.69,"standard_charge_algorithm": "Lesser of $712.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":913.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1017.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":625.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":445.95,"standard_charge_algorithm": "Lesser of $445.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":429.28,"standard_charge_algorithm": "Lesser of $429.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":437.62,"standard_charge_algorithm": "Lesser of $437.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":458.46,"standard_charge_algorithm": "Lesser of $458.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":441.79,"standard_charge_algorithm": "Lesser of $441.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"GARDERELLA VAGINALIS DNA","code_information":[{"code":"87510","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":70.47,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"}]}]},{"description":"GARDERELLA VAGINALIS DNA","code_information":[{"code":"87510","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.05,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.29,"standard_charge_algorithm": "Lesser of $34.29 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"standard_charge_algorithm": "Lesser of $20.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.45,"standard_charge_algorithm": "Lesser of $21.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.65,"standard_charge_algorithm": "Lesser of $20.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.05,"standard_charge_algorithm": "Lesser of $21.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.05,"standard_charge_algorithm": "Lesser of $22.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.25,"standard_charge_algorithm": "Lesser of $21.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"H PYLRI CLRTHMCN RST AMP PRB","code_information":[{"code":"87513","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"H PYLRI CLRTHMCN RST AMP PRB","code_information":[{"code":"87513","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.75,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"}]}]},{"description":"HBV DNA REALTIME ABBOTT","code_information":[{"code":"87517","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":340.2,"maximum":340.2,"gross_charge":420,"discounted_cash":124.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.2,"methodology":"fee schedule"}]}]},{"description":"HBV DNA REALTIME ABBOTT","code_information":[{"code":"87517","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":340.2,"gross_charge":420,"discounted_cash":124.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HBV QUANT PCR RFX TO GENOTYPE","code_information":[{"code":"87517","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":187.11,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"}]}]},{"description":"HBV QUANT PCR RFX TO GENOTYPE","code_information":[{"code":"87517","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HBV DNAQUANT","code_information":[{"code":"87517","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB HBV DNAQUANT","code_information":[{"code":"87517","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP C PCR-QUAL","code_information":[{"code":"87521","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP C PCR-QUAL","code_information":[{"code":"87521","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEP C PCR-QUANT","code_information":[{"code":"87522","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":208.98,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEP C PCR-QUANT","code_information":[{"code":"87522","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HCV RNA BY PCR QN RFX GENO","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":208.98,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"}]}]},{"description":"HCV RNA BY PCR QN RFX GENO","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HCV RT-PCR QUANT (WITH GRAPH)","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":221.94,"maximum":221.94,"gross_charge":274,"discounted_cash":81.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.94,"methodology":"fee schedule"}]}]},{"description":"HCV RT-PCR QUANT (WITH GRAPH)","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":221.94,"gross_charge":274,"discounted_cash":81.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HCV VIRAL LOAD REALTIME ABBOTT","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":583.2,"maximum":583.2,"gross_charge":720,"discounted_cash":213.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":583.2,"methodology":"fee schedule"}]}]},{"description":"HCV VIRAL LOAD REALTIME ABBOTT","code_information":[{"code":"87522","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":42.84,"maximum":583.2,"gross_charge":720,"discounted_cash":213.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HSV PCR","code_information":[{"code":"87529","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":89.1,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"}]}]},{"description":"HC LAB HSV PCR","code_information":[{"code":"87529","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":106.27,"gross_charge":110,"discounted_cash":32.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HERPES SIMPLEX VIRUS-AMP PROBE","code_information":[{"code":"87529","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":143.37,"maximum":143.37,"gross_charge":177,"discounted_cash":52.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.37,"methodology":"fee schedule"}]}]},{"description":"HERPES SIMPLEX VIRUS-AMP PROBE","code_information":[{"code":"87529","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":143.37,"gross_charge":177,"discounted_cash":52.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HHV-6-DNAPCR","code_information":[{"code":"87532","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":355.59,"maximum":355.59,"gross_charge":439,"discounted_cash":129.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":355.59,"methodology":"fee schedule"}]}]},{"description":"HC LAB HHV-6-DNAPCR","code_information":[{"code":"87532","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":355.59,"gross_charge":439,"discounted_cash":129.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":355.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HIV-1 DNAQUAL PCR","code_information":[{"code":"87535","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":618.84,"maximum":618.84,"gross_charge":764,"discounted_cash":226.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":618.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":618.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":618.84,"methodology":"fee schedule"}]}]},{"description":"HC LAB HIV-1 DNAQUAL PCR","code_information":[{"code":"87535","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":618.84,"gross_charge":764,"discounted_cash":226.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":618.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":618.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":618.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HIV-1 RNA","code_information":[{"code":"87536","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":393.66,"maximum":393.66,"gross_charge":486,"discounted_cash":143.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":393.66,"methodology":"fee schedule"}]}]},{"description":"HC LAB HIV-1 RNA","code_information":[{"code":"87536","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":63.21,"maximum":393.66,"gross_charge":486,"discounted_cash":143.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":257.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":204.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":145.52,"standard_charge_algorithm": "Lesser of $145.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":186.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":207.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":127.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"standard_charge_algorithm": "Lesser of $85.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":91.06,"standard_charge_algorithm": "Lesser of $91.06 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":87.65,"standard_charge_algorithm": "Lesser of $87.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":89.36,"standard_charge_algorithm": "Lesser of $89.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":93.61,"standard_charge_algorithm": "Lesser of $93.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":90.21,"standard_charge_algorithm": "Lesser of $90.21 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RNA PCR(GRAPH)RFX/GENOPRI","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":393.66,"maximum":393.66,"gross_charge":486,"discounted_cash":143.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":393.66,"methodology":"fee schedule"}]}]},{"description":"RNA PCR(GRAPH)RFX/GENOPRI","code_information":[{"code":"87536","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":63.21,"maximum":393.66,"gross_charge":486,"discounted_cash":143.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":257.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":204.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":145.52,"standard_charge_algorithm": "Lesser of $145.52 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":186.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":207.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":127.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":85.1,"standard_charge_algorithm": "Lesser of $85.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":91.06,"standard_charge_algorithm": "Lesser of $91.06 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":87.65,"standard_charge_algorithm": "Lesser of $87.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":89.36,"standard_charge_algorithm": "Lesser of $89.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":93.61,"standard_charge_algorithm": "Lesser of $93.61 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":90.21,"standard_charge_algorithm": "Lesser of $90.21 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HIV-2 PROBE&REVRSE TRNSCRIPJ","code_information":[{"code":"87538","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"HIV-2 PROBE&REVRSE TRNSCRIPJ","code_information":[{"code":"87538","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LEGIONELLA BY PCR","code_information":[{"code":"87541","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":430.11,"maximum":430.11,"gross_charge":531,"discounted_cash":157.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":430.11,"methodology":"fee schedule"}]}]},{"description":"HC LEGIONELLA BY PCR","code_information":[{"code":"87541","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":430.11,"gross_charge":531,"discounted_cash":157.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":430.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-MTB DNA BY PCR","code_information":[{"code":"87551","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":279.45,"maximum":279.45,"gross_charge":345,"discounted_cash":102.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":279.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":279.45,"methodology":"fee schedule"}]}]},{"description":"NON-MTB DNA BY PCR","code_information":[{"code":"87551","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":279.45,"gross_charge":345,"discounted_cash":102.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":279.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":279.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":82.49,"standard_charge_algorithm": "Lesser of $82.49 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":106.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":48.24,"standard_charge_algorithm": "Lesser of $48.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.62,"standard_charge_algorithm": "Lesser of $51.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.69,"standard_charge_algorithm": "Lesser of $49.69 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.65,"standard_charge_algorithm": "Lesser of $50.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":53.06,"standard_charge_algorithm": "Lesser of $53.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":51.13,"standard_charge_algorithm": "Lesser of $51.13 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MTB NAA WITHOUT AFB CULTURE","code_information":[{"code":"87556","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":417.15,"maximum":417.15,"gross_charge":515,"discounted_cash":152.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.15,"methodology":"fee schedule"}]}]},{"description":"HC LAB MTB NAA WITHOUT AFB CULTURE","code_information":[{"code":"87556","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":41.68,"maximum":417.15,"gross_charge":515,"discounted_cash":152.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":71.27,"standard_charge_algorithm": "Lesser of $71.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":91.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":103,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":103,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"standard_charge_algorithm": "Lesser of $41.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.6,"standard_charge_algorithm": "Lesser of $44.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.93,"standard_charge_algorithm": "Lesser of $42.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.76,"standard_charge_algorithm": "Lesser of $43.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.85,"standard_charge_algorithm": "Lesser of $45.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44.18,"standard_charge_algorithm": "Lesser of $44.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MYCOBACTERIUM TBPCR","code_information":[{"code":"87556","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":417.15,"maximum":417.15,"gross_charge":515,"discounted_cash":152.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.15,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYCOBACTERIUM TBPCR","code_information":[{"code":"87556","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":41.68,"maximum":417.15,"gross_charge":515,"discounted_cash":152.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":71.27,"standard_charge_algorithm": "Lesser of $71.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":91.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":103,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":103,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.68,"standard_charge_algorithm": "Lesser of $41.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.6,"standard_charge_algorithm": "Lesser of $44.60 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.93,"standard_charge_algorithm": "Lesser of $42.93 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.76,"standard_charge_algorithm": "Lesser of $43.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.85,"standard_charge_algorithm": "Lesser of $45.85 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44.18,"standard_charge_algorithm": "Lesser of $44.18 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MYCOPLASMA GENITALIUM NAA","code_information":[{"code":"87563","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"MYCOPLASMA GENITALIUM NAA","code_information":[{"code":"87563","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":31.4,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MTB RIFAMPIN RST AMP PRB TQ","code_information":[{"code":"87564","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":255.15,"maximum":255.15,"gross_charge":315,"discounted_cash":93.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.15,"methodology":"fee schedule"}]}]},{"description":"MTB RIFAMPIN RST AMP PRB TQ","code_information":[{"code":"87564","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":47.25,"maximum":255.15,"gross_charge":315,"discounted_cash":93.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYCOPLASMA PNEUMONIA DIR PROBE","code_information":[{"code":"87581","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":179.82,"maximum":179.82,"gross_charge":222,"discounted_cash":65.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.82,"methodology":"fee schedule"}]}]},{"description":"HC LAB MYCOPLASMA PNEUMONIA DIR PROBE","code_information":[{"code":"87581","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":179.82,"gross_charge":222,"discounted_cash":65.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GC RNA TMA THROAT","code_information":[{"code":"87591","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":221.13,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB GC RNA TMA THROAT","code_information":[{"code":"87591","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":23.96,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB N. GONORRHOEAE RNA","code_information":[{"code":"87591","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":221.13,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB N. GONORRHOEAE RNA","code_information":[{"code":"87591","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.96,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"MONKEYPOX","code_information":[{"code":"87593","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":141.75,"maximum":141.75,"gross_charge":175,"discounted_cash":51.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.75,"methodology":"fee schedule"}]}]},{"description":"MONKEYPOX","code_information":[{"code":"87593","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":26.25,"maximum":141.75,"gross_charge":175,"discounted_cash":51.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"}]}]},{"description":"PNEUMCYSTS JIROVECII AMP PRB","code_information":[{"code":"87594","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"PNEUMCYSTS JIROVECII AMP PRB","code_information":[{"code":"87594","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":21.75,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"minimum":11640,"maximum":58359,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41232,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38657,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":48482.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34549,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41191,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39397,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":51034.47,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58359,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36235,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36235,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11640,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28352.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30337.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29203.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29770.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30053.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29770.11,"methodology":"case rate"}]}]},{"description":"HPV GENOTYPE","code_information":[{"code":"87625","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":146.61,"maximum":146.61,"gross_charge":181,"discounted_cash":53.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.61,"methodology":"fee schedule"}]}]},{"description":"HPV GENOTYPE","code_information":[{"code":"87625","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":20.42,"maximum":146.61,"gross_charge":181,"discounted_cash":53.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":69.34,"standard_charge_algorithm": "Lesser of $69.34 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":88.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":40.55,"standard_charge_algorithm": "Lesser of $40.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":43.39,"standard_charge_algorithm": "Lesser of $43.39 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":41.77,"standard_charge_algorithm": "Lesser of $41.77 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":42.58,"standard_charge_algorithm": "Lesser of $42.58 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":44.6,"standard_charge_algorithm": "Lesser of $44.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":42.98,"standard_charge_algorithm": "Lesser of $42.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HPV SEP HI-RSK TYP&POOL RSLT","code_information":[{"code":"87626","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":234.09,"maximum":234.09,"gross_charge":289,"discounted_cash":85.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.09,"methodology":"fee schedule"}]}]},{"description":"HPV SEP HI-RSK TYP&POOL RSLT","code_information":[{"code":"87626","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":43.35,"maximum":234.09,"gross_charge":289,"discounted_cash":85.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.8,"methodology":"fee schedule"}]}]},{"description":"HC INFLUENZA PCR","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":461.7,"maximum":461.7,"gross_charge":570,"discounted_cash":168.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":461.7,"methodology":"fee schedule"}]}]},{"description":"HC INFLUENZA PCR","code_information":[{"code":"87631","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":82.99,"maximum":461.7,"gross_charge":570,"discounted_cash":168.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":461.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":388.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":308.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":243.9,"standard_charge_algorithm": "Lesser of $243.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":281.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":313.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":213.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":142.63,"standard_charge_algorithm": "Lesser of $142.63 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":152.61,"standard_charge_algorithm": "Lesser of $152.61 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":146.91,"standard_charge_algorithm": "Lesser of $146.91 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":149.76,"standard_charge_algorithm": "Lesser of $149.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":156.89,"standard_charge_algorithm": "Lesser of $156.89 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":151.19,"standard_charge_algorithm": "Lesser of $151.19 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RESP VIRUS 6-11 TARGETS","code_information":[{"code":"87632","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":873.18,"maximum":873.18,"gross_charge":1078,"discounted_cash":319.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":873.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":873.18,"methodology":"fee schedule"}]}]},{"description":"RESP VIRUS 6-11 TARGETS","code_information":[{"code":"87632","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":121.27,"maximum":873.18,"gross_charge":1078,"discounted_cash":319.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":873.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":873.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":873.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":646.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":512.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":372.88,"standard_charge_algorithm": "Lesser of $372.88 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":521.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":327.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":218.06,"standard_charge_algorithm": "Lesser of $218.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":233.32,"standard_charge_algorithm": "Lesser of $233.32 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":224.6,"standard_charge_algorithm": "Lesser of $224.60 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":228.96,"standard_charge_algorithm": "Lesser of $228.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":239.87,"standard_charge_algorithm": "Lesser of $239.87 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":231.14,"standard_charge_algorithm": "Lesser of $231.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"EXPLIFY (RPIP) - ATHENA","code_information":[{"code":"87633","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":476.28,"maximum":476.28,"gross_charge":588,"discounted_cash":174.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"}]}]},{"description":"EXPLIFY (RPIP) - ATHENA","code_information":[{"code":"87633","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":216.94,"maximum":1262.29,"gross_charge":588,"discounted_cash":174.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1262.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1000.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":712.69,"standard_charge_algorithm": "Lesser of $712.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":913.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1017.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":625.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":445.95,"standard_charge_algorithm": "Lesser of $445.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":429.28,"standard_charge_algorithm": "Lesser of $429.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":437.62,"standard_charge_algorithm": "Lesser of $437.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":458.46,"standard_charge_algorithm": "Lesser of $458.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":441.79,"standard_charge_algorithm": "Lesser of $441.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RESP VIRUS 12-25 TARGETS","code_information":[{"code":"87633","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1769.04,"maximum":1769.04,"gross_charge":2184,"discounted_cash":646.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1769.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1769.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1769.04,"methodology":"fee schedule"}]}]},{"description":"HC LAB RESP VIRUS 12-25 TARGETS","code_information":[{"code":"87633","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":216.94,"maximum":1769.04,"gross_charge":2184,"discounted_cash":646.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1769.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1769.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1769.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1262.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1000.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":712.69,"standard_charge_algorithm": "Lesser of $712.69 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":913.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1017.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":625.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":416.78,"standard_charge_algorithm": "Lesser of $416.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":445.95,"standard_charge_algorithm": "Lesser of $445.95 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":429.28,"standard_charge_algorithm": "Lesser of $429.28 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":437.62,"standard_charge_algorithm": "Lesser of $437.62 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":458.46,"standard_charge_algorithm": "Lesser of $458.46 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":441.79,"standard_charge_algorithm": "Lesser of $441.79 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RSV BY PCR","code_information":[{"code":"87634","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":250.29,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"}]}]},{"description":"RSV BY PCR","code_information":[{"code":"87634","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":70.2,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":192.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":152.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.04,"standard_charge_algorithm": "Lesser of $120.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":171.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"standard_charge_algorithm": "Lesser of $70.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.11,"standard_charge_algorithm": "Lesser of $75.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.31,"standard_charge_algorithm": "Lesser of $72.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":73.71,"standard_charge_algorithm": "Lesser of $73.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.22,"standard_charge_algorithm": "Lesser of $77.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.41,"standard_charge_algorithm": "Lesser of $74.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"STAPH AUREUSAMP PROBE TECHN","code_information":[{"code":"87640","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":113.4,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"}]}]},{"description":"STAPH AUREUSAMP PROBE TECHN","code_information":[{"code":"87640","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":113.4,"gross_charge":140,"discounted_cash":41.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MR STAPH DNA AMP PROBE","code_information":[{"code":"87641","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":237.33,"maximum":237.33,"gross_charge":293,"discounted_cash":86.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.33,"methodology":"fee schedule"}]}]},{"description":"HC LAB MR STAPH DNA AMP PROBE","code_information":[{"code":"87641","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":237.33,"gross_charge":293,"discounted_cash":86.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":237.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB MENINGITIS/ENCEPHALITIS PANEL","code_information":[{"code":"87653","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC LAB MENINGITIS/ENCEPHALITIS PANEL","code_information":[{"code":"87653","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":106.27,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRICHOMONAS VAGINALIS DNA","code_information":[{"code":"87660","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":70.47,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"}]}]},{"description":"TRICHOMONAS VAGINALIS DNA","code_information":[{"code":"87660","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":20.05,"maximum":70.47,"gross_charge":87,"discounted_cash":25.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":60.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.29,"standard_charge_algorithm": "Lesser of $34.29 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.05,"standard_charge_algorithm": "Lesser of $20.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.45,"standard_charge_algorithm": "Lesser of $21.45 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.65,"standard_charge_algorithm": "Lesser of $20.65 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.05,"standard_charge_algorithm": "Lesser of $21.05 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.05,"standard_charge_algorithm": "Lesser of $22.05 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.25,"standard_charge_algorithm": "Lesser of $21.25 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"TRICHAMONAS VAG BY NAA","code_information":[{"code":"87661","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":122.31,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"}]}]},{"description":"TRICHAMONAS VAG BY NAA","code_information":[{"code":"87661","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":23.96,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ZIKA VIRUS URINE OR SERUM","code_information":[{"code":"87662","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":246.24,"maximum":246.24,"gross_charge":304,"discounted_cash":89.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.24,"methodology":"fee schedule"}]}]},{"description":"HC ZIKA VIRUS URINE OR SERUM","code_information":[{"code":"87662","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":51.31,"maximum":246.24,"gross_charge":304,"discounted_cash":89.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":140.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":111.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":87.74,"standard_charge_algorithm": "Lesser of $87.74 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":112.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":125.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"standard_charge_algorithm": "Lesser of $51.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":54.9,"standard_charge_algorithm": "Lesser of $54.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":52.85,"standard_charge_algorithm": "Lesser of $52.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":53.88,"standard_charge_algorithm": "Lesser of $53.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":56.44,"standard_charge_algorithm": "Lesser of $56.44 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":54.39,"standard_charge_algorithm": "Lesser of $54.39 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB AMPLIF NA PROBE NOS AG","code_information":[{"code":"87798","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":191.16,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMPLIF NA PROBE NOS AG","code_information":[{"code":"87798","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB WHIPPLES DISEASE SEROLOGY","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":191.16,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB WHIPPLES DISEASE SEROLOGY","code_information":[{"code":"87798","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"POWVC (POWASSAN VIRUS)","code_information":[{"code":"87798","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":451.98,"maximum":451.98,"gross_charge":558,"discounted_cash":165.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.98,"methodology":"fee schedule"}]}]},{"description":"POWVC (POWASSAN VIRUS)","code_information":[{"code":"87798","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":451.98,"gross_charge":558,"discounted_cash":165.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":451.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"standard_charge_algorithm": "Lesser of $60.00 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"standard_charge_algorithm": "Lesser of $35.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"standard_charge_algorithm": "Lesser of $37.55 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"standard_charge_algorithm": "Lesser of $36.14 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"standard_charge_algorithm": "Lesser of $36.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"standard_charge_algorithm": "Lesser of $38.60 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"standard_charge_algorithm": "Lesser of $37.20 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INFEC AGENT NA QUAN NOS","code_information":[{"code":"87799","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":217.89,"maximum":217.89,"gross_charge":269,"discounted_cash":79.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.89,"methodology":"fee schedule"}]}]},{"description":"HC LAB INFEC AGENT NA QUAN NOS","code_information":[{"code":"87799","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":40.35,"maximum":217.89,"gross_charge":269,"discounted_cash":79.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":129.74,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.26,"standard_charge_algorithm": "Lesser of $73.26 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.84,"standard_charge_algorithm": "Lesser of $42.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.84,"standard_charge_algorithm": "Lesser of $45.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.13,"standard_charge_algorithm": "Lesser of $44.13 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":44.98,"standard_charge_algorithm": "Lesser of $44.98 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.12,"standard_charge_algorithm": "Lesser of $47.12 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.41,"standard_charge_algorithm": "Lesser of $45.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"BACTERIAL DNA BY PCR","code_information":[{"code":"87801","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":244.62,"maximum":244.62,"gross_charge":302,"discounted_cash":89.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":244.62,"methodology":"fee schedule"}]}]},{"description":"BACTERIAL DNA BY PCR","code_information":[{"code":"87801","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":55.2,"maximum":244.62,"gross_charge":302,"discounted_cash":89.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":168.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.04,"standard_charge_algorithm": "Lesser of $120.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":171.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"standard_charge_algorithm": "Lesser of $70.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.11,"standard_charge_algorithm": "Lesser of $75.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.31,"standard_charge_algorithm": "Lesser of $72.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":73.71,"standard_charge_algorithm": "Lesser of $73.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.22,"standard_charge_algorithm": "Lesser of $77.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.41,"standard_charge_algorithm": "Lesser of $74.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"FUNGAL DNA BY PCR","code_information":[{"code":"87801","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":396.9,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"}]}]},{"description":"FUNGAL DNA BY PCR","code_information":[{"code":"87801","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":55.2,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":168.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.04,"standard_charge_algorithm": "Lesser of $120.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":171.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"standard_charge_algorithm": "Lesser of $70.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.11,"standard_charge_algorithm": "Lesser of $75.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.31,"standard_charge_algorithm": "Lesser of $72.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":73.71,"standard_charge_algorithm": "Lesser of $73.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.22,"standard_charge_algorithm": "Lesser of $77.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.41,"standard_charge_algorithm": "Lesser of $74.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB DNA MULT ORG AMP PROBE","code_information":[{"code":"87801","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":396.9,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB DNA MULT ORG AMP PROBE","code_information":[{"code":"87801","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":55.2,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":212.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":168.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.04,"standard_charge_algorithm": "Lesser of $120.04 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":171.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.2,"standard_charge_algorithm": "Lesser of $70.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.11,"standard_charge_algorithm": "Lesser of $75.11 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.31,"standard_charge_algorithm": "Lesser of $72.31 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":73.71,"standard_charge_algorithm": "Lesser of $73.71 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.22,"standard_charge_algorithm": "Lesser of $77.22 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.41,"standard_charge_algorithm": "Lesser of $74.41 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC GROUP B STREP AG","code_information":[{"code":"87802","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC GROUP B STREP AG","code_information":[{"code":"87802","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":12.73,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21.77,"standard_charge_algorithm": "Lesser of $21.77 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.73,"standard_charge_algorithm": "Lesser of $12.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13.62,"standard_charge_algorithm": "Lesser of $13.62 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.11,"standard_charge_algorithm": "Lesser of $13.11 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14,"standard_charge_algorithm": "Lesser of $14.00 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.49,"standard_charge_algorithm": "Lesser of $13.49 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INFLUENZA IA W/DO","code_information":[{"code":"87804","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB INFLUENZA IA W/DO","code_information":[{"code":"87804","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.55,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.3,"standard_charge_algorithm": "Lesser of $28.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.71,"standard_charge_algorithm": "Lesser of $17.71 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.05,"standard_charge_algorithm": "Lesser of $17.05 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.38,"standard_charge_algorithm": "Lesser of $17.38 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.2,"standard_charge_algorithm": "Lesser of $18.20 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.54,"standard_charge_algorithm": "Lesser of $17.54 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RAPID RSV AG","code_information":[{"code":"87807","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":63.99,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"}]}]},{"description":"HC LAB RAPID RSV AG","code_information":[{"code":"87807","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":13.1,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22.4,"standard_charge_algorithm": "Lesser of $22.40 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.1,"standard_charge_algorithm": "Lesser of $13.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.02,"standard_charge_algorithm": "Lesser of $14.02 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13.49,"standard_charge_algorithm": "Lesser of $13.49 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13.76,"standard_charge_algorithm": "Lesser of $13.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14.41,"standard_charge_algorithm": "Lesser of $14.41 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13.89,"standard_charge_algorithm": "Lesser of $13.89 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB RAPID STREP A AG","code_information":[{"code":"87880","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":93.96,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"HC LAB RAPID STREP A AG","code_information":[{"code":"87880","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.53,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.27,"standard_charge_algorithm": "Lesser of $28.27 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.53,"standard_charge_algorithm": "Lesser of $16.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.69,"standard_charge_algorithm": "Lesser of $17.69 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.36,"standard_charge_algorithm": "Lesser of $17.36 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.18,"standard_charge_algorithm": "Lesser of $18.18 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.52,"standard_charge_algorithm": "Lesser of $17.52 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB INF AGENT NOS","code_information":[{"code":"87899","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":111.78,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB INF AGENT NOS","code_information":[{"code":"87899","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":16.07,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.48,"standard_charge_algorithm": "Lesser of $27.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"standard_charge_algorithm": "Lesser of $17.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.87,"standard_charge_algorithm": "Lesser of $16.87 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.68,"standard_charge_algorithm": "Lesser of $17.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SHIGA TOXIN 1 2","code_information":[{"code":"87899","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":111.78,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB SHIGA TOXIN 1 2","code_information":[{"code":"87899","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":16.07,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27.48,"standard_charge_algorithm": "Lesser of $27.48 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.07,"standard_charge_algorithm": "Lesser of $16.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.19,"standard_charge_algorithm": "Lesser of $17.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.87,"standard_charge_algorithm": "Lesser of $16.87 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.68,"standard_charge_algorithm": "Lesser of $17.68 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.03,"standard_charge_algorithm": "Lesser of $17.03 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HBV DRUG RESISTANCE","code_information":[{"code":"87900","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":477.9,"maximum":477.9,"gross_charge":590,"discounted_cash":174.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"}]}]},{"description":"HBV DRUG RESISTANCE","code_information":[{"code":"87900","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":130.35,"maximum":477.9,"gross_charge":590,"discounted_cash":174.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":394.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":312.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":222.9,"standard_charge_algorithm": "Lesser of $222.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":285.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":318.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":195.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":130.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":130.35,"standard_charge_algorithm": "Lesser of $130.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":139.47,"standard_charge_algorithm": "Lesser of $139.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":134.26,"standard_charge_algorithm": "Lesser of $134.26 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":136.87,"standard_charge_algorithm": "Lesser of $136.87 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":143.38,"standard_charge_algorithm": "Lesser of $143.38 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":138.17,"standard_charge_algorithm": "Lesser of $138.17 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HIV-1 GENOTYPE","code_information":[{"code":"87901","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":784.89,"maximum":784.89,"gross_charge":969,"discounted_cash":286.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":784.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":784.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":784.89,"methodology":"fee schedule"}]}]},{"description":"HC LAB HIV-1 GENOTYPE","code_information":[{"code":"87901","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":122.7,"maximum":784.89,"gross_charge":969,"discounted_cash":286.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":784.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":784.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":784.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":544.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":431.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":440.24,"standard_charge_algorithm": "Lesser of $440.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":564.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":628.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"standard_charge_algorithm": "Lesser of $257.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":275.47,"standard_charge_algorithm": "Lesser of $275.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":265.17,"standard_charge_algorithm": "Lesser of $265.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":270.32,"standard_charge_algorithm": "Lesser of $270.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":283.19,"standard_charge_algorithm": "Lesser of $283.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":272.9,"standard_charge_algorithm": "Lesser of $272.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB HEPATITIS C-GENOTYPE","code_information":[{"code":"87902","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":902.34,"maximum":902.34,"gross_charge":1114,"discounted_cash":329.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":902.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":902.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":902.34,"methodology":"fee schedule"}]}]},{"description":"HC LAB HEPATITIS C-GENOTYPE","code_information":[{"code":"87902","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":122.7,"maximum":902.34,"gross_charge":1114,"discounted_cash":329.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":902.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":902.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":902.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":544.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":431.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":440.24,"standard_charge_algorithm": "Lesser of $440.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":564.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":628.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"standard_charge_algorithm": "Lesser of $257.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":275.47,"standard_charge_algorithm": "Lesser of $275.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":265.17,"standard_charge_algorithm": "Lesser of $265.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":270.32,"standard_charge_algorithm": "Lesser of $270.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":283.19,"standard_charge_algorithm": "Lesser of $283.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":272.9,"standard_charge_algorithm": "Lesser of $272.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"RFX HEP C GENOTYPE","code_information":[{"code":"87902","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":859.41,"maximum":859.41,"gross_charge":1061,"discounted_cash":314.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":859.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":859.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":859.41,"methodology":"fee schedule"}]}]},{"description":"RFX HEP C GENOTYPE","code_information":[{"code":"87902","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":122.7,"maximum":859.41,"gross_charge":1061,"discounted_cash":314.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":859.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":859.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":859.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":544.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":431.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":440.24,"standard_charge_algorithm": "Lesser of $440.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":564.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":628.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"standard_charge_algorithm": "Lesser of $257.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":275.47,"standard_charge_algorithm": "Lesser of $275.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":265.17,"standard_charge_algorithm": "Lesser of $265.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":270.32,"standard_charge_algorithm": "Lesser of $270.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":283.19,"standard_charge_algorithm": "Lesser of $283.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":272.9,"standard_charge_algorithm": "Lesser of $272.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PHENOSENSE INTEGRASE","code_information":[{"code":"87903","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":1631.34,"maximum":1631.34,"gross_charge":2014,"discounted_cash":596.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.34,"methodology":"fee schedule"}]}]},{"description":"PHENOSENSE INTEGRASE","code_information":[{"code":"87903","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":475.83,"maximum":1631.34,"gross_charge":2014,"discounted_cash":596.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":488.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1479.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1173.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":835.61,"standard_charge_algorithm": "Lesser of $835.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1071.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1192.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":732.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":488.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":488.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":488.66,"standard_charge_algorithm": "Lesser of $488.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":522.87,"standard_charge_algorithm": "Lesser of $522.87 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":503.32,"standard_charge_algorithm": "Lesser of $503.32 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":513.09,"standard_charge_algorithm": "Lesser of $513.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":537.53,"standard_charge_algorithm": "Lesser of $537.53 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":517.98,"standard_charge_algorithm": "Lesser of $517.98 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HBV GENOTYPE","code_information":[{"code":"87912","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":947.7,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"}]}]},{"description":"HBV GENOTYPE","code_information":[{"code":"87912","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":107.29,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":544.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":431.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":440.24,"standard_charge_algorithm": "Lesser of $440.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":564.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":628.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"standard_charge_algorithm": "Lesser of $257.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":275.47,"standard_charge_algorithm": "Lesser of $275.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":265.17,"standard_charge_algorithm": "Lesser of $265.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":270.32,"standard_charge_algorithm": "Lesser of $270.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":283.19,"standard_charge_algorithm": "Lesser of $283.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":272.9,"standard_charge_algorithm": "Lesser of $272.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB GENOTYPE DNA HEPATITIS B","code_information":[{"code":"87912","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":1169.64,"maximum":1169.64,"gross_charge":1444,"discounted_cash":427.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1169.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1169.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1169.64,"methodology":"fee schedule"}]}]},{"description":"HC LAB GENOTYPE DNA HEPATITIS B","code_information":[{"code":"87912","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":107.29,"maximum":1169.64,"gross_charge":1444,"discounted_cash":427.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1169.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1169.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1169.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":544.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":431.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":440.24,"standard_charge_algorithm": "Lesser of $440.24 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":564.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":628.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":257.45,"standard_charge_algorithm": "Lesser of $257.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":275.47,"standard_charge_algorithm": "Lesser of $275.47 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":265.17,"standard_charge_algorithm": "Lesser of $265.17 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":270.32,"standard_charge_algorithm": "Lesser of $270.32 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":283.19,"standard_charge_algorithm": "Lesser of $283.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":272.9,"standard_charge_algorithm": "Lesser of $272.90 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"JOINT INFECTION PANEL PCR-BIOFIRE","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":1091.07,"maximum":1091.07,"gross_charge":1347,"discounted_cash":398.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1091.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1091.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1091.07,"methodology":"fee schedule"}]}]},{"description":"JOINT INFECTION PANEL PCR-BIOFIRE","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":50.58,"maximum":1091.07,"gross_charge":1347,"discounted_cash":398.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1091.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1091.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1091.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":673.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":673.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.4,"methodology":"fee schedule"}]}]},{"description":"TROFILE DNA -TROPISM","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":2116.53,"maximum":2116.53,"gross_charge":2613,"discounted_cash":773.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2116.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2116.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2116.53,"methodology":"fee schedule"}]}]},{"description":"TROFILE DNA -TROPISM","code_information":[{"code":"87999","type":"CPT"},{"code":"0306","type":"RC"}],"standard_charges":[{"minimum":50.58,"maximum":2116.53,"gross_charge":2613,"discounted_cash":773.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2116.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2116.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2116.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1306.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1306.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.6,"methodology":"fee schedule"}]}]},{"description":"ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"minimum":3677,"maximum":16679.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8247,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7732,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15845.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9795,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11678,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10079,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16679.99,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14236,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8839,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8839,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3677,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9266.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9915.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9544.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9730,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9822.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9730,"methodology":"case rate"}]}]},{"description":"DEPRESSIVE NEUROSES","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"minimum":3172,"maximum":16165.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7479,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7012,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15357.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9247,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11025,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9571,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16165.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13575,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8429,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8429,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3172,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8980.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9609.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9250.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9429.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9519.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9429.83,"methodology":"case rate"}]}]},{"description":"HC LAB CYTOLESION SMEAR 1","code_information":[{"code":"88104","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":221.13,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYTOLESION SMEAR 1","code_information":[{"code":"88104","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":33.43,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":79.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":88.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"HC THIN PREP CELL ENHANCEMT","code_information":[{"code":"88112","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC THIN PREP CELL ENHANCEMT","code_information":[{"code":"88112","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC CERVICAL-VAGINAL THIN LAYER PR","code_information":[{"code":"88142","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":161.19,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"}]}]},{"description":"HC CERVICAL-VAGINAL THIN LAYER PR","code_information":[{"code":"88142","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":20.26,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":48.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34.64,"standard_charge_algorithm": "Lesser of $34.64 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.26,"standard_charge_algorithm": "Lesser of $20.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.68,"standard_charge_algorithm": "Lesser of $21.68 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20.87,"standard_charge_algorithm": "Lesser of $20.87 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.27,"standard_charge_algorithm": "Lesser of $21.27 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.29,"standard_charge_algorithm": "Lesser of $22.29 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.48,"standard_charge_algorithm": "Lesser of $21.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC CONVENTIONAL PAP SMEAR","code_information":[{"code":"88164","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC CONVENTIONAL PAP SMEAR","code_information":[{"code":"88164","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":14.86,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":31.1,"standard_charge_algorithm": "Lesser of $31.10 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.19,"standard_charge_algorithm": "Lesser of $18.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":19.46,"standard_charge_algorithm": "Lesser of $19.46 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":18.74,"standard_charge_algorithm": "Lesser of $18.74 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.1,"standard_charge_algorithm": "Lesser of $19.10 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.01,"standard_charge_algorithm": "Lesser of $20.01 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19.28,"standard_charge_algorithm": "Lesser of $19.28 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FNA DX EVAL 1ST EA SITE","code_information":[{"code":"88172","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":477.9,"maximum":477.9,"gross_charge":590,"discounted_cash":174.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB FNA DX EVAL 1ST EA SITE","code_information":[{"code":"88172","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":28.64,"maximum":477.9,"gross_charge":590,"discounted_cash":174.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB FNA; INT & REP","code_information":[{"code":"88173","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":140.13,"maximum":140.13,"gross_charge":173,"discounted_cash":51.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB FNA; INT & REP","code_information":[{"code":"88173","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":182.53,"gross_charge":173,"discounted_cash":51.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":148.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":118.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":163.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":182.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB CYTP FNA EVAL EA ADDL","code_information":[{"code":"88177","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":66.42,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"}]}]},{"description":"HC LAB CYTP FNA EVAL EA ADDL","code_information":[{"code":"88177","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":7.22,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW CYTOM 1ST MRK","code_information":[{"code":"88184","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":920.16,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW CYTOM 1ST MRK","code_information":[{"code":"88184","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":51.58,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":174.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":138.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":133.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":149.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB FLOW CYTOMETRY CD59","code_information":[{"code":"88184","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":920.16,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW CYTOMETRY CD59","code_information":[{"code":"88184","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":51.58,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":174.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":138.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":133.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":149.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB FLOW TC FIRST MARKER CD2","code_information":[{"code":"88184","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":920.16,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW TC FIRST MARKER CD2","code_information":[{"code":"88184","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":51.58,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":174.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":138.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":133.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":149.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB FLOW CYTOM ADDL MRK","code_information":[{"code":"88185","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":100.44,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW CYTOM ADDL MRK","code_information":[{"code":"88185","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":22.38,"maximum":106.83,"gross_charge":124,"discounted_cash":36.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW CYTOMETRY FLAER","code_information":[{"code":"88185","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":100.44,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"}]}]},{"description":"HC LAB FLOW CYTOMETRY FLAER","code_information":[{"code":"88185","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":22.38,"maximum":106.83,"gross_charge":124,"discounted_cash":36.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.36,"methodology":"fee schedule"}]}]},{"description":"FLOW INTERP 9 TO 15","code_information":[{"code":"88188","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"FLOW INTERP 9 TO 15","code_information":[{"code":"88188","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":66.04,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":190.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":151.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":105.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":66.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":66.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.46,"methodology":"fee schedule"}]}]},{"description":"NEUROSES EXCEPT DEPRESSIVE","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"minimum":3267,"maximum":16719.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8309,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7791,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15883.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9442,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11257,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9917,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16719.3,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14287,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8871,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8871,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3267,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9288.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9938.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9567.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9752.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9845.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9752.93,"methodology":"case rate"}]}]},{"description":"HC LAB TISSUE CULT LYMPHOCYTE","code_information":[{"code":"88230","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":397.71,"maximum":397.71,"gross_charge":491,"discounted_cash":145.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.71,"methodology":"fee schedule"}]}]},{"description":"HC LAB TISSUE CULT LYMPHOCYTE","code_information":[{"code":"88230","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":116.49,"maximum":397.71,"gross_charge":491,"discounted_cash":145.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":352.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":279.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":199.2,"standard_charge_algorithm": "Lesser of $199.20 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":255.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":284.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":174.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":116.49,"standard_charge_algorithm": "Lesser of $116.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":124.64,"standard_charge_algorithm": "Lesser of $124.64 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":119.98,"standard_charge_algorithm": "Lesser of $119.98 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":122.31,"standard_charge_algorithm": "Lesser of $122.31 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":128.14,"standard_charge_algorithm": "Lesser of $128.14 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":123.48,"standard_charge_algorithm": "Lesser of $123.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB TISSUE CULT BM BLD CELL","code_information":[{"code":"88237","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":528.93,"maximum":528.93,"gross_charge":653,"discounted_cash":193.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":528.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":528.93,"methodology":"fee schedule"}]}]},{"description":"HC LAB TISSUE CULT BM BLD CELL","code_information":[{"code":"88237","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":124.21,"maximum":528.93,"gross_charge":653,"discounted_cash":193.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":528.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":528.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":382.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":303.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":245.81,"standard_charge_algorithm": "Lesser of $245.81 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":283.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":315.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":215.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":143.75,"standard_charge_algorithm": "Lesser of $143.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":153.81,"standard_charge_algorithm": "Lesser of $153.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":148.06,"standard_charge_algorithm": "Lesser of $148.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":150.94,"standard_charge_algorithm": "Lesser of $150.94 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":158.13,"standard_charge_algorithm": "Lesser of $158.13 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":152.38,"standard_charge_algorithm": "Lesser of $152.38 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHROMOSOME ANALYSIS","code_information":[{"code":"88262","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHROMOSOME ANALYSIS","code_information":[{"code":"88262","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":377.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":377.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":299.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":214.59,"standard_charge_algorithm": "Lesser of $214.59 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":273.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":304.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":188.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":125.49,"standard_charge_algorithm": "Lesser of $125.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":134.27,"standard_charge_algorithm": "Lesser of $134.27 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":129.25,"standard_charge_algorithm": "Lesser of $129.25 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":131.76,"standard_charge_algorithm": "Lesser of $131.76 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":138.04,"standard_charge_algorithm": "Lesser of $138.04 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":133.02,"standard_charge_algorithm": "Lesser of $133.02 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHROM COUNT 20-25 CELLS","code_information":[{"code":"88264","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":532.98,"maximum":532.98,"gross_charge":658,"discounted_cash":194.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.98,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHROM COUNT 20-25 CELLS","code_information":[{"code":"88264","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":144.61,"maximum":532.98,"gross_charge":658,"discounted_cash":194.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":377.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":299.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":247.28,"standard_charge_algorithm": "Lesser of $247.28 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":285.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":318.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":216.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":144.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":144.61,"standard_charge_algorithm": "Lesser of $144.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":154.73,"standard_charge_algorithm": "Lesser of $154.73 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":148.95,"standard_charge_algorithm": "Lesser of $148.95 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":151.84,"standard_charge_algorithm": "Lesser of $151.84 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":159.07,"standard_charge_algorithm": "Lesser of $159.07 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":153.29,"standard_charge_algorithm": "Lesser of $153.29 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CHROM ANALEA ADDL","code_information":[{"code":"88280","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":159.57,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"}]}]},{"description":"HC LAB CHROM ANALEA ADDL","code_information":[{"code":"88280","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":33.47,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.23,"standard_charge_algorithm": "Lesser of $57.23 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":66.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.47,"standard_charge_algorithm": "Lesser of $33.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.81,"standard_charge_algorithm": "Lesser of $35.81 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.47,"standard_charge_algorithm": "Lesser of $34.47 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.14,"standard_charge_algorithm": "Lesser of $35.14 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.82,"standard_charge_algorithm": "Lesser of $36.82 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.48,"standard_charge_algorithm": "Lesser of $35.48 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"minimum":4685,"maximum":27532,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14340,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13445,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25680.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17451,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20806,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19800,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27032.58,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27532,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17095,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17095,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4685,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15018.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16069.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15468.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15769.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15919.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15769.01,"methodology":"case rate"}]}]},{"description":"HC LAB SURG/PATH-LEVEL I","code_information":[{"code":"88300","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":122.31,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"}]}]},{"description":"HC LAB SURG/PATH-LEVEL I","code_information":[{"code":"88300","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":15.61,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"HC LAB SURG/PATH-LEVEL II","code_information":[{"code":"88302","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":261.63,"maximum":261.63,"gross_charge":323,"discounted_cash":95.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":261.63,"methodology":"fee schedule"}]}]},{"description":"HC LAB SURG/PATH-LEVEL II","code_information":[{"code":"88302","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":22.99,"maximum":261.63,"gross_charge":323,"discounted_cash":95.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"HC LAB SURG/PATH-LEVEL III","code_information":[{"code":"88304","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":475.47,"maximum":475.47,"gross_charge":587,"discounted_cash":173.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":475.47,"methodology":"fee schedule"}]}]},{"description":"HC LAB SURG/PATH-LEVEL III","code_information":[{"code":"88304","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":33.77,"maximum":475.47,"gross_charge":587,"discounted_cash":173.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":475.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB RENAL BIOPSY","code_information":[{"code":"88305","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":213.84,"maximum":213.84,"gross_charge":264,"discounted_cash":78.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.84,"methodology":"fee schedule"}]}]},{"description":"HC LAB RENAL BIOPSY","code_information":[{"code":"88305","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":213.84,"gross_charge":264,"discounted_cash":78.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB SURG/PATH-LEVEL IV","code_information":[{"code":"88305","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":213.84,"maximum":213.84,"gross_charge":264,"discounted_cash":78.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.84,"methodology":"fee schedule"}]}]},{"description":"HC LAB SURG/PATH-LEVEL IV","code_information":[{"code":"88305","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":213.84,"gross_charge":264,"discounted_cash":78.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB SURG/PATH-LEVEL V","code_information":[{"code":"88307","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":806.76,"maximum":806.76,"gross_charge":996,"discounted_cash":294.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":806.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":806.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":806.76,"methodology":"fee schedule"}]}]},{"description":"HC LAB SURG/PATH-LEVEL V","code_information":[{"code":"88307","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":149.14,"maximum":806.76,"gross_charge":996,"discounted_cash":294.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":806.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":806.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":806.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":406.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":322.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":383.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":427.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB SURG/PATH-LEVEL VI","code_information":[{"code":"88309","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1127.52,"maximum":1127.52,"gross_charge":1392,"discounted_cash":412.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1127.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB SURG/PATH-LEVEL VI","code_information":[{"code":"88309","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":210.09,"maximum":1788.47,"gross_charge":1392,"discounted_cash":412.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1127.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1254.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":576.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":457.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1248.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":541.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":603.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":730.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":781.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":752.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":766.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":803.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":774.16,"methodology":"case rate"}]}]},{"description":"HC LAB DECALCIFICATION-TECH","code_information":[{"code":"88311","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":121.5,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"}]}]},{"description":"HC LAB DECALCIFICATION-TECH","code_information":[{"code":"88311","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":9.02,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"}]}]},{"description":"HC LAB GMS/ LIGHT GREEN STAIN","code_information":[{"code":"88312","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":241.38,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB GMS/ LIGHT GREEN STAIN","code_information":[{"code":"88312","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":133.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":156.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":174.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB SPECIAL STAINS GROUP 1","code_information":[{"code":"88312","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":241.38,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"}]}]},{"description":"HC LAB SPECIAL STAINS GROUP 1","code_information":[{"code":"88312","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":133.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":105.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":156.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":174.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB SPECIAL STAINS GROUP 2","code_information":[{"code":"88313","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":253.53,"maximum":253.53,"gross_charge":313,"discounted_cash":92.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.53,"methodology":"fee schedule"}]}]},{"description":"HC LAB SPECIAL STAINS GROUP 2","code_information":[{"code":"88313","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":33.43,"maximum":282.21,"gross_charge":313,"discounted_cash":92.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC PER ACID SCHIFFS REAGENT STAIN","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":253.53,"maximum":253.53,"gross_charge":313,"discounted_cash":92.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.53,"methodology":"fee schedule"}]}]},{"description":"HC PER ACID SCHIFFS REAGENT STAIN","code_information":[{"code":"88313","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":33.43,"maximum":282.21,"gross_charge":313,"discounted_cash":92.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC LAB HISTOCHEM/ENZYME","code_information":[{"code":"88319","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":234.9,"maximum":234.9,"gross_charge":290,"discounted_cash":85.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.9,"methodology":"fee schedule"}]}]},{"description":"HC LAB HISTOCHEM/ENZYME","code_information":[{"code":"88319","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":90.92,"maximum":1788.47,"gross_charge":290,"discounted_cash":85.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1254.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":114.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1248.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":187.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":730.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":781.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":752.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":766.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":803.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":774.16,"methodology":"case rate"}]}]},{"description":"HC LAB REF CONSULT W SLIDE PREP","code_information":[{"code":"88323","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB REF CONSULT W SLIDE PREP","code_information":[{"code":"88323","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":47.77,"maximum":118.26,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":116.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":93.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":51.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":49.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":50.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.64,"methodology":"case rate"}]}]},{"description":"HC LAB SP CON 1ST TB W FZS SGL","code_information":[{"code":"88331","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":377.46,"maximum":377.46,"gross_charge":466,"discounted_cash":137.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":377.46,"methodology":"fee schedule"}]}]},{"description":"HC LAB SP CON 1ST TB W FZS SGL","code_information":[{"code":"88331","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":56.95,"maximum":377.46,"gross_charge":466,"discounted_cash":137.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":377.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":71.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":56.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":68.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":76.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB SP CON FZS EA ADDL","code_information":[{"code":"88332","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":181.44,"maximum":181.44,"gross_charge":224,"discounted_cash":66.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.44,"methodology":"fee schedule"}]}]},{"description":"HC LAB SP CON FZS EA ADDL","code_information":[{"code":"88332","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":19.59,"maximum":181.44,"gross_charge":224,"discounted_cash":66.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"}]}]},{"description":"HC LAB INTRAOP CYTO PATH CONSULT 1","code_information":[{"code":"88333","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":2142.45,"maximum":2142.45,"gross_charge":2645,"discounted_cash":782.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2142.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB INTRAOP CYTO PATH CONSULT 1","code_information":[{"code":"88333","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":52.39,"maximum":2142.45,"gross_charge":2645,"discounted_cash":782.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1254.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":81.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1248.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":730.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":781.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":752.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":766.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":803.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":774.16,"methodology":"case rate"}]}]},{"description":"HC LAB TOUCH PREP","code_information":[{"code":"88333","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":2142.45,"maximum":2142.45,"gross_charge":2645,"discounted_cash":782.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2142.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB TOUCH PREP","code_information":[{"code":"88333","type":"CPT"},{"code":"0311","type":"RC"}],"standard_charges":[{"minimum":52.39,"maximum":2142.45,"gross_charge":2645,"discounted_cash":782.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2142.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1254.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":81.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1248.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":730.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":781.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":752.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":766.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":803.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":774.16,"methodology":"case rate"}]}]},{"description":"HC LAB INTRAOP CYTO PATH CONSULT 2","code_information":[{"code":"88334","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC LAB INTRAOP CYTO PATH CONSULT 2","code_information":[{"code":"88334","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":18.04,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOHISTO ANTIBODY ADD","code_information":[{"code":"88341","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":356.4,"maximum":356.4,"gross_charge":440,"discounted_cash":130.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":356.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356.4,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOHISTO ANTIBODY ADD","code_information":[{"code":"88341","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":64.2,"maximum":356.4,"gross_charge":440,"discounted_cash":130.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":356.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":90.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":127.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMACR RACEMASE IMMUNOPEROXID","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMACR RACEMASE IMMUNOPEROXID","code_information":[{"code":"88342","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":75.29,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":94.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":138.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":154.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB IMMUNOHISTO ANTIBODY INTL SGL","code_information":[{"code":"88342","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOHISTO ANTIBODY INTL SGL","code_information":[{"code":"88342","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":75.29,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":94.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":138.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":154.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB IMMUNOHISTO ANTIBODY SLIDE MULTPLX","code_information":[{"code":"88344","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":1122.66,"maximum":1122.66,"gross_charge":1386,"discounted_cash":410.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1122.66,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOHISTO ANTIBODY SLIDE MULTPLX","code_information":[{"code":"88344","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":111.11,"maximum":1122.66,"gross_charge":1386,"discounted_cash":410.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":152.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":121.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":266.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":297.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB SYNAPTOPHYSIN/KI67","code_information":[{"code":"88344","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":1122.66,"maximum":1122.66,"gross_charge":1386,"discounted_cash":410.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1122.66,"methodology":"fee schedule"}]}]},{"description":"HC LAB SYNAPTOPHYSIN/KI67","code_information":[{"code":"88344","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":111.11,"maximum":1122.66,"gross_charge":1386,"discounted_cash":410.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1122.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":152.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":121.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":266.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":297.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB IF STUDY EA AB DIRECT","code_information":[{"code":"88346","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":853.74,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"}]}]},{"description":"HC LAB IF STUDY EA AB DIRECT","code_information":[{"code":"88346","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":79.36,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":126.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":99.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":179.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":199.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB KAPPA IMMUNOFLUORESCENT","code_information":[{"code":"88346","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":853.74,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"}]}]},{"description":"HC LAB KAPPA IMMUNOFLUORESCENT","code_information":[{"code":"88346","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":79.36,"maximum":853.74,"gross_charge":1054,"discounted_cash":311.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":853.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":126.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":99.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":179.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":199.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC LAB ELECTRON MICROSCOPY","code_information":[{"code":"88348","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":684.45,"maximum":684.45,"gross_charge":845,"discounted_cash":250.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB ELECTRON MICROSCOPY","code_information":[{"code":"88348","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":312.67,"maximum":1788.47,"gross_charge":845,"discounted_cash":250.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1788.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1254.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1245.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":987.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1248.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":618.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":688.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":628.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":730.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":781.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":752.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":766.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":803.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":774.16,"methodology":"case rate"}]}]},{"description":"HC LAB IMMUNOFLUOR ANTB ADDL STAIN","code_information":[{"code":"88350","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":66.42,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"}]}]},{"description":"HC LAB IMMUNOFLUOR ANTB ADDL STAIN","code_information":[{"code":"88350","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":63.88,"maximum":140.04,"gross_charge":82,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":125.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":140.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":63.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":63.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"}]}]},{"description":"HC LAB IM TUMOR IHC","code_information":[{"code":"88360","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":507.87,"maximum":507.87,"gross_charge":627,"discounted_cash":185.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.87,"methodology":"fee schedule"}]}]},{"description":"HC LAB IM TUMOR IHC","code_information":[{"code":"88360","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":109.25,"maximum":507.87,"gross_charge":627,"discounted_cash":185.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":149.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":118.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":164.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":182.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"IN SITU HYB(ISH)ADD SNG STAIN","code_information":[{"code":"88364","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":455.22,"maximum":455.22,"gross_charge":562,"discounted_cash":166.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":455.22,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYB(ISH)ADD SNG STAIN","code_information":[{"code":"88364","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":92.42,"maximum":455.22,"gross_charge":562,"discounted_cash":166.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":139.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":205.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":228.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":104.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.42,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYB(ISH) INT SNG STAIN","code_information":[{"code":"88365","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":227.61,"maximum":227.61,"gross_charge":281,"discounted_cash":83.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.61,"methodology":"fee schedule"}]}]},{"description":"IN SITU HYB(ISH) INT SNG STAIN","code_information":[{"code":"88365","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":98.66,"maximum":375.17,"gross_charge":281,"discounted_cash":83.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":375.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":249.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":233.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":184.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":261.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":272.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":303.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":143.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":153.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":163.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":157.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":160.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":168.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":162.39,"methodology":"case rate"}]}]},{"description":"HC FISH BCR-ABL CML/ALL PROBE #1","code_information":[{"code":"88367","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":947.7,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"}]}]},{"description":"HC FISH BCR-ABL CML/ALL PROBE #1","code_information":[{"code":"88367","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":156.37,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":384.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":304.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":156.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":174.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB FISH PROBE #1 MAN MORPH ANALYS","code_information":[{"code":"88368","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":947.7,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB FISH PROBE #1 MAN MORPH ANALYS","code_information":[{"code":"88368","type":"CPT"},{"code":"0312","type":"RC"}],"standard_charges":[{"minimum":178.14,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":333.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":264.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":178.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":198.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"HC LAB INSITU HYBRID MANUAL","code_information":[{"code":"88368","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":947.7,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"}]}]},{"description":"HC LAB INSITU HYBRID MANUAL","code_information":[{"code":"88368","type":"CPT"},{"code":"0310","type":"RC"}],"standard_charges":[{"minimum":178.14,"maximum":947.7,"gross_charge":1170,"discounted_cash":346.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":787.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":524.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":333.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":264.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":549.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":178.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":198.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":283.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":321.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":344.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":331.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":337.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":353.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":340.9,"methodology":"case rate"}]}]},{"description":"ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"minimum":6660,"maximum":24908.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11500,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10782,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23663,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16970,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20233,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18549,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24908.42,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24804,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15401,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15401,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6660,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13838.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14806.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14253.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14529.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14668.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14529.92,"methodology":"case rate"}]}]},{"description":"PSYCHOSES","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":4292,"maximum":21895.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11722,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10991,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20800.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14003,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16695,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14426,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21895.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20934,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12998,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12998,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12163.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13015.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12528.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12772.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12893.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12772.1,"methodology":"case rate"}]}]},{"description":"BEHAVIORAL AND DEVELOPMENTAL DISORDERS","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"minimum":3397,"maximum":26680,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10058,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9431,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25050.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14754,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17591,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17755,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26368.85,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26680,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16566,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16566,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3397,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14649.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15674.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15088.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15381.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15528.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15381.83,"methodology":"case rate"}]}]},{"description":"OTHER MENTAL DISORDER DIAGNOSES","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"minimum":3536,"maximum":19348.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16203,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15192,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18381.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14014,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16708,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13679,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19348.8,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17664,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10967,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10967,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3536,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10749.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11501.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11071.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11286.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11394.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11286.8,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8901","type":"APR-DRG"}],"standard_charges":[{"minimum":6118,"maximum":6118,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6118,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6118,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6118,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8902","type":"APR-DRG"}],"standard_charges":[{"minimum":6441,"maximum":6441,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6441,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6441,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6441,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8903","type":"APR-DRG"}],"standard_charges":[{"minimum":14444,"maximum":14444,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14444,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14444,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14444,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS","code_information":[{"code":"8904","type":"APR-DRG"}],"standard_charges":[{"minimum":23664,"maximum":23664,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23664,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23664,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23664,"methodology":"case rate"}]}]},{"description":"HC CELL COUNT BODY FLUID W/O DIFF","code_information":[{"code":"89050","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":233.28,"maximum":233.28,"gross_charge":288,"discounted_cash":85.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.28,"methodology":"fee schedule"}]}]},{"description":"HC CELL COUNT BODY FLUID W/O DIFF","code_information":[{"code":"89050","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":4.72,"maximum":233.28,"gross_charge":288,"discounted_cash":85.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.07,"standard_charge_algorithm": "Lesser of $8.07 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.72,"standard_charge_algorithm": "Lesser of $4.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.05,"standard_charge_algorithm": "Lesser of $5.05 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.86,"standard_charge_algorithm": "Lesser of $4.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.96,"standard_charge_algorithm": "Lesser of $4.96 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.19,"standard_charge_algorithm": "Lesser of $5.19 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5,"standard_charge_algorithm": "Lesser of $5.00 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CELL COUNT-DIFF NOT BLD","code_information":[{"code":"89051","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":332.91,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"}]}]},{"description":"HC LAB CELL COUNT-DIFF NOT BLD","code_information":[{"code":"89051","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":2.47,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.58,"standard_charge_algorithm": "Lesser of $9.58 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.6,"standard_charge_algorithm": "Lesser of $5.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.99,"standard_charge_algorithm": "Lesser of $5.99 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.77,"standard_charge_algorithm": "Lesser of $5.77 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.88,"standard_charge_algorithm": "Lesser of $5.88 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.16,"standard_charge_algorithm": "Lesser of $6.16 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.94,"standard_charge_algorithm": "Lesser of $5.94 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FECAL LEUKOCYTE EXAM","code_information":[{"code":"89055","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":178.2,"maximum":178.2,"gross_charge":220,"discounted_cash":65.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":178.2,"methodology":"fee schedule"}]}]},{"description":"HC LAB FECAL LEUKOCYTE EXAM","code_information":[{"code":"89055","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":3.3,"maximum":178.2,"gross_charge":220,"discounted_cash":65.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.3,"standard_charge_algorithm": "Lesser of $7.30 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.57,"standard_charge_algorithm": "Lesser of $4.57 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.4,"standard_charge_algorithm": "Lesser of $4.40 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.48,"standard_charge_algorithm": "Lesser of $4.48 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.7,"standard_charge_algorithm": "Lesser of $4.70 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.53,"standard_charge_algorithm": "Lesser of $4.53 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CRYSTAL IDLIGHT MICROS","code_information":[{"code":"89060","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":236.52,"maximum":236.52,"gross_charge":292,"discounted_cash":86.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.52,"methodology":"fee schedule"}]}]},{"description":"HC LAB CRYSTAL IDLIGHT MICROS","code_information":[{"code":"89060","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":7.33,"maximum":236.52,"gross_charge":292,"discounted_cash":86.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.53,"standard_charge_algorithm": "Lesser of $12.53 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.33,"standard_charge_algorithm": "Lesser of $7.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.84,"standard_charge_algorithm": "Lesser of $7.84 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.55,"standard_charge_algorithm": "Lesser of $7.55 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.7,"standard_charge_algorithm": "Lesser of $7.70 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8.06,"standard_charge_algorithm": "Lesser of $8.06 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.77,"standard_charge_algorithm": "Lesser of $7.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB FAT STAIN","code_information":[{"code":"89125","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":161.19,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"}]}]},{"description":"HC LAB FAT STAIN","code_information":[{"code":"89125","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.88,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.05,"standard_charge_algorithm": "Lesser of $10.05 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"standard_charge_algorithm": "Lesser of $5.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.29,"standard_charge_algorithm": "Lesser of $6.29 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.06,"standard_charge_algorithm": "Lesser of $6.06 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.17,"standard_charge_algorithm": "Lesser of $6.17 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.47,"standard_charge_algorithm": "Lesser of $6.47 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.23,"standard_charge_algorithm": "Lesser of $6.23 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC STOOL FOR MEAT FIBERS","code_information":[{"code":"89160","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":132.84,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"}]}]},{"description":"HC STOOL FOR MEAT FIBERS","code_information":[{"code":"89160","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":4.85,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.29,"standard_charge_algorithm": "Lesser of $8.29 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.85,"standard_charge_algorithm": "Lesser of $4.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.19,"standard_charge_algorithm": "Lesser of $5.19 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5,"standard_charge_algorithm": "Lesser of $5.00 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.09,"standard_charge_algorithm": "Lesser of $5.09 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.33,"standard_charge_algorithm": "Lesser of $5.33 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.14,"standard_charge_algorithm": "Lesser of $5.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB N EOSINOPHILS SMEAR","code_information":[{"code":"89190","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC LAB N EOSINOPHILS SMEAR","code_information":[{"code":"89190","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":5.79,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.9,"standard_charge_algorithm": "Lesser of $9.90 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"standard_charge_algorithm": "Lesser of $5.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"standard_charge_algorithm": "Lesser of $6.20 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.96,"standard_charge_algorithm": "Lesser of $5.96 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.08,"standard_charge_algorithm": "Lesser of $6.08 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.37,"standard_charge_algorithm": "Lesser of $6.37 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.14,"standard_charge_algorithm": "Lesser of $6.14 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8921","type":"APR-DRG"}],"standard_charges":[{"minimum":5132,"maximum":5132,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5132,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5132,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5132,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8922","type":"APR-DRG"}],"standard_charges":[{"minimum":7810,"maximum":7810,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7810,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7810,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7810,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8923","type":"APR-DRG"}],"standard_charges":[{"minimum":10140,"maximum":10140,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10140,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10140,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10140,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR HIV RELATED CONDITION","code_information":[{"code":"8924","type":"APR-DRG"}],"standard_charges":[{"minimum":13202,"maximum":13202,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13202,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13202,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13202,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8931","type":"APR-DRG"}],"standard_charges":[{"minimum":5653,"maximum":5653,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5653,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5653,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5653,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8932","type":"APR-DRG"}],"standard_charges":[{"minimum":6225,"maximum":6225,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6225,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6225,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6225,"methodology":"case rate"}]}]},{"description":"HC SPERM POST VASECTOMY EVAL","code_information":[{"code":"89321","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC SPERM POST VASECTOMY EVAL","code_information":[{"code":"89321","type":"CPT"},{"code":"0309","type":"RC"}],"standard_charges":[{"minimum":8.11,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.61,"standard_charge_algorithm": "Lesser of $20.61 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.05,"standard_charge_algorithm": "Lesser of $12.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.89,"standard_charge_algorithm": "Lesser of $12.89 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.41,"standard_charge_algorithm": "Lesser of $12.41 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.65,"standard_charge_algorithm": "Lesser of $12.65 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.26,"standard_charge_algorithm": "Lesser of $13.26 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.77,"standard_charge_algorithm": "Lesser of $12.77 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ANTI SPERMATOZOA ANTIBODIES","code_information":[{"code":"89325","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":147.42,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"}]}]},{"description":"HC ANTI SPERMATOZOA ANTIBODIES","code_information":[{"code":"89325","type":"CPT"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":10.67,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.25,"standard_charge_algorithm": "Lesser of $18.25 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10.67,"standard_charge_algorithm": "Lesser of $10.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.42,"standard_charge_algorithm": "Lesser of $11.42 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10.99,"standard_charge_algorithm": "Lesser of $10.99 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.2,"standard_charge_algorithm": "Lesser of $11.20 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11.74,"standard_charge_algorithm": "Lesser of $11.74 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.31,"standard_charge_algorithm": "Lesser of $11.31 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8933","type":"APR-DRG"}],"standard_charges":[{"minimum":11904,"maximum":11904,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11904,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11904,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11904,"methodology":"case rate"}]}]},{"description":"HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS","code_information":[{"code":"8934","type":"APR-DRG"}],"standard_charges":[{"minimum":13048,"maximum":13048,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13048,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13048,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13048,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE LEFT AMA","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":3432,"maximum":12812.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3694,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3464,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12171.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6181,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7369,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6066,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12812.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9269,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5755,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5755,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3432,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7117.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7616.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7331.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7473.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7544.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7473.72,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8941","type":"APR-DRG"}],"standard_charges":[{"minimum":5030,"maximum":5030,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5030,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5030,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5030,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8942","type":"APR-DRG"}],"standard_charges":[{"minimum":5741,"maximum":5741,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5741,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5741,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5741,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8943","type":"APR-DRG"}],"standard_charges":[{"minimum":6480,"maximum":6480,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6480,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6480,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6480,"methodology":"case rate"}]}]},{"description":"HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS","code_information":[{"code":"8944","type":"APR-DRG"}],"standard_charges":[{"minimum":11662,"maximum":11662,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11662,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11662,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11662,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"minimum":2626,"maximum":22337.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12650,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11860,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21221,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16848,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20087,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16986,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22337.9,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21503,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13351,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13351,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2626,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12409.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13278.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12782.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13030.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13154.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13030.44,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"minimum":8306,"maximum":26447,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16498,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15468,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24877.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18976,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22624,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18773,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26187.32,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26447,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16421,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16421,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8306,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14548.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15566.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14984.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15275.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15421.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15275.94,"methodology":"case rate"}]}]},{"description":"ALCOHOL DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":7783,"maximum":15796.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8301,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7783,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15006.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9202,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10971,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9033,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15796.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13102,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8135,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8775.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9390.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9039.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9214.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9302.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9214.66,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"898","type":"MS-DRG"}],"standard_charges":[{"minimum":4263,"maximum":4263,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4263,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"899","type":"MS-DRG"}],"standard_charges":[{"minimum":2980,"maximum":2980,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2980,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENTS FOR INJURIES WITH MCC","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"minimum":18255,"maximum":65798,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39826,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":37650,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24588,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":47763,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44781,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":53985.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47544,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56685,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45693,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":56826.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65798,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":40854,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":40854,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18255,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31570.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33780.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32517.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":33148.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":33464.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":33148.8,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENTS FOR INJURIES WITH CC","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"minimum":8196,"maximum":33381,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17057,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16126,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10708,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":33381,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31297,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26161,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21421,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25539,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19899,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27537.9,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28181,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":17498,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":17498,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8196,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15298.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16369.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15757.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16063.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16216.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16063.78,"methodology":"case rate"}]}]},{"description":"WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"minimum":5947,"maximum":19692.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10958,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10360,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7053,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19118,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17924,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18707.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13139,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15665,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13108,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19692.22,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18105,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11241,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11241,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5947,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10940.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11705.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11268.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11487.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11596.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11487.13,"methodology":"case rate"}]}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90371","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0636-02","type":"NDC"}],"standard_charges":[{"minimum":385.46,"maximum":520.37,"gross_charge":642.43,"discounted_cash":190.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":520.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":417.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":449.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":385.46,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90371","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0636-02","type":"NDC"}],"standard_charges":[{"minimum":60.74,"maximum":520.37,"gross_charge":642.43,"discounted_cash":190.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":520.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":520.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":411.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":146.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":137.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":218.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":179.59,"standard_charge_algorithm": "Lesser of $179.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":179.59,"standard_charge_algorithm": "Lesser of $179.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":289.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":449.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":385.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":128.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":137,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":131.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":134.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":140.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":135.72,"methodology":"case rate"}]}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90375","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0318-01","type":"NDC"}],"standard_charges":[{"minimum":1241.48,"maximum":1675.99,"gross_charge":2069.12,"discounted_cash":612.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1344.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1448.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1241.48,"methodology":"fee schedule"}]}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90375","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0318-01","type":"NDC"}],"standard_charges":[{"minimum":259.19,"maximum":1675.99,"gross_charge":2069.12,"discounted_cash":612.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1324.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":280.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":293.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":295.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":443.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":424.26,"standard_charge_algorithm": "Lesser of $424.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":424.26,"standard_charge_algorithm": "Lesser of $424.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":931.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1448.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1241.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":259.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":277.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":266.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":272.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":285.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":274.74,"methodology":"case rate"}]}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90375","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0318-10","type":"NDC"}],"standard_charges":[{"minimum":1259.61,"maximum":1700.47,"gross_charge":2099.34,"discounted_cash":621.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1700.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1700.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1700.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1364.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1469.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1259.61,"methodology":"fee schedule"}]}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90375","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0318-10","type":"NDC"}],"standard_charges":[{"minimum":259.19,"maximum":1700.47,"gross_charge":2099.34,"discounted_cash":621.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1700.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1700.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1700.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1343.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":280.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":293.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":295.46,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":443.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":424.26,"standard_charge_algorithm": "Lesser of $424.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":424.26,"standard_charge_algorithm": "Lesser of $424.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":944.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1469.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1259.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":259.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":277.33,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":266.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":272.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":285.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":274.74,"methodology":"case rate"}]}]},{"description":"SKIN GRAFTS FOR INJURIES WITH CC/MCC","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"minimum":15649,"maximum":57341,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34707,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32812,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18500,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35855,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33617,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47730.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38392,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45773,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34379,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":50242.4,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57341,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35603,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35603,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15649,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27912.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29866.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28749.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29308.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29587.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29308.07,"methodology":"case rate"}]}]},{"description":"HC ADMIN VACCINE","code_information":[{"code":"90471","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":173.34,"maximum":173.34,"gross_charge":214,"discounted_cash":63.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.34,"methodology":"fee schedule"}]}]},{"description":"HC ADMIN VACCINE","code_information":[{"code":"90471","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":32.1,"maximum":173.34,"gross_charge":214,"discounted_cash":63.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC ADDITIONAL PNEUMOCOCCAL ADM","code_information":[{"code":"90472","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":112.59,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"}]}]},{"description":"HC ADDITIONAL PNEUMOCOCCAL ADM","code_information":[{"code":"90472","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":20.85,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"}]}]},{"description":"ADMIN SARSCOV2 VACC 1 DOS","code_information":[{"code":"90480","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":129.6,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"}]}]},{"description":"ADMIN SARSCOV2 VACC 1 DOS","code_information":[{"code":"90480","type":"CPT"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":24,"maximum":129.6,"gross_charge":160,"discounted_cash":47.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"minimum":8221,"maximum":24654.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14816,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14006,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8998,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18888,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17709,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23421.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16861,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20102,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16721,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24654.03,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24478,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15198,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15198,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8221,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13696.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14655.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14107.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14381.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14518.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14381.52,"methodology":"case rate"}]}]},{"description":"HAND PROCEDURES FOR INJURIES","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"minimum":6253,"maximum":32412,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19618,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18547,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10690,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27122,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25429,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29290.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19324,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23039,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19866,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30832.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32412,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20125,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20125,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6253,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17129.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18328.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17642.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17985.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18156.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17985.5,"methodology":"case rate"}]}]},{"description":"SMALLPOXMPOX LIVE VACCINE(PF) 0.5X TO 3.95X 10EXP8/0.5 ML SUBCUT SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90611","type":"CPT"},{"code":"0636","type":"RC"},{"code":"50632-0001-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"SMALLPOXMPOX LIVE VACCINE(PF) 0.5X TO 3.95X 10EXP8/0.5 ML SUBCUT SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90611","type":"CPT"},{"code":"0636","type":"RC"},{"code":"50632-0001-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90620","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0976-02","type":"NDC"}],"standard_charges":[{"minimum":425.79,"maximum":574.82,"gross_charge":709.65,"discounted_cash":210.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":461.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.79,"methodology":"fee schedule"}]}]},{"description":"MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90620","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0976-02","type":"NDC"}],"standard_charges":[{"minimum":106.45,"maximum":574.82,"gross_charge":709.65,"discounted_cash":210.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":454.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":254.77,"standard_charge_algorithm": "Lesser of $254.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":254.77,"standard_charge_algorithm": "Lesser of $254.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.93,"methodology":"fee schedule"}]}]},{"description":"MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90620","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0976-06","type":"NDC"}],"standard_charges":[{"minimum":403.09,"maximum":544.17,"gross_charge":671.81,"discounted_cash":198.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":544.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":544.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":544.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":436.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":403.09,"methodology":"fee schedule"}]}]},{"description":"MENINGOCOCCAL B VAC4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90620","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0976-06","type":"NDC"}],"standard_charges":[{"minimum":100.78,"maximum":544.17,"gross_charge":671.81,"discounted_cash":198.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":544.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":544.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":544.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":429.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":254.77,"standard_charge_algorithm": "Lesser of $254.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":254.77,"standard_charge_algorithm": "Lesser of $254.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":302.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":403.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.37,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A VACCINE (PF) 1440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90632","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0826-52","type":"NDC"}],"standard_charges":[{"minimum":199.21,"maximum":268.93,"gross_charge":332.01,"discounted_cash":98.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":215.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":232.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":199.21,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A VACCINE (PF) 1440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90632","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0826-52","type":"NDC"}],"standard_charges":[{"minimum":49.81,"maximum":268.93,"gross_charge":332.01,"discounted_cash":98.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":212.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":97.03,"standard_charge_algorithm": "Lesser of $97.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":97.03,"standard_charge_algorithm": "Lesser of $97.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":149.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":232.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":199.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.41,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SUSPENSION","code_information":[{"code":"90632","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.37,"maximum":50.44,"gross_charge":62.27,"discounted_cash":18.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SUSPENSION","code_information":[{"code":"90632","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.35,"maximum":62.27,"gross_charge":62.27,"discounted_cash":18.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":62.27,"standard_charge_algorithm": "Lesser of $97.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.27,"standard_charge_algorithm": "Lesser of $97.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SYRINGE","code_information":[{"code":"90632","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.49,"maximum":58.71,"gross_charge":72.47,"discounted_cash":21.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.49,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SYRINGE","code_information":[{"code":"90632","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.88,"maximum":72.47,"gross_charge":72.47,"discounted_cash":21.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":72.47,"standard_charge_algorithm": "Lesser of $97.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.47,"standard_charge_algorithm": "Lesser of $97.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"}]}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90648","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0545-03","type":"NDC"}],"standard_charges":[{"minimum":60.54,"maximum":81.73,"gross_charge":100.89,"discounted_cash":29.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.54,"methodology":"fee schedule"}]}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90648","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0545-03","type":"NDC"}],"standard_charges":[{"minimum":15.14,"maximum":81.73,"gross_charge":100.89,"discounted_cash":29.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.19,"standard_charge_algorithm": "Lesser of $15.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.19,"standard_charge_algorithm": "Lesser of $15.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.18,"methodology":"fee schedule"}]}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90648","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0816-01","type":"NDC"}],"standard_charges":[{"minimum":58.44,"maximum":78.9,"gross_charge":97.4,"discounted_cash":28.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.44,"methodology":"fee schedule"}]}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90648","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0816-01","type":"NDC"}],"standard_charges":[{"minimum":14.61,"maximum":78.9,"gross_charge":97.4,"discounted_cash":28.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.19,"standard_charge_algorithm": "Lesser of $15.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.19,"standard_charge_algorithm": "Lesser of $15.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"}]}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90648","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0816-03","type":"NDC"}],"standard_charges":[{"minimum":60.14,"maximum":81.19,"gross_charge":100.23,"discounted_cash":29.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.14,"methodology":"fee schedule"}]}]},{"description":"HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90648","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0816-03","type":"NDC"}],"standard_charges":[{"minimum":15.04,"maximum":81.19,"gross_charge":100.23,"discounted_cash":29.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.19,"standard_charge_algorithm": "Lesser of $15.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.19,"standard_charge_algorithm": "Lesser of $15.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90653","type":"CPT"},{"code":"0636","type":"RC"},{"code":"70461-0024-03","type":"NDC"}],"standard_charges":[{"minimum":22.72,"maximum":131.44,"gross_charge":162.26,"discounted_cash":48.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.08,"methodology":"fee schedule"}]}]},{"description":"FLU VACC 2024-25(65YR UP)-MF59C(PF) 45 MCG(15 MCGX3)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90653","type":"CPT"},{"code":"0636","type":"RC"},{"code":"70461-0024-03","type":"NDC"}],"standard_charges":[{"minimum":22.72,"maximum":131.44,"gross_charge":162.26,"discounted_cash":48.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":103.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":66.24,"standard_charge_algorithm": "Lesser of $66.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.24,"standard_charge_algorithm": "Lesser of $66.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.08,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90656","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0810-41","type":"NDC"}],"standard_charges":[{"minimum":11.8,"maximum":68.22,"gross_charge":84.22,"discounted_cash":24.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.5,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90656","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0810-41","type":"NDC"}],"standard_charges":[{"minimum":11.8,"maximum":68.22,"gross_charge":84.22,"discounted_cash":24.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.11,"standard_charge_algorithm": "Lesser of $22.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22.11,"standard_charge_algorithm": "Lesser of $22.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.5,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS2022-23(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90662","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0122-65","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.04,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS2022-23(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90662","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0122-65","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":73.4,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":73.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $77.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $77.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.04,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90670","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":112.54,"maximum":651.08,"gross_charge":803.8,"discounted_cash":237.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":522.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":192.43,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":202.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":562.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":112.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":120.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":115.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":118.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":123.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":119.29,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90670","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":112.54,"maximum":651.08,"gross_charge":803.8,"discounted_cash":237.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":514.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":192.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":286.57,"standard_charge_algorithm": "Lesser of $286.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":286.57,"standard_charge_algorithm": "Lesser of $286.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":361.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":562.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":112.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":120.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":115.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":118.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":123.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":119.29,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90670","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":115.84,"maximum":670.19,"gross_charge":827.39,"discounted_cash":244.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":670.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":670.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":537.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":208.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":579.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":496.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":119.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":127.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.79,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90670","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":115.84,"maximum":670.19,"gross_charge":827.39,"discounted_cash":244.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":670.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":670.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":529.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":257.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":286.57,"standard_charge_algorithm": "Lesser of $286.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":286.57,"standard_charge_algorithm": "Lesser of $286.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":372.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":579.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":496.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":119.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":127.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.79,"methodology":"fee schedule"}]}]},{"description":"RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90675","type":"CPT"},{"code":"0636","type":"RC"},{"code":"50632-0010-01","type":"NDC"}],"standard_charges":[{"minimum":858.39,"maximum":1158.82,"gross_charge":1430.64,"discounted_cash":423.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1158.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":929.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1001.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":858.39,"methodology":"fee schedule"}]}]},{"description":"RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90675","type":"CPT"},{"code":"0636","type":"RC"},{"code":"50632-0010-01","type":"NDC"}],"standard_charges":[{"minimum":214.6,"maximum":1158.82,"gross_charge":1430.64,"discounted_cash":423.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1158.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":915.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":327.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":327.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":324.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":417.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":428.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":485.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":479.71,"standard_charge_algorithm": "Lesser of $479.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":479.71,"standard_charge_algorithm": "Lesser of $479.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":643.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1001.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":858.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":271.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":284.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":303.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":292.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":298.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":312.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":301.05,"methodology":"case rate"}]}]},{"description":"RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90675","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0966-01","type":"NDC"}],"standard_charges":[{"minimum":745.96,"maximum":1007.05,"gross_charge":1243.26,"discounted_cash":368.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":808.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":870.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":745.96,"methodology":"fee schedule"}]}]},{"description":"RABIES VACCINE PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90675","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0966-01","type":"NDC"}],"standard_charges":[{"minimum":186.49,"maximum":1007.05,"gross_charge":1243.26,"discounted_cash":368.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1007.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":795.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":327.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":327.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":324.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":417.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":428.84,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":485.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":479.71,"standard_charge_algorithm": "Lesser of $479.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":479.71,"standard_charge_algorithm": "Lesser of $479.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":559.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":870.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":745.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":284.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":303.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":292.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":298.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":312.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":301.05,"methodology":"case rate"}]}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90677","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":583.22,"maximum":787.35,"gross_charge":972.03,"discounted_cash":287.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":787.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":787.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":631.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":680.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":583.22,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90677","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":145.81,"maximum":787.35,"gross_charge":972.03,"discounted_cash":287.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":787.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":787.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":622.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":486.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":486.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":437.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":680.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":583.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.41,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90677","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":600.47,"maximum":810.63,"gross_charge":1000.77,"discounted_cash":296.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":650.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":700.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.47,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE","code_information":[{"code":"90677","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":150.12,"maximum":810.63,"gross_charge":1000.77,"discounted_cash":296.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":640.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":500.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":500.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":450.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":700.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.16,"methodology":"fee schedule"}]}]},{"description":"PREVNAR VACCINE FOR IM","code_information":[{"code":"90677","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":179.25,"maximum":241.99,"gross_charge":298.75,"discounted_cash":88.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":194.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":209.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.25,"methodology":"fee schedule"}]}]},{"description":"PREVNAR VACCINE FOR IM","code_information":[{"code":"90677","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.82,"maximum":241.99,"gross_charge":298.75,"discounted_cash":88.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":191.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":149.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":149.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":209.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.75,"methodology":"fee schedule"}]}]},{"description":"FLU VACC QS2020-21 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"33332-0320-01","type":"NDC"}],"standard_charges":[{"minimum":11,"maximum":63.6,"gross_charge":78.51,"discounted_cash":23.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"FLU VACC QS2020-21 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"33332-0320-01","type":"NDC"}],"standard_charges":[{"minimum":11,"maximum":63.6,"gross_charge":78.51,"discounted_cash":23.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"FLU VACC QS2021-22 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"33332-0321-01","type":"NDC"}],"standard_charges":[{"minimum":16.52,"maximum":95.57,"gross_charge":117.98,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.25,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":29.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.51,"methodology":"fee schedule"}]}]},{"description":"FLU VACC QS2021-22 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"33332-0321-01","type":"NDC"}],"standard_charges":[{"minimum":16.52,"maximum":95.57,"gross_charge":117.98,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.51,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0818-41","type":"NDC"}],"standard_charges":[{"minimum":15.01,"maximum":86.82,"gross_charge":107.18,"discounted_cash":31.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.91,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0818-41","type":"NDC"}],"standard_charges":[{"minimum":15.01,"maximum":86.82,"gross_charge":107.18,"discounted_cash":31.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.91,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS 2022-23(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0808-41","type":"NDC"}],"standard_charges":[{"minimum":20.49,"maximum":118.5,"gross_charge":146.29,"discounted_cash":43.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.71,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS 2022-23(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0808-41","type":"NDC"}],"standard_charges":[{"minimum":20.49,"maximum":118.5,"gross_charge":146.29,"discounted_cash":43.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.71,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0814-52","type":"NDC"}],"standard_charges":[{"minimum":16.7,"maximum":96.62,"gross_charge":119.28,"discounted_cash":35.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.71,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"19515-0814-52","type":"NDC"}],"standard_charges":[{"minimum":16.7,"maximum":96.62,"gross_charge":119.28,"discounted_cash":35.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.71,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS2021-22(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0121-65","type":"NDC"}],"standard_charges":[{"minimum":33.91,"maximum":196.2,"gross_charge":242.21,"discounted_cash":71.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":157.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.99,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":61.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.95,"methodology":"fee schedule"}]}]},{"description":"FLU VACCINE QS2021-22(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90686","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0121-65","type":"NDC"}],"standard_charges":[{"minimum":22.35,"maximum":196.2,"gross_charge":242.21,"discounted_cash":71.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":155.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24.05,"standard_charge_algorithm": "Lesser of $24.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":109,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":37.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.95,"methodology":"fee schedule"}]}]},{"description":"FLU VACC 2023-24(65YR UP)-MF59C(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90694","type":"CPT"},{"code":"0636","type":"RC"},{"code":"70461-0123-04","type":"NDC"}],"standard_charges":[{"minimum":37.08,"maximum":214.48,"gross_charge":264.79,"discounted_cash":78.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":172.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":185.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39.3,"methodology":"fee schedule"}]}]},{"description":"FLU VACC 2023-24(65YR UP)-MF59C(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90694","type":"CPT"},{"code":"0636","type":"RC"},{"code":"70461-0123-04","type":"NDC"}],"standard_charges":[{"minimum":37.08,"maximum":214.48,"gross_charge":264.79,"discounted_cash":78.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":169.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":77.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":79.73,"standard_charge_algorithm": "Lesser of $79.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":79.73,"standard_charge_algorithm": "Lesser of $79.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":119.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":185.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":158.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":39.3,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITH MCC","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":21132,"maximum":59162,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35809,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33853,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21132,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":45376,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":42543,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49077.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41784,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49817,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39270,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":51660.04,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59162,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":36734,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":36734,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25851,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28700.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30709.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29561.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30135.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30422.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30135.03,"methodology":"case rate"}]}]},{"description":"MEASLESMUMPSRUBELLA VACCINE LIVE(PF)1000-12500TCID50/0.5 ML SUBCUT","code_information":[{"code":"90707","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":232.44,"maximum":313.8,"gross_charge":387.4,"discounted_cash":114.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":251.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":271.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.44,"methodology":"fee schedule"}]}]},{"description":"MEASLESMUMPSRUBELLA VACCINE LIVE(PF)1000-12500TCID50/0.5 ML SUBCUT","code_information":[{"code":"90707","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58.11,"maximum":313.8,"gross_charge":387.4,"discounted_cash":114.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":247.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":110.5,"standard_charge_algorithm": "Lesser of $110.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110.5,"standard_charge_algorithm": "Lesser of $110.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":174.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":271.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.48,"methodology":"fee schedule"}]}]},{"description":"TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90714","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0215-88","type":"NDC"}],"standard_charges":[{"minimum":102.32,"maximum":138.13,"gross_charge":170.52,"discounted_cash":50.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.32,"methodology":"fee schedule"}]}]},{"description":"TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90714","type":"CPT"},{"code":"0636","type":"RC"},{"code":"49281-0215-88","type":"NDC"}],"standard_charges":[{"minimum":25.58,"maximum":138.13,"gross_charge":170.52,"discounted_cash":50.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.39,"standard_charge_algorithm": "Lesser of $34.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.39,"standard_charge_algorithm": "Lesser of $34.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"}]}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90714","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0131-00","type":"NDC"}],"standard_charges":[{"minimum":87.74,"maximum":118.45,"gross_charge":146.23,"discounted_cash":43.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.74,"methodology":"fee schedule"}]}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS-TD 2 LF UNIT-2 LF UNIT/0.5 ML IM SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90714","type":"CPT"},{"code":"0636","type":"RC"},{"code":"13533-0131-00","type":"NDC"}],"standard_charges":[{"minimum":21.94,"maximum":118.45,"gross_charge":146.23,"discounted_cash":43.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.39,"standard_charge_algorithm": "Lesser of $34.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.39,"standard_charge_algorithm": "Lesser of $34.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.25,"methodology":"fee schedule"}]}]},{"description":"DIPHTHPERTUSSIS(ACEL)TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90715","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0842-43","type":"NDC"}],"standard_charges":[{"minimum":122.9,"maximum":165.91,"gross_charge":204.82,"discounted_cash":60.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":133.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":143.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.9,"methodology":"fee schedule"}]}]},{"description":"DIPHTHPERTUSSIS(ACEL)TETANUS 2.5 LF UNIT-8 MCG-5 LF/0.5ML IM SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90715","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0842-43","type":"NDC"}],"standard_charges":[{"minimum":30.73,"maximum":165.91,"gross_charge":204.82,"discounted_cash":60.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.7,"standard_charge_algorithm": "Lesser of $56.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.7,"standard_charge_algorithm": "Lesser of $56.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":143.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION","code_information":[{"code":"90732","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.77,"maximum":345.79,"gross_charge":426.89,"discounted_cash":126.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":345.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":277.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":102.2,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":107.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":298.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":256.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":63.36,"methodology":"fee schedule"}]}]},{"description":"PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5 ML INJECTION SOLUTION","code_information":[{"code":"90732","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.77,"maximum":345.79,"gross_charge":426.89,"discounted_cash":126.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":345.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":273.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":133.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":102.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":148.18,"standard_charge_algorithm": "Lesser of $148.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":148.18,"standard_charge_algorithm": "Lesser of $148.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":192.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":298.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":256.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":63.36,"methodology":"fee schedule"}]}]},{"description":"MENINGOC VAC ACYW-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90734","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0955-09","type":"NDC"}],"standard_charges":[{"minimum":292.34,"maximum":394.66,"gross_charge":487.23,"discounted_cash":144.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":316.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":341.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.34,"methodology":"fee schedule"}]}]},{"description":"MENINGOC VAC ACYW-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90734","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0955-09","type":"NDC"}],"standard_charges":[{"minimum":73.09,"maximum":394.66,"gross_charge":487.23,"discounted_cash":144.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":311.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":179.33,"standard_charge_algorithm": "Lesser of $179.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":179.33,"standard_charge_algorithm": "Lesser of $179.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":219.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":341.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.45,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE","code_information":[{"code":"90746","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.7,"maximum":160.21,"gross_charge":197.79,"discounted_cash":58.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.36,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SYRINGE","code_information":[{"code":"90746","type":"CPT"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.7,"maximum":160.21,"gross_charge":197.79,"discounted_cash":58.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":126.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.29,"standard_charge_algorithm": "Lesser of $78.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.29,"standard_charge_algorithm": "Lesser of $78.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29.36,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90746","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0821-43","type":"NDC"}],"standard_charges":[{"minimum":29.17,"maximum":168.73,"gross_charge":208.3,"discounted_cash":61.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":135.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":52.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":145.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.92,"methodology":"fee schedule"}]}]},{"description":"HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90746","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0821-43","type":"NDC"}],"standard_charges":[{"minimum":29.17,"maximum":168.73,"gross_charge":208.3,"discounted_cash":61.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":133.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.29,"standard_charge_algorithm": "Lesser of $78.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.29,"standard_charge_algorithm": "Lesser of $78.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":145.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.92,"methodology":"fee schedule"}]}]},{"description":"VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90750","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0819-12","type":"NDC"}],"standard_charges":[{"minimum":394.8,"maximum":532.98,"gross_charge":658,"discounted_cash":194.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":427.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":460.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"}]}]},{"description":"VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"90750","type":"CPT"},{"code":"0636","type":"RC"},{"code":"58160-0819-12","type":"NDC"}],"standard_charges":[{"minimum":98.7,"maximum":532.98,"gross_charge":658,"discounted_cash":194.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":421.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":217.14,"standard_charge_algorithm": "Lesser of $217.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":217.14,"standard_charge_algorithm": "Lesser of $217.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":460.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITH CC","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":10408,"maximum":35264,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18132,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17141,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":11386,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35264,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33063,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27473.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22229,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26502,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21159,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28919.72,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29956,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18600,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18600,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10408,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16066.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17191.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16548.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16869.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17030.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16869.84,"methodology":"case rate"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"minimum":7286,"maximum":20261.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11401,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10778,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7706,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17871,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16755,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19248.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14751,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17587,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14320,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20261.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18836,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11695,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11695,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7286,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11256.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12044.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11593.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11818.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11931.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11818.99,"methodology":"case rate"}]}]},{"description":"HC PT BRB TRAINING 1ST 15","code_information":[{"code":"90912","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC PT BRB TRAINING 1ST 15","code_information":[{"code":"90912","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":270,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC PT BRB TRAINING ADD 15","code_information":[{"code":"90913","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC PT BRB TRAINING ADD 15","code_information":[{"code":"90913","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":270,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC HEMODIALYSIS/SLED","code_information":[{"code":"90935","type":"CPT"},{"code":"0800","type":"RC"}],"standard_charges":[{"minimum":1675.89,"maximum":1675.89,"gross_charge":2069,"discounted_cash":612.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.89,"methodology":"fee schedule"}]}]},{"description":"HC HEMODIALYSIS/SLED","code_information":[{"code":"90935","type":"CPT"},{"code":"0800","type":"RC"}],"standard_charges":[{"minimum":310.35,"maximum":1675.89,"gross_charge":2069,"discounted_cash":612.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1675.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1675.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1675.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1531.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1531.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1019.57,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1069.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":413.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":625.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":669.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":644.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":656.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":688.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":663.11,"methodology":"case rate"}]}]},{"description":"HC PERITONEAL/CRRT DAILY","code_information":[{"code":"90945","type":"CPT"},{"code":"0800","type":"RC"}],"standard_charges":[{"minimum":1562.49,"maximum":1562.49,"gross_charge":1929,"discounted_cash":570.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"fee schedule"}]}]},{"description":"HC PERITONEAL/CRRT DAILY","code_information":[{"code":"90945","type":"CPT"},{"code":"0800","type":"RC"}],"standard_charges":[{"minimum":289.35,"maximum":1562.49,"gross_charge":1929,"discounted_cash":570.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":932.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":932.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":646.22,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":393,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":312,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":651,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":380.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":407.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":392.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":399.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":418.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":403.54,"methodology":"case rate"}]}]},{"description":"HC CONTINUOUS RENAL RPLMT THERAPY","code_information":[{"code":"90947","type":"CPT"},{"code":"0801","type":"RC"}],"standard_charges":[{"minimum":607.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"}]}]},{"description":"HC CONTINUOUS RENAL RPLMT THERAPY","code_information":[{"code":"90947","type":"CPT"},{"code":"0801","type":"RC"}],"standard_charges":[{"minimum":112.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9101","type":"APR-DRG"}],"standard_charges":[{"minimum":22757,"maximum":22757,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22757,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22757,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22757,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9102","type":"APR-DRG"}],"standard_charges":[{"minimum":26032,"maximum":26032,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26032,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26032,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26032,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9103","type":"APR-DRG"}],"standard_charges":[{"minimum":30423,"maximum":30423,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30423,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30423,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30423,"methodology":"case rate"}]}]},{"description":"HC ESOPH ACID REFLUX TEST - 24 HR","code_information":[{"code":"91034","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":3334.77,"maximum":3334.77,"gross_charge":4117,"discounted_cash":1218.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3334.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3334.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3334.77,"methodology":"fee schedule"}]}]},{"description":"HC ESOPH ACID REFLUX TEST - 24 HR","code_information":[{"code":"91034","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":423.75,"maximum":3642,"gross_charge":4117,"discounted_cash":1218.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3334.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3334.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3334.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":546.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":423.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":617.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"HC BRAVO ESOPHAGEAL ACID REFLUX","code_information":[{"code":"91035","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":2299.59,"maximum":2299.59,"gross_charge":2839,"discounted_cash":840.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2299.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2299.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2299.59,"methodology":"fee schedule"}]}]},{"description":"HC BRAVO ESOPHAGEAL ACID REFLUX","code_information":[{"code":"91035","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":425.85,"maximum":3642,"gross_charge":2839,"discounted_cash":840.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2299.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2299.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2299.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1569.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1222.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":567.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":567.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"GERD TST NASL IMPEDENCE ELECTRD","code_information":[{"code":"91037","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1073.25,"maximum":1073.25,"gross_charge":1325,"discounted_cash":392.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1073.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1073.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1073.25,"methodology":"fee schedule"}]}]},{"description":"GERD TST NASL IMPEDENCE ELECTRD","code_information":[{"code":"91037","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":198.75,"maximum":3642,"gross_charge":1325,"discounted_cash":392.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1073.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1073.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1073.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":445.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":335.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9104","type":"APR-DRG"}],"standard_charges":[{"minimum":69311,"maximum":69311,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69311,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69311,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69311,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9111","type":"APR-DRG"}],"standard_charges":[{"minimum":11850,"maximum":11850,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11850,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11850,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11850,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9112","type":"APR-DRG"}],"standard_charges":[{"minimum":15759,"maximum":15759,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15759,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15759,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15759,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9113","type":"APR-DRG"}],"standard_charges":[{"minimum":23612,"maximum":23612,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23612,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23612,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23612,"methodology":"case rate"}]}]},{"description":"EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9114","type":"APR-DRG"}],"standard_charges":[{"minimum":41060,"maximum":41060,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41060,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41060,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41060,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9121","type":"APR-DRG"}],"standard_charges":[{"minimum":15811,"maximum":15811,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15811,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15811,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15811,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9122","type":"APR-DRG"}],"standard_charges":[{"minimum":20526,"maximum":20526,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20526,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20526,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20526,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9123","type":"APR-DRG"}],"standard_charges":[{"minimum":26782,"maximum":26782,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26782,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26782,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26782,"methodology":"case rate"}]}]},{"description":"MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"9124","type":"APR-DRG"}],"standard_charges":[{"minimum":55367,"maximum":55367,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55367,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55367,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55367,"methodology":"case rate"}]}]},{"description":"TRAUMATIC INJURY WITH MCC","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"minimum":6740,"maximum":24308.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14547,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8491,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17027,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15964,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23092.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16366,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19512,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15779,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24308.28,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24033,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14922,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14922,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6740,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13504.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14449.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13909.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14179.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14314.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14179.83,"methodology":"case rate"}]}]},{"description":"TRAUMATIC INJURY WITHOUT MCC","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"minimum":4104,"maximum":16192.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8238,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7788,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5157,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8336,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7816,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15382.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9610,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11458,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9584,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16192.03,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13610,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8450,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8450,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4104,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8995.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9625.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9265.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9445.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9535.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9445.35,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS WITH MCC","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"minimum":9082,"maximum":25810,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15622,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14769,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9687,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9082,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24406.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19673,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23456,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18730,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25691.24,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25810,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16025,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16025,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9507,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14272.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15272.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14701.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14986.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15129.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14986.56,"methodology":"case rate"}]}]},{"description":"ALLERGIC REACTIONS WITHOUT MCC","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"minimum":3676,"maximum":13274.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5970,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5644,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3743,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5246,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4918,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12610.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7179,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8560,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6956,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13274.61,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9863,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6124,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6124,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3676,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7374.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7891.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7596.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7743.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7817.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7743.52,"methodology":"case rate"}]}]},{"description":"POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":7499,"maximum":24555.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14739,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13934,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9067,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":17060,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15995,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23327.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16457,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19620,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16850,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24555.73,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24351,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15120,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15120,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7499,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13642.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14597.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14051.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14324.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14460.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14324.18,"methodology":"case rate"}]}]},{"description":"POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":3910,"maximum":15824.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7952,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7517,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4891,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6265,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5874,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15033.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8839,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10538,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9089,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":15824.31,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13137,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8157,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8157,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3910,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8791.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9406.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9055.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9230.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9318.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9230.85,"methodology":"case rate"}]}]},{"description":"COMPLICATIONS OF TREATMENT WITH MCC","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":7070,"maximum":27082,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16392,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15497,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10367,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20999,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19688,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":25348.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19387,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23114,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19265,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":26682.21,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27082,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":16815,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":16815,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7070,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14823.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15861.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15268.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15564.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15712.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15564.63,"methodology":"case rate"}]}]},{"description":"COMPLICATIONS OF TREATMENT WITH CC","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":5873,"maximum":17342.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9132,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8633,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5873,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12293,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":11526,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16475.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11045,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13168,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10915,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17342.57,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15087,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9368,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9368,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6525,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9634.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10309.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9923.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10116.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10212.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10116.5,"methodology":"case rate"}]}]},{"description":"COMPLICATIONS OF TREATMENT WITHOUT CC/MCC","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":3964,"maximum":13547.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6182,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5844,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3964,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8420,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7894,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12870.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7868,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9380,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7367,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":13547.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10213,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":6341,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":6341,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4500,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7526.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8053.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7752.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7902.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7977.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7902.71,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"minimum":7963,"maximum":25130.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15186,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14357,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9913,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14181,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13296,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23873.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16817,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20050,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18423,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25130.43,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25089,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15578,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7963,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13961.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14938.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14380.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14659.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14799.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14659.42,"methodology":"case rate"}]}]},{"description":"OTHER INJURY POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"minimum":4675,"maximum":17388.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9168,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8667,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5746,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7598,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7124,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16519.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10195,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12155,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10678,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17388.81,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15147,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9404,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4675,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9660.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10336.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9950.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10143.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10240.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10143.48,"methodology":"case rate"}]}]},{"description":"HC SPEECH-LANGUAGE TREATMENT","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":241.38,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"}]}]},{"description":"HC SPEECH-LANGUAGE TREATMENT","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":44.7,"maximum":326.86,"gross_charge":298,"discounted_cash":88.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":258.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.6,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT OF SPEECH 15 MIN","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":190.35,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT OF SPEECH 15 MIN","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":35.25,"maximum":326.86,"gross_charge":235,"discounted_cash":69.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":258.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT OF SPEECH 45 MIN","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":313.47,"maximum":313.47,"gross_charge":387,"discounted_cash":114.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.47,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT OF SPEECH 45 MIN","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":58.05,"maximum":326.86,"gross_charge":387,"discounted_cash":114.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":258.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT OF SPEECH 90 MIN","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":503.82,"maximum":503.82,"gross_charge":622,"discounted_cash":184.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.82,"methodology":"fee schedule"}]}]},{"description":"HC TREATMENT OF SPEECH 90 MIN","code_information":[{"code":"92507","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":77.22,"maximum":503.82,"gross_charge":622,"discounted_cash":184.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":503.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":326.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":258.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.4,"methodology":"fee schedule"}]}]},{"description":"HC NASOPHARYNGOSCOPY","code_information":[{"code":"92511","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1250.64,"maximum":1250.64,"gross_charge":1544,"discounted_cash":457.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1250.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1250.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1250.64,"methodology":"fee schedule"}]}]},{"description":"HC NASOPHARYNGOSCOPY","code_information":[{"code":"92511","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":173.57,"maximum":5079,"gross_charge":1544,"discounted_cash":457.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1250.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1250.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1250.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":425.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":289,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":444.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":427.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":296.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":308.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":173.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":185.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":178.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":182.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":183.98,"methodology":"case rate"}]}]},{"description":"HC EVAL OF SPEECH FLUENCY","code_information":[{"code":"92521","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":255.96,"maximum":255.96,"gross_charge":316,"discounted_cash":93.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF SPEECH FLUENCY","code_information":[{"code":"92521","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":47.4,"maximum":469.39,"gross_charge":316,"discounted_cash":93.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":134.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":469.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":367.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.2,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF SP PRODUCTION","code_information":[{"code":"92522","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":208.98,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF SP PRODUCTION","code_information":[{"code":"92522","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":38.7,"maximum":379.64,"gross_charge":258,"discounted_cash":76.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":112.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":379.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":299.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF SP LANGUAGE","code_information":[{"code":"92523","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":394.47,"maximum":394.47,"gross_charge":487,"discounted_cash":144.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.47,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF SP LANGUAGE","code_information":[{"code":"92523","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":73.05,"maximum":809.39,"gross_charge":487,"discounted_cash":144.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":229.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":809.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":620.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.4,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF VOICE LEVEL","code_information":[{"code":"92524","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":230.85,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"}]}]},{"description":"HC EVAL OF VOICE LEVEL","code_information":[{"code":"92524","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":42.75,"maximum":367.69,"gross_charge":285,"discounted_cash":84.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":110.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":367.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":309.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"}]}]},{"description":"HC SWALLOW TX FOR DYSFUNCTION","code_information":[{"code":"92526","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":408.24,"maximum":408.24,"gross_charge":504,"discounted_cash":149.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.24,"methodology":"fee schedule"}]}]},{"description":"HC SWALLOW TX FOR DYSFUNCTION","code_information":[{"code":"92526","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":75.6,"maximum":408.24,"gross_charge":504,"discounted_cash":149.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":356.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":280.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.8,"methodology":"fee schedule"}]}]},{"description":"HC EVAL TO USE/FIT VOICE PROSTH","code_information":[{"code":"92597","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":218.7,"maximum":218.7,"gross_charge":270,"discounted_cash":79.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":218.7,"methodology":"fee schedule"}]}]},{"description":"HC EVAL TO USE/FIT VOICE PROSTH","code_information":[{"code":"92597","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":302.08,"gross_charge":270,"discounted_cash":79.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":72.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":302.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":235.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"}]}]},{"description":"HC SWALLOW EVAL FOR DYSFUNCTI","code_information":[{"code":"92610","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":427.68,"maximum":427.68,"gross_charge":528,"discounted_cash":156.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":427.68,"methodology":"fee schedule"}]}]},{"description":"HC SWALLOW EVAL FOR DYSFUNCTI","code_information":[{"code":"92610","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":79.2,"maximum":427.68,"gross_charge":528,"discounted_cash":156.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":356.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":274.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.6,"methodology":"fee schedule"}]}]},{"description":"HC VIDEOFLUORO SWALLOW STUDY SP","code_information":[{"code":"92611","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":720.9,"maximum":720.9,"gross_charge":890,"discounted_cash":263.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":720.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":720.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":720.9,"methodology":"fee schedule"}]}]},{"description":"HC VIDEOFLUORO SWALLOW STUDY SP","code_information":[{"code":"92611","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":121,"maximum":720.9,"gross_charge":890,"discounted_cash":263.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":720.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":720.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":720.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":370.22,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":293.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":178,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":178,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"minimum":80572,"maximum":352309,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":145874,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136767,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":265913.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":205179,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":244624,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":278295,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":279908.63,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":352309,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":218748,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":218748,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80572,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":155504.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":166390.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":160169.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":163280.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":164835.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":163280.03,"methodology":"case rate"}]}]},{"description":"HC EXCHANGE VOICE PROSTHESIS","code_information":[{"code":"92700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC EXCHANGE VOICE PROSTHESIS","code_information":[{"code":"92700","type":"CPT"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":5079,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"minimum":13290,"maximum":99189,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67083,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62895,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":78684.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":66922,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":79787,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73058,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":82825.38,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99189,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":61586,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":61586,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13290,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46014.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49235.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47394.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48314.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48774.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":48314.81,"methodology":"case rate"}]}]},{"description":"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"minimum":6356,"maximum":47232,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":20276,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":19010,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40252.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31765,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37872,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33949,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42371.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47232,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29326,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29326,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6356,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23539.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25187.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24245.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24716.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24951.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24716.57,"methodology":"case rate"}]}]},{"description":"HC PRQ CARDIAC ANGIOPLST 1 ART","code_information":[{"code":"92920","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":28695.87,"maximum":28695.87,"gross_charge":35427,"discounted_cash":10486.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28695.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28695.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28695.87,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARDIAC ANGIOPLST 1 ART","code_information":[{"code":"92920","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":28695.87,"gross_charge":35427,"discounted_cash":10486.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28695.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28695.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28695.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6731.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7085.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5314.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7085.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC PRQ CARDIAC ANGPLST ART ADD","code_information":[{"code":"92921","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":10058.58,"maximum":10058.58,"gross_charge":12418,"discounted_cash":3675.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10058.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10058.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10058.58,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARDIAC ANGPLST ART ADD","code_information":[{"code":"92921","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":10650,"gross_charge":12418,"discounted_cash":3675.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10058.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10058.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10058.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2359.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2483.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1862.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2483.6,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD ANGIO/ATHRCT 1 ART","code_information":[{"code":"92924","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD ANGIO/ATHRCT 1 ART","code_information":[{"code":"92924","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"PTCRA/ANGIO ADDL BRCH","code_information":[{"code":"92925","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":13312.35,"maximum":13312.35,"gross_charge":16435,"discounted_cash":4864.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13312.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13312.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13312.35,"methodology":"fee schedule"}]}]},{"description":"PTCRA/ANGIO ADDL BRCH","code_information":[{"code":"92925","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":13312.35,"gross_charge":16435,"discounted_cash":4864.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13312.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13312.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13312.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3122.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3287,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2465.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3287,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD STNT W/ANGIO 1 VSL","code_information":[{"code":"92928","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD STNT W/ANGIO 1 VSL","code_information":[{"code":"92928","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC PPQ CARD STNT W/ANGIO ADDL","code_information":[{"code":"92929","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11241.99,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"}]}]},{"description":"HC PPQ CARD STNT W/ANGIO ADDL","code_information":[{"code":"92929","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2637.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2081.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD STENT/ATH/ANGIO","code_information":[{"code":"92933","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":30174.93,"maximum":30174.93,"gross_charge":37253,"discounted_cash":11026.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD STENT/ATH/ANGIO","code_information":[{"code":"92933","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":39313.11,"gross_charge":37253,"discounted_cash":11026.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5587.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC PRQ REVASC BYP GRAFT 1 VSL","code_information":[{"code":"92937","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ REVASC BYP GRAFT 1 VSL","code_information":[{"code":"92937","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"PRQ REVSC BYP-GRFT ADDL VSL","code_information":[{"code":"92938","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":12128.94,"maximum":12128.94,"gross_charge":14974,"discounted_cash":4432.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12128.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12128.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12128.94,"methodology":"fee schedule"}]}]},{"description":"PRQ REVSC BYP-GRFT ADDL VSL","code_information":[{"code":"92938","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":12128.94,"gross_charge":14974,"discounted_cash":4432.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12128.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12128.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12128.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2845.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2994.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2246.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2994.8,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD REVASC MI 1 VSL","code_information":[{"code":"92941","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD REVASC MI 1 VSL","code_information":[{"code":"92941","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD REVASC CHRONC 1VSL","code_information":[{"code":"92943","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD REVASC CHRONC 1VSL","code_information":[{"code":"92943","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC PRQ CARD REVASC CHRONC ADDL","code_information":[{"code":"92944","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11241.99,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"}]}]},{"description":"HC PRQ CARD REVASC CHRONC ADDL","code_information":[{"code":"92944","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2637.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2081.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"}]}]},{"description":"HC RESUSCITATION","code_information":[{"code":"92950","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":2526.39,"maximum":2526.39,"gross_charge":3119,"discounted_cash":923.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2526.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2526.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2526.39,"methodology":"fee schedule"}]}]},{"description":"HC RESUSCITATION","code_information":[{"code":"92950","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":278.4,"maximum":2526.39,"gross_charge":3119,"discounted_cash":923.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2526.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2526.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2526.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1279.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":964.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1996.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":592.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC CARDIOVERSIONEXTERNAL","code_information":[{"code":"92960","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1786.05,"maximum":1786.05,"gross_charge":2205,"discounted_cash":652.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1786.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1786.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1786.05,"methodology":"fee schedule"}]}]},{"description":"HC CARDIOVERSIONEXTERNAL","code_information":[{"code":"92960","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":330.75,"maximum":7669,"gross_charge":2205,"discounted_cash":652.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1786.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1786.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1786.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1432.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1432.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":949.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":649.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":649.02,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1000.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":441,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":441,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":585.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":625.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":602.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":614.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":643.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":620.14,"methodology":"case rate"}]}]},{"description":"HC CARDIOVERSIONINTERNAL","code_information":[{"code":"92961","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1826.55,"maximum":1826.55,"gross_charge":2255,"discounted_cash":667.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1826.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1826.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1826.55,"methodology":"fee schedule"}]}]},{"description":"HC CARDIOVERSIONINTERNAL","code_information":[{"code":"92961","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":338.25,"maximum":7669,"gross_charge":2255,"discounted_cash":667.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1826.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1826.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1826.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1432.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1432.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":949.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1014.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":791.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1000.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":451,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":338.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":451,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":585.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":625.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":602.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":614.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":643.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":620.14,"methodology":"case rate"}]}]},{"description":"PERCUT CORONARY LITHORIPSY","code_information":[{"code":"92972","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":3845.88,"maximum":3845.88,"gross_charge":4748,"discounted_cash":1405.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3845.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3845.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3845.88,"methodology":"fee schedule"}]}]},{"description":"PERCUT CORONARY LITHORIPSY","code_information":[{"code":"92972","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":712.2,"maximum":3845.88,"gross_charge":4748,"discounted_cash":1405.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3845.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3845.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3845.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3038.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":902.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":949.6,"methodology":"fee schedule"}]}]},{"description":"PERQ COR IVL","code_information":[{"code":"92972","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":15383.52,"maximum":15383.52,"gross_charge":18992,"discounted_cash":5621.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15383.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15383.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15383.52,"methodology":"fee schedule"}]}]},{"description":"PERQ COR IVL","code_information":[{"code":"92972","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":783,"maximum":15383.52,"gross_charge":18992,"discounted_cash":5621.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15383.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15383.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15383.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12154.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3608.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3798.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2848.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3798.4,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMYPERC COR-MCH","code_information":[{"code":"92973","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":527.31,"maximum":527.31,"gross_charge":651,"discounted_cash":192.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":527.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":527.31,"methodology":"fee schedule"}]}]},{"description":"HC THROMBECTOMYPERC COR-MCH","code_information":[{"code":"92973","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":97.65,"maximum":7669,"gross_charge":651,"discounted_cash":192.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":527.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":527.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.2,"methodology":"fee schedule"}]}]},{"description":"HC ENDOLUMINL IVUS OCT C INITIAL","code_information":[{"code":"92978","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6646.86,"maximum":6646.86,"gross_charge":8206,"discounted_cash":2428.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6646.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6646.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6646.86,"methodology":"fee schedule"}]}]},{"description":"HC ENDOLUMINL IVUS OCT C INITIAL","code_information":[{"code":"92978","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":8206,"discounted_cash":2428.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6646.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6646.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6646.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1559.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1641.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1230.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1641.2,"methodology":"fee schedule"}]}]},{"description":"HC ENDOLUMINL IVUS OCT C EA ADDTL","code_information":[{"code":"92979","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":5450.49,"maximum":5450.49,"gross_charge":6729,"discounted_cash":1991.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5450.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5450.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5450.49,"methodology":"fee schedule"}]}]},{"description":"HC ENDOLUMINL IVUS OCT C EA ADDTL","code_information":[{"code":"92979","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":6729,"discounted_cash":1991.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5450.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5450.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5450.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1009.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1345.8,"methodology":"fee schedule"}]}]},{"description":"HC VALVULOPLASTY AORTIC","code_information":[{"code":"92986","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":27076.68,"maximum":27076.68,"gross_charge":33428,"discounted_cash":9894.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27076.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27076.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27076.68,"methodology":"fee schedule"}]}]},{"description":"HC VALVULOPLASTY AORTIC","code_information":[{"code":"92986","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":27076.68,"gross_charge":33428,"discounted_cash":9894.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27076.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27076.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27076.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12482.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8339.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8716.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6351.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6685.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5014.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6685.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5097.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5454.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5250.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5352.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5607.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5403.23,"methodology":"case rate"}]}]},{"description":"HC EKG-12 LEAD TRACING ONLY","code_information":[{"code":"93005","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":666.63,"maximum":666.63,"gross_charge":823,"discounted_cash":243.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":666.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":666.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":666.63,"methodology":"fee schedule"}]}]},{"description":"HC EKG-12 LEAD TRACING ONLY","code_information":[{"code":"93005","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":24.61,"maximum":666.63,"gross_charge":823,"discounted_cash":243.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":666.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":666.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":666.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9301","type":"APR-DRG"}],"standard_charges":[{"minimum":5721,"maximum":5721,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5721,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5721,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5721,"methodology":"case rate"}]}]},{"description":"HC CARDIOVASCULAR STRESS TEST","code_information":[{"code":"93017","type":"CPT"},{"code":"0482","type":"RC"}],"standard_charges":[{"minimum":2297.97,"maximum":2297.97,"gross_charge":2837,"discounted_cash":839.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2297.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2297.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2297.97,"methodology":"fee schedule"}]}]},{"description":"HC CARDIOVASCULAR STRESS TEST","code_information":[{"code":"93017","type":"CPT"},{"code":"0482","type":"RC"}],"standard_charges":[{"minimum":118.41,"maximum":2297.97,"gross_charge":2837,"discounted_cash":839.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2297.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2297.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2297.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":132.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":118.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":567.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":567.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9302","type":"APR-DRG"}],"standard_charges":[{"minimum":7533,"maximum":7533,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7533,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7533,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7533,"methodology":"case rate"}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9303","type":"APR-DRG"}],"standard_charges":[{"minimum":11277,"maximum":11277,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11277,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11277,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11277,"methodology":"case rate"}]}]},{"description":"MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE","code_information":[{"code":"9304","type":"APR-DRG"}],"standard_charges":[{"minimum":26721,"maximum":26721,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26721,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26721,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26721,"methodology":"case rate"}]}]},{"description":"HC HOLTER RECORDING UP TO 48HRS","code_information":[{"code":"93225","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":636.66,"maximum":636.66,"gross_charge":786,"discounted_cash":232.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":636.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":636.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":636.66,"methodology":"fee schedule"}]}]},{"description":"HC HOLTER RECORDING UP TO 48HRS","code_information":[{"code":"93225","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":81.33,"maximum":783,"gross_charge":786,"discounted_cash":232.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":636.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":636.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":636.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":100.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC HOLTER SCAN UP TO 48HRS","code_information":[{"code":"93226","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":1631.34,"maximum":1631.34,"gross_charge":2014,"discounted_cash":596.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.34,"methodology":"fee schedule"}]}]},{"description":"HC HOLTER SCAN UP TO 48HRS","code_information":[{"code":"93226","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":53.11,"maximum":1631.34,"gross_charge":2014,"discounted_cash":596.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":142.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":115.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"EXT EKG RECORDING 48 HRS-7 DAYS","code_information":[{"code":"93242","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":155.52,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"}]}]},{"description":"EXT EKG RECORDING 48 HRS-7 DAYS","code_information":[{"code":"93242","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":28.8,"maximum":783,"gross_charge":192,"discounted_cash":56.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"EXT EKG RECORDING 7-15 DAYS","code_information":[{"code":"93246","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":259.2,"maximum":259.2,"gross_charge":320,"discounted_cash":94.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"}]}]},{"description":"EXT EKG RECORDING 7-15 DAYS","code_information":[{"code":"93246","type":"CPT"},{"code":"0731","type":"RC"}],"standard_charges":[{"minimum":35.09,"maximum":783,"gross_charge":320,"discounted_cash":94.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":58.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"HC ECG SIGNAL AVERAGE","code_information":[{"code":"93278","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":103.68,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"}]}]},{"description":"HC ECG SIGNAL AVERAGE","code_information":[{"code":"93278","type":"CPT"},{"code":"0730","type":"RC"}],"standard_charges":[{"minimum":19.2,"maximum":214,"gross_charge":128,"discounted_cash":37.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":70.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC PPM/LDLS SNG LEAD EVAL PROGR","code_information":[{"code":"93279","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC PPM/LDLS SNG LEAD EVAL PROGR","code_information":[{"code":"93279","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":783,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":82.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC PPM DUAL LEAD EVAL PROGR","code_information":[{"code":"93280","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC PPM DUAL LEAD EVAL PROGR","code_information":[{"code":"93280","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":783,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":59.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":82.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC ICD SNG LEAD EVAL PROG","code_information":[{"code":"93282","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC ICD SNG LEAD EVAL PROG","code_information":[{"code":"93282","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":10.2,"maximum":783,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":95.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC ICD DUAL LEAD EVAL PROG","code_information":[{"code":"93283","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC ICD DUAL LEAD EVAL PROG","code_information":[{"code":"93283","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":783,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":103.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC ICD MULTI LEAD EVAL PROG","code_information":[{"code":"93284","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC ICD MULTI LEAD EVAL PROG","code_information":[{"code":"93284","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":13.5,"maximum":783,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":110.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"PERI-PROCD DEVICE EVAL&PROGRM","code_information":[{"code":"93286","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"}]}]},{"description":"PERI-PROCD DEVICE EVAL&PROGRM","code_information":[{"code":"93286","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":19.5,"maximum":783,"gross_charge":130,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"}]}]},{"description":"PERI-PROC ICD DEVICE EVAL","code_information":[{"code":"93287","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"}]}]},{"description":"PERI-PROC ICD DEVICE EVAL","code_information":[{"code":"93287","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":19.5,"maximum":783,"gross_charge":130,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"}]}]},{"description":"HC PM/LDLS DEVICE EVAL IN PERSON","code_information":[{"code":"93288","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":123.12,"maximum":123.12,"gross_charge":152,"discounted_cash":45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.12,"methodology":"fee schedule"}]}]},{"description":"HC PM/LDLS DEVICE EVAL IN PERSON","code_information":[{"code":"93288","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":22.8,"maximum":783,"gross_charge":152,"discounted_cash":45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":97.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC ICD DEVICE EVAL IN PERSON","code_information":[{"code":"93289","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":63.18,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"}]}]},{"description":"HC ICD DEVICE EVAL IN PERSON","code_information":[{"code":"93289","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11.7,"maximum":783,"gross_charge":78,"discounted_cash":23.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":88.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":58.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC ICPM DEVICE EVAL PER PT ENCTR","code_information":[{"code":"93290","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":29.97,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"}]}]},{"description":"HC ICPM DEVICE EVAL PER PT ENCTR","code_information":[{"code":"93290","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":5.55,"maximum":783,"gross_charge":37,"discounted_cash":10.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":78.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC PPM/LDLS/ICD/ REMOTE EVAL","code_information":[{"code":"93296","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":153.09,"maximum":153.09,"gross_charge":189,"discounted_cash":55.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.09,"methodology":"fee schedule"}]}]},{"description":"HC PPM/LDLS/ICD/ REMOTE EVAL","code_information":[{"code":"93296","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":783,"gross_charge":189,"discounted_cash":55.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":99.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":78.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":120.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"HC ILR DEVICE INTERROGAT REMOTE","code_information":[{"code":"93298","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":63.99,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"}]}]},{"description":"HC ILR DEVICE INTERROGAT REMOTE","code_information":[{"code":"93298","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11.85,"maximum":783,"gross_charge":79,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.64,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.01,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.34,"methodology":"case rate"}]}]},{"description":"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"minimum":21776,"maximum":64259,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44569,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41787,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":52847.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32784,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39086,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32012,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":55628.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64259,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":39898,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":39898,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21776,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":30904.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33068.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":31831.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32449.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32759.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32449.99,"methodology":"case rate"}]}]},{"description":"HC ECHOCARDIO CONGEN W/O CONT","code_information":[{"code":"93303","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2549.07,"maximum":2549.07,"gross_charge":3147,"discounted_cash":931.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2549.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2549.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2549.07,"methodology":"fee schedule"}]}]},{"description":"HC ECHOCARDIO CONGEN W/O CONT","code_information":[{"code":"93303","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":472.05,"maximum":2549.07,"gross_charge":3147,"discounted_cash":931.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2549.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2549.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2549.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":671.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":531.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC FOLLOW-UP CONGENITAL W/O CONTR","code_information":[{"code":"93304","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1807.92,"maximum":1807.92,"gross_charge":2232,"discounted_cash":660.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1807.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.92,"methodology":"fee schedule"}]}]},{"description":"HC FOLLOW-UP CONGENITAL W/O CONTR","code_information":[{"code":"93304","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":334.8,"maximum":1807.92,"gross_charge":2232,"discounted_cash":660.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1807.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1807.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1807.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":484.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":369.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"2D ECHO W/DOPPLER COMP WO CON","code_information":[{"code":"93306","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1861.38,"maximum":1861.38,"gross_charge":2298,"discounted_cash":680.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1861.38,"methodology":"fee schedule"}]}]},{"description":"2D ECHO W/DOPPLER COMP WO CON","code_information":[{"code":"93306","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":344.7,"maximum":1861.38,"gross_charge":2298,"discounted_cash":680.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":521.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":501.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":436.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC 2D ECHO W/DOPPLER COMP","code_information":[{"code":"93306","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2327.13,"maximum":2327.13,"gross_charge":2873,"discounted_cash":850.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2327.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2327.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2327.13,"methodology":"fee schedule"}]}]},{"description":"HC 2D ECHO W/DOPPLER COMP","code_information":[{"code":"93306","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":430.95,"maximum":2327.13,"gross_charge":2873,"discounted_cash":850.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2327.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2327.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2327.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":521.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":501.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":574.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC 2D ECHO W/O DOPPLER COMP","code_information":[{"code":"93307","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1921.32,"maximum":1921.32,"gross_charge":2372,"discounted_cash":702.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1921.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1921.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1921.32,"methodology":"fee schedule"}]}]},{"description":"HC 2D ECHO W/O DOPPLER COMP","code_information":[{"code":"93307","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":1921.32,"gross_charge":2372,"discounted_cash":702.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1921.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1921.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1921.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":373.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":263.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC 2D ECHO F/U OR LIMITED","code_information":[{"code":"93308","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":693.36,"maximum":693.36,"gross_charge":856,"discounted_cash":253.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":693.36,"methodology":"fee schedule"}]}]},{"description":"HC 2D ECHO F/U OR LIMITED","code_information":[{"code":"93308","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":128.4,"maximum":693.36,"gross_charge":856,"discounted_cash":253.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":693.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":284.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC LIMITED ECHO","code_information":[{"code":"93308","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":1574.64,"maximum":1574.64,"gross_charge":1944,"discounted_cash":575.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1574.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1574.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1574.64,"methodology":"fee schedule"}]}]},{"description":"HC LIMITED ECHO","code_information":[{"code":"93308","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":1574.64,"gross_charge":1944,"discounted_cash":575.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1574.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1574.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1574.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":284.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC TEE-ECHOCARDIOGRAM W/O CONTR","code_information":[{"code":"93312","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":3551.04,"maximum":3551.04,"gross_charge":4384,"discounted_cash":1297.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3551.04,"methodology":"fee schedule"}]}]},{"description":"HC TEE-ECHOCARDIOGRAM W/O CONTR","code_information":[{"code":"93312","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":490.2,"maximum":3551.04,"gross_charge":4384,"discounted_cash":1297.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":535.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":691.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC TEE-PROBE PLACEMENT ONLY","code_information":[{"code":"93313","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2769.39,"maximum":2769.39,"gross_charge":3419,"discounted_cash":1012.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2769.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2769.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2769.39,"methodology":"fee schedule"}]}]},{"description":"HC TEE-PROBE PLACEMENT ONLY","code_information":[{"code":"93313","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":48.66,"maximum":2769.39,"gross_charge":3419,"discounted_cash":1012.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2769.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2769.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2769.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":649.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":683.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC TEE-CONGENITAL W/O CONTR","code_information":[{"code":"93315","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2006.37,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"}]}]},{"description":"HC TEE-CONGENITAL W/O CONTR","code_information":[{"code":"93315","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":371.55,"maximum":2006.37,"gross_charge":2477,"discounted_cash":733.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2006.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":598.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":452.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":371.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"3D ECHOCARDIOGRAPHY","code_information":[{"code":"93319","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":750.87,"maximum":750.87,"gross_charge":927,"discounted_cash":274.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":750.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":750.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":750.87,"methodology":"fee schedule"}]}]},{"description":"3D ECHOCARDIOGRAPHY","code_information":[{"code":"93319","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":139.05,"maximum":750.87,"gross_charge":927,"discounted_cash":274.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":750.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":750.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":750.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.4,"methodology":"fee schedule"}]}]},{"description":"HC DOPPLER CONT WVE PULSE","code_information":[{"code":"93320","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":855.36,"maximum":855.36,"gross_charge":1056,"discounted_cash":312.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":855.36,"methodology":"fee schedule"}]}]},{"description":"HC DOPPLER CONT WVE PULSE","code_information":[{"code":"93320","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":109.7,"maximum":855.36,"gross_charge":1056,"discounted_cash":312.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":137.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":109.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.2,"methodology":"fee schedule"}]}]},{"description":"HC DOPPLER CONT WVE PULSE LTD","code_information":[{"code":"93321","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":632.61,"maximum":632.61,"gross_charge":781,"discounted_cash":231.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":632.61,"methodology":"fee schedule"}]}]},{"description":"HC DOPPLER CONT WVE PULSE LTD","code_information":[{"code":"93321","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":71.53,"maximum":641,"gross_charge":781,"discounted_cash":231.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.2,"methodology":"fee schedule"}]}]},{"description":"HC DOPPLER COLOR-FLOW MAPPING","code_information":[{"code":"93325","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":855.36,"maximum":855.36,"gross_charge":1056,"discounted_cash":312.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":855.36,"methodology":"fee schedule"}]}]},{"description":"HC DOPPLER COLOR-FLOW MAPPING","code_information":[{"code":"93325","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":68.24,"maximum":855.36,"gross_charge":1056,"discounted_cash":312.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":86.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.2,"methodology":"fee schedule"}]}]},{"description":"HC STRESS ECHO RECORDING W/O CONT","code_information":[{"code":"93350","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2742.66,"maximum":2742.66,"gross_charge":3386,"discounted_cash":1002.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2742.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2742.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2742.66,"methodology":"fee schedule"}]}]},{"description":"HC STRESS ECHO RECORDING W/O CONT","code_information":[{"code":"93350","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":456.68,"maximum":2742.66,"gross_charge":3386,"discounted_cash":1002.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2742.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2742.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2742.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1200.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":804.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":456.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":516.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":838.24,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":643.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":490.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":524.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":504.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":514.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":539.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":519.61,"methodology":"case rate"}]}]},{"description":"HC TEE ECHO INTERVENTIONAL","code_information":[{"code":"93355","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":757.35,"maximum":757.35,"gross_charge":935,"discounted_cash":276.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":757.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":757.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":757.35,"methodology":"fee schedule"}]}]},{"description":"HC TEE ECHO INTERVENTIONAL","code_information":[{"code":"93355","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":140.25,"maximum":966.3,"gross_charge":935,"discounted_cash":276.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":757.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":757.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":757.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":966.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":742.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":187,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":187,"methodology":"fee schedule"}]}]},{"description":"HC MYOCRD STRAIN IMG SPCKL TRCK","code_information":[{"code":"93356","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"HC MYOCRD STRAIN IMG SPCKL TRCK","code_information":[{"code":"93356","type":"CPT"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":10.05,"maximum":641,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":158.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":125.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"minimum":5713,"maximum":31867,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24635,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":23097,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28887.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20278,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24176,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22093,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30407.91,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31867,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19786,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19786,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5713,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16893.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18075.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17400.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17737.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17906.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17737.95,"methodology":"case rate"}]}]},{"description":"HC RIGHT HEART CATH","code_information":[{"code":"93451","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":13089.6,"maximum":13089.6,"gross_charge":16160,"discounted_cash":4783.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13089.6,"methodology":"fee schedule"}]}]},{"description":"HC RIGHT HEART CATH","code_information":[{"code":"93451","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":13089.6,"gross_charge":16160,"discounted_cash":4783.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3232,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2424,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3232,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC LT HRT CATH W/VENTRCLGRP","code_information":[{"code":"93452","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":13089.6,"maximum":13089.6,"gross_charge":16160,"discounted_cash":4783.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13089.6,"methodology":"fee schedule"}]}]},{"description":"HC LT HRT CATH W/VENTRCLGRP","code_information":[{"code":"93452","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":13089.6,"gross_charge":16160,"discounted_cash":4783.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3232,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2424,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3232,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC R&L HRT CATH W/VENTRICLGR","code_information":[{"code":"93453","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":13089.6,"maximum":13089.6,"gross_charge":16160,"discounted_cash":4783.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13089.6,"methodology":"fee schedule"}]}]},{"description":"HC R&L HRT CATH W/VENTRICLGR","code_information":[{"code":"93453","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":13089.6,"gross_charge":16160,"discounted_cash":4783.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13089.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3232,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2424,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3232,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC COR ARTERY ANGIO S&I","code_information":[{"code":"93454","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6903.63,"maximum":6903.63,"gross_charge":8523,"discounted_cash":2522.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6903.63,"methodology":"fee schedule"}]}]},{"description":"HC COR ARTERY ANGIO S&I","code_information":[{"code":"93454","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":8523,"discounted_cash":2522.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1619.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC COR ART/GRF ANGIO S&I","code_information":[{"code":"93455","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6903.63,"maximum":6903.63,"gross_charge":8523,"discounted_cash":2522.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6903.63,"methodology":"fee schedule"}]}]},{"description":"HC COR ART/GRF ANGIO S&I","code_information":[{"code":"93455","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":8523,"discounted_cash":2522.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6903.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1619.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1278.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1704.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC R HRT CORONARY ARTERY ANGIO","code_information":[{"code":"93456","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":19359,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"}]}]},{"description":"HC R HRT CORONARY ARTERY ANGIO","code_information":[{"code":"93456","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3585,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC R HRT ART/GRFT ANGIO","code_information":[{"code":"93457","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":19359,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"}]}]},{"description":"HC R HRT ART/GRFT ANGIO","code_information":[{"code":"93457","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3585,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC L HRT ART/VENTR ANGIO","code_information":[{"code":"93458","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":19359,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"}]}]},{"description":"HC L HRT ART/VENTR ANGIO","code_information":[{"code":"93458","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3585,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC L HRT ART/GRFT ANGIO","code_information":[{"code":"93459","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":19359,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"}]}]},{"description":"HC L HRT ART/GRFT ANGIO","code_information":[{"code":"93459","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3585,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC R&L HRT ART/VENTR ANGIO","code_information":[{"code":"93460","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":19359,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"}]}]},{"description":"HC R&L HRT ART/VENTR ANGIO","code_information":[{"code":"93460","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1566,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3585,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC R&L HRT ART/VENT GRF ANG","code_information":[{"code":"93461","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":19359,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"}]}]},{"description":"HC R&L HRT ART/VENT GRF ANG","code_information":[{"code":"93461","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19359,"gross_charge":23900,"discounted_cash":7074.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19359,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7041.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4754.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4917.28,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":4782,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4541,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3585,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4780,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2875.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3076.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2961.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3019.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3163.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3048.14,"methodology":"case rate"}]}]},{"description":"HC L HRT CATH TRNSPTL PUNCT","code_information":[{"code":"93462","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":2647.08,"maximum":2647.08,"gross_charge":3268,"discounted_cash":967.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2647.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2647.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2647.08,"methodology":"fee schedule"}]}]},{"description":"HC L HRT CATH TRNSPTL PUNCT","code_information":[{"code":"93462","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":3268,"discounted_cash":967.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2647.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2647.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2647.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":490.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":653.6,"methodology":"fee schedule"}]}]},{"description":"HC DRUG ADM&HEMODYN MEAS","code_information":[{"code":"93463","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":238.95,"maximum":238.95,"gross_charge":295,"discounted_cash":87.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.95,"methodology":"fee schedule"}]}]},{"description":"HC DRUG ADM&HEMODYN MEAS","code_information":[{"code":"93463","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":44.25,"maximum":7669,"gross_charge":295,"discounted_cash":87.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59,"methodology":"fee schedule"}]}]},{"description":"NON-EXTENSIVE BURNS","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"minimum":5137,"maximum":32619,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10236,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9597,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29443.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":21878,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26085,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21550,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30993.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32619,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":20253,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":20253,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5137,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17218.34,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18423.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17734.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18079.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18251.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18079.26,"methodology":"case rate"}]}]},{"description":"HC INS SWAN GANZ BEDSIDE","code_information":[{"code":"93503","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":2900.61,"maximum":2900.61,"gross_charge":3581,"discounted_cash":1059.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2900.61,"methodology":"fee schedule"}]}]},{"description":"HC INS SWAN GANZ BEDSIDE","code_information":[{"code":"93503","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7126,"gross_charge":3581,"discounted_cash":1059.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3400.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2336.7,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2374.92,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2291.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1388.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1486.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1430.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1458.28,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1527.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1472.17,"methodology":"case rate"}]}]},{"description":"HC ENDOMYOCARDIAL BIOPSY","code_information":[{"code":"93505","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":9335.25,"maximum":9335.25,"gross_charge":11525,"discounted_cash":3411.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9335.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9335.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9335.25,"methodology":"fee schedule"}]}]},{"description":"HC ENDOMYOCARDIAL BIOPSY","code_information":[{"code":"93505","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":9335.25,"gross_charge":11525,"discounted_cash":3411.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9335.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9335.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9335.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6890.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4650.65,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4811.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7376,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":3442,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2189.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2305,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1728.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2305,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2813.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3010.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2898.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2954.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3095.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2982.83,"methodology":"case rate"}]}]},{"description":"COA DURING CONGENITAL HEART","code_information":[{"code":"93563","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":177.39,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"}]}]},{"description":"COA DURING CONGENITAL HEART","code_information":[{"code":"93563","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":32.85,"maximum":7669,"gross_charge":219,"discounted_cash":64.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"}]}]},{"description":"LV/LA ANGIO CONGENITAL HEART","code_information":[{"code":"93565","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"LV/LA ANGIO CONGENITAL HEART","code_information":[{"code":"93565","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":7669,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"}]}]},{"description":"HC INJ R VENTR/ATRIAL ANGIO","code_information":[{"code":"93566","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":108.54,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"}]}]},{"description":"HC INJ R VENTR/ATRIAL ANGIO","code_information":[{"code":"93566","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":20.1,"maximum":7669,"gross_charge":134,"discounted_cash":39.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"}]}]},{"description":"HC INJECT SUPRVLV AORTO","code_information":[{"code":"93567","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":191.16,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"}]}]},{"description":"HC INJECT SUPRVLV AORTO","code_information":[{"code":"93567","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":35.4,"maximum":7669,"gross_charge":236,"discounted_cash":69.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"}]}]},{"description":"PULMONARY ANGIO W/COA","code_information":[{"code":"93568","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":191.16,"maximum":191.16,"gross_charge":236,"discounted_cash":69.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"}]}]},{"description":"PULMONARY ANGIO W/COA","code_information":[{"code":"93568","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":35.4,"maximum":7669,"gross_charge":236,"discounted_cash":69.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRVSC DOPPL FLOW INIT VES","code_information":[{"code":"93571","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":931.5,"maximum":931.5,"gross_charge":1150,"discounted_cash":340.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":931.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":931.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":931.5,"methodology":"fee schedule"}]}]},{"description":"HC INTRVSC DOPPL FLOW INIT VES","code_information":[{"code":"93571","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":1150,"discounted_cash":340.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":931.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":931.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":931.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":230,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":230,"methodology":"fee schedule"}]}]},{"description":"HC INTRVSC DOPPL FLOW ADDL VES","code_information":[{"code":"93572","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":643.14,"maximum":643.14,"gross_charge":794,"discounted_cash":235.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.14,"methodology":"fee schedule"}]}]},{"description":"HC INTRVSC DOPPL FLOW ADDL VES","code_information":[{"code":"93572","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":119.1,"maximum":7669,"gross_charge":794,"discounted_cash":235.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6411,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.8,"methodology":"fee schedule"}]}]},{"description":"HC TC CLOSURE ASD/PFO C IMP","code_information":[{"code":"93580","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8765.82,"maximum":8765.82,"gross_charge":10822,"discounted_cash":3203.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8765.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8765.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8765.82,"methodology":"fee schedule"}]}]},{"description":"HC TC CLOSURE ASD/PFO C IMP","code_information":[{"code":"93580","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":39313.11,"gross_charge":10822,"discounted_cash":3203.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8765.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8765.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8765.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2056.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2164.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1623.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2164.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"RHC-CONGENITAL/NORMAL CON","code_information":[{"code":"93593","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8964.27,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"}]}]},{"description":"RHC-CONGENITAL/NORMAL CON","code_information":[{"code":"93593","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1660.05,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1660.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"}]}]},{"description":"RHC-CONGENITAL/ABNORMAL CON","code_information":[{"code":"93594","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8964.27,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"}]}]},{"description":"RHC-CONGENITAL/ABNORMAL CON","code_information":[{"code":"93594","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1660.05,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1660.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"}]}]},{"description":"RT/LT CONGT HEART/ NORML CONECT","code_information":[{"code":"93596","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8964.27,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"}]}]},{"description":"RT/LT CONGT HEART/ NORML CONECT","code_information":[{"code":"93596","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1660.05,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1660.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"}]}]},{"description":"RT/LT CONGT HEART/ ABNORML CONECT","code_information":[{"code":"93597","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":8964.27,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"}]}]},{"description":"RT/LT CONGT HEART/ ABNORML CONECT","code_information":[{"code":"93597","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1660.05,"maximum":8964.27,"gross_charge":11067,"discounted_cash":3275.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8964.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2102.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1660.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2213.4,"methodology":"fee schedule"}]}]},{"description":"CO- CONGENITAL HEART","code_information":[{"code":"93598","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":221.13,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"}]}]},{"description":"CO- CONGENITAL HEART","code_information":[{"code":"93598","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":40.95,"maximum":7669,"gross_charge":273,"discounted_cash":80.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"}]}]},{"description":"HC BUNDLE OF HIS RECORDING","code_information":[{"code":"93600","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":17090.19,"maximum":17090.19,"gross_charge":21099,"discounted_cash":6245.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17090.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17090.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17090.19,"methodology":"fee schedule"}]}]},{"description":"HC BUNDLE OF HIS RECORDING","code_information":[{"code":"93600","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":234.05,"maximum":17090.19,"gross_charge":21099,"discounted_cash":6245.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17090.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17090.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17090.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10896.31,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":309.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":234.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11600.74,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13503.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4008.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4219.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3164.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4219.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6784.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7258.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6987.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7123.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7462.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7191.1,"methodology":"case rate"}]}]},{"description":"HC INTRA ATRIAL RECORDING","code_information":[{"code":"93602","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":22505.85,"maximum":22505.85,"gross_charge":27785,"discounted_cash":8224.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22505.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22505.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22505.85,"methodology":"fee schedule"}]}]},{"description":"HC INTRA ATRIAL RECORDING","code_information":[{"code":"93602","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":128.65,"maximum":22505.85,"gross_charge":27785,"discounted_cash":8224.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22505.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22505.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22505.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10896.31,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":170.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":128.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11600.74,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17782.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5279.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5557,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4167.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5557,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6784.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7258.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6987.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7123.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7462.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7191.1,"methodology":"case rate"}]}]},{"description":"RT.VENTRICULAR RECORDING","code_information":[{"code":"93603","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":3354.21,"maximum":3354.21,"gross_charge":4141,"discounted_cash":1225.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3354.21,"methodology":"fee schedule"}]}]},{"description":"RT.VENTRICULAR RECORDING","code_information":[{"code":"93603","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":199.3,"maximum":3354.21,"gross_charge":4141,"discounted_cash":1225.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2657.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2657.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1736.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":263.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":199.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1855.97,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2650.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1085.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1161.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1117.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1139.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1193.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1150.48,"methodology":"case rate"}]}]},{"description":"TACHY MAPPING","code_information":[{"code":"93609","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1676.7,"maximum":1676.7,"gross_charge":2070,"discounted_cash":612.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1676.7,"methodology":"fee schedule"}]}]},{"description":"TACHY MAPPING","code_information":[{"code":"93609","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":310.5,"maximum":1676.7,"gross_charge":2070,"discounted_cash":612.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1676.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":415.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":314.19,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1324.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":414,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":414,"methodology":"fee schedule"}]}]},{"description":"HC INTRAVENTRICULAR PACING","code_information":[{"code":"93612","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":4371.57,"maximum":4371.57,"gross_charge":5397,"discounted_cash":1597.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"}]}]},{"description":"HC INTRAVENTRICULAR PACING","code_information":[{"code":"93612","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":189.87,"maximum":16612.83,"gross_charge":5397,"discounted_cash":1597.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4371.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10896.31,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":251.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":189.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11600.74,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3454.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6784.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7258.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6987.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7123.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7462.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7191.1,"methodology":"case rate"}]}]},{"description":"HC INTRACARDIAC EP 3D MAPPING","code_information":[{"code":"93613","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":11103.48,"maximum":11103.48,"gross_charge":13708,"discounted_cash":4057.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11103.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11103.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11103.48,"methodology":"fee schedule"}]}]},{"description":"HC INTRACARDIAC EP 3D MAPPING","code_information":[{"code":"93613","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":479,"maximum":11103.48,"gross_charge":13708,"discounted_cash":4057.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11103.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11103.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11103.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1209.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1247.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8773.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2604.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2741.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2056.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2741.6,"methodology":"fee schedule"}]}]},{"description":"INDUCT.ARRHYTH.BY PACING","code_information":[{"code":"93618","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":3354.21,"maximum":3354.21,"gross_charge":4141,"discounted_cash":1225.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3354.21,"methodology":"fee schedule"}]}]},{"description":"INDUCT.ARRHYTH.BY PACING","code_information":[{"code":"93618","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":468.8,"maximum":3354.21,"gross_charge":4141,"discounted_cash":1225.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3354.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2657.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2657.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1736.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":620.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":468.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1855.97,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2650.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":621.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1085.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1161.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1117.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1139.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1193.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1150.48,"methodology":"case rate"}]}]},{"description":"HC COMP EP EVAL W INDUCTION","code_information":[{"code":"93620","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":7910.46,"maximum":7910.46,"gross_charge":9766,"discounted_cash":2890.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7910.46,"methodology":"fee schedule"}]}]},{"description":"HC COMP EP EVAL W INDUCTION","code_information":[{"code":"93620","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":1061.82,"maximum":16612.83,"gross_charge":9766,"discounted_cash":2890.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10896.31,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1405.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1061.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11600.74,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6250.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1953.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1953.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6784.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7258.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6987.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7123.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7462.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7191.1,"methodology":"case rate"}]}]},{"description":"HC COMP EP EVAL W CS/LA RCRDNG","code_information":[{"code":"93621","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":7910.46,"maximum":7910.46,"gross_charge":9766,"discounted_cash":2890.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7910.46,"methodology":"fee schedule"}]}]},{"description":"HC COMP EP EVAL W CS/LA RCRDNG","code_information":[{"code":"93621","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":479,"maximum":10468.84,"gross_charge":9766,"discounted_cash":2890.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10468.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7908.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6250.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1953.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1953.2,"methodology":"fee schedule"}]}]},{"description":"HC COMP EP EVAL W LV RECORDING","code_information":[{"code":"93622","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":7910.46,"maximum":7910.46,"gross_charge":9766,"discounted_cash":2890.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7910.46,"methodology":"fee schedule"}]}]},{"description":"HC COMP EP EVAL W LV RECORDING","code_information":[{"code":"93622","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":176.31,"maximum":7910.46,"gross_charge":9766,"discounted_cash":2890.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7910.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":227.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":176.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6250.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1855.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1953.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1953.2,"methodology":"fee schedule"}]}]},{"description":"HC STIM&PACING S/P IV DRUGS","code_information":[{"code":"93623","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":798.66,"maximum":798.66,"gross_charge":986,"discounted_cash":291.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":798.66,"methodology":"fee schedule"}]}]},{"description":"HC STIM&PACING S/P IV DRUGS","code_information":[{"code":"93623","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":147.9,"maximum":823.16,"gross_charge":986,"discounted_cash":291.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":379.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":823.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":631.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.2,"methodology":"fee schedule"}]}]},{"description":"HC EP EVAL ICD W GEN TEST","code_information":[{"code":"93641","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":9565.29,"maximum":9565.29,"gross_charge":11809,"discounted_cash":3495.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9565.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9565.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9565.29,"methodology":"fee schedule"}]}]},{"description":"HC EP EVAL ICD W GEN TEST","code_information":[{"code":"93641","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":479,"maximum":9565.29,"gross_charge":11809,"discounted_cash":3495.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9565.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9565.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9565.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1136.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":858.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7557.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2243.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2361.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1771.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2361.8,"methodology":"fee schedule"}]}]},{"description":"HC EP EVAL ICD W PACING PROG","code_information":[{"code":"93642","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":6599.88,"maximum":6599.88,"gross_charge":8148,"discounted_cash":2411.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6599.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6599.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6599.88,"methodology":"fee schedule"}]}]},{"description":"HC EP EVAL ICD W PACING PROG","code_information":[{"code":"93642","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":321.26,"maximum":6599.88,"gross_charge":8148,"discounted_cash":2411.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6599.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6599.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6599.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2657.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2657.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1736.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":321.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":455.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1855.97,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5214.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1548.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1222.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1629.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1085.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1161.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1117.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1139.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1193.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1150.48,"methodology":"case rate"}]}]},{"description":"HC ELECTROPHYSIOLOGY EVALUATION","code_information":[{"code":"93644","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1040.85,"maximum":1040.85,"gross_charge":1285,"discounted_cash":380.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1040.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1040.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1040.85,"methodology":"fee schedule"}]}]},{"description":"HC ELECTROPHYSIOLOGY EVALUATION","code_information":[{"code":"93644","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":1285,"discounted_cash":380.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1040.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1040.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1040.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":822.4,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":244.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":257,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":257,"methodology":"fee schedule"}]}]},{"description":"HC ICC ABLATION AV NODE CHB","code_information":[{"code":"93650","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":31253.85,"maximum":31253.85,"gross_charge":38585,"discounted_cash":11421.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31253.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31253.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31253.85,"methodology":"fee schedule"}]}]},{"description":"HC ICC ABLATION AV NODE CHB","code_information":[{"code":"93650","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":31253.85,"gross_charge":38585,"discounted_cash":11421.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31253.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31253.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31253.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19142,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16612.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10896.31,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11600.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12467,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14481,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":27720,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7331.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7717,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5787.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7717,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6784.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7258.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6987.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7123.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7462.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7191.1,"methodology":"case rate"}]}]},{"description":"HC EP&ABLATE SUPRAVENT ARRHYT","code_information":[{"code":"93653","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":67942.8,"maximum":67942.8,"gross_charge":83880,"discounted_cash":24828.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67942.8,"methodology":"fee schedule"}]}]},{"description":"HC EP&ABLATE SUPRAVENT ARRHYT","code_information":[{"code":"93653","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":67942.8,"gross_charge":83880,"discounted_cash":24828.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19142,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53709.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53709.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34652.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37505.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12467,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14481,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15937.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16776,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12582,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16776,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21932.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23468.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22590.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23029.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24126.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23248.83,"methodology":"case rate"}]}]},{"description":"HC EP&ABLATE VENTRIC TACHY","code_information":[{"code":"93654","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":67942.8,"maximum":67942.8,"gross_charge":83880,"discounted_cash":24828.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67942.8,"methodology":"fee schedule"}]}]},{"description":"HC EP&ABLATE VENTRIC TACHY","code_information":[{"code":"93654","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":67942.8,"gross_charge":83880,"discounted_cash":24828.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19142,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53709.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53709.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34652.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37505.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12467,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14481,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15937.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16776,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12582,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16776,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21932.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23468.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22590.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23029.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24126.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23248.83,"methodology":"case rate"}]}]},{"description":"HC ABLATE ARRHYTHMIA ADD ON","code_information":[{"code":"93655","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1359.18,"maximum":1359.18,"gross_charge":1678,"discounted_cash":496.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1359.18,"methodology":"fee schedule"}]}]},{"description":"HC ABLATE ARRHYTHMIA ADD ON","code_information":[{"code":"93655","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19142,"gross_charge":1678,"discounted_cash":496.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19142,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12467,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14481,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":318.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.6,"methodology":"fee schedule"}]}]},{"description":"HC TX ATRIAL FIB PULM VEIN ISOL","code_information":[{"code":"93656","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":67942.8,"maximum":67942.8,"gross_charge":83880,"discounted_cash":24828.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67942.8,"methodology":"fee schedule"}]}]},{"description":"HC TX ATRIAL FIB PULM VEIN ISOL","code_information":[{"code":"93656","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":67942.8,"gross_charge":83880,"discounted_cash":24828.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67942.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19142,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53709.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53709.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34652.59,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37505.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12467,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14481,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":12250,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15937.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16776,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12582,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16776,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21932.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23468.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22590.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23029.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24126.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23248.83,"methodology":"case rate"}]}]},{"description":"HC L/R ATRIAL FIB ADDL","code_information":[{"code":"93657","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":1359.18,"maximum":1359.18,"gross_charge":1678,"discounted_cash":496.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1359.18,"methodology":"fee schedule"}]}]},{"description":"HC L/R ATRIAL FIB ADDL","code_information":[{"code":"93657","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":19142,"gross_charge":1678,"discounted_cash":496.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19142,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12467,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14481,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12540,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":318.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRACARDIAC ECG AT OP","code_information":[{"code":"93662","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":6301.8,"maximum":6301.8,"gross_charge":7780,"discounted_cash":2302.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6301.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6301.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6301.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRACARDIAC ECG AT OP","code_information":[{"code":"93662","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":7669,"gross_charge":7780,"discounted_cash":2302.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6301.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6301.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6301.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4979.2,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1478.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1556,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1167,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1556,"methodology":"fee schedule"}]}]},{"description":"HC SET PAD REHAB PER SESSION","code_information":[{"code":"93668","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":174.15,"maximum":174.15,"gross_charge":215,"discounted_cash":63.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"}]}]},{"description":"HC SET PAD REHAB PER SESSION","code_information":[{"code":"93668","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":32.25,"maximum":783,"gross_charge":215,"discounted_cash":63.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":67.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"THER/PROPH/DIAG INJ IV PUSH","code_information":[{"code":"93674","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":626.13,"maximum":626.13,"gross_charge":773,"discounted_cash":228.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.13,"methodology":"fee schedule"}]}]},{"description":"THER/PROPH/DIAG INJ IV PUSH","code_information":[{"code":"93674","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":115.95,"maximum":626.13,"gross_charge":773,"discounted_cash":228.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":626.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":626.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":626.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.6,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRONIC ANALYSIS VIA PPM","code_information":[{"code":"93724","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":938.79,"maximum":938.79,"gross_charge":1159,"discounted_cash":343.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":938.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":938.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":938.79,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRONIC ANALYSIS VIA PPM","code_information":[{"code":"93724","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":84.61,"maximum":938.79,"gross_charge":1159,"discounted_cash":343.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":938.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":938.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":938.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":656.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":435.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":458.5,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":741.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":783,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":268.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":286.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":276.17,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":281.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":294.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":284.22,"methodology":"case rate"}]}]},{"description":"HC CARDIAC REHAB","code_information":[{"code":"93797","type":"CPT"},{"code":"0943","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC CARDIAC REHAB","code_information":[{"code":"93797","type":"CPT"},{"code":"0943","type":"RC"}],"standard_charges":[{"minimum":81.15,"maximum":455,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":275.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":192.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":142,"standard_charge_algorithm": "Lesser of $142.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"standard_charge_algorithm": "Lesser of $106.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":192.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":455,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":455,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":112.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":120.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":115.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":118.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":123.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":119.32,"methodology":"case rate"}]}]},{"description":"HC CARDIAC REHAB/MONITOR","code_information":[{"code":"93798","type":"CPT"},{"code":"0943","type":"RC"}],"standard_charges":[{"minimum":438.21,"maximum":438.21,"gross_charge":541,"discounted_cash":160.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"}]}]},{"description":"HC CARDIAC REHAB/MONITOR","code_information":[{"code":"93798","type":"CPT"},{"code":"0943","type":"RC"}],"standard_charges":[{"minimum":81.15,"maximum":455,"gross_charge":541,"discounted_cash":160.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":438.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":275.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":192.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":112,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":192.49,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":455,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":455,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":112.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":120.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":115.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":118.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":123.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":119.32,"methodology":"case rate"}]}]},{"description":"ASPIRATION THROMBECTOMY","code_information":[{"code":"93799","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":442.26,"maximum":442.26,"gross_charge":546,"discounted_cash":161.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"}]}]},{"description":"ASPIRATION THROMBECTOMY","code_information":[{"code":"93799","type":"CPT"},{"code":"0480","type":"RC"}],"standard_charges":[{"minimum":81.9,"maximum":479,"gross_charge":546,"discounted_cash":161.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":349.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC CARDIOVERSION DONE VIA ICD/DEFIB","code_information":[{"code":"93799","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":437.4,"maximum":437.4,"gross_charge":540,"discounted_cash":159.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":437.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":437.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":437.4,"methodology":"fee schedule"}]}]},{"description":"HC CARDIOVERSION DONE VIA ICD/DEFIB","code_information":[{"code":"93799","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":81,"maximum":7669,"gross_charge":540,"discounted_cash":159.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":437.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":437.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":437.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC NIPS VIA IMPLANTED ICD/PPM","code_information":[{"code":"93799","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":442.26,"maximum":442.26,"gross_charge":546,"discounted_cash":161.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"}]}]},{"description":"HC NIPS VIA IMPLANTED ICD/PPM","code_information":[{"code":"93799","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":81.9,"maximum":7669,"gross_charge":546,"discounted_cash":161.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"INST WAVE/FREE RATION","code_information":[{"code":"93799","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":429.3,"maximum":429.3,"gross_charge":530,"discounted_cash":156.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.3,"methodology":"fee schedule"}]}]},{"description":"INST WAVE/FREE RATION","code_information":[{"code":"93799","type":"CPT"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":7669,"gross_charge":530,"discounted_cash":156.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC CAROTID DOPPLER BIL","code_information":[{"code":"93880","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":2081.7,"maximum":2081.7,"gross_charge":2570,"discounted_cash":760.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2081.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2081.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2081.7,"methodology":"fee schedule"}]}]},{"description":"HC CAROTID DOPPLER BIL","code_information":[{"code":"93880","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2081.7,"gross_charge":2570,"discounted_cash":760.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2081.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2081.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2081.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":632.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":491.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":320.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":357.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":488.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":514,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":514,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC CAROTID DOPPLER UNIL","code_information":[{"code":"93882","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":958.23,"maximum":958.23,"gross_charge":1183,"discounted_cash":350.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":958.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":958.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":958.23,"methodology":"fee schedule"}]}]},{"description":"HC CAROTID DOPPLER UNIL","code_information":[{"code":"93882","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":958.23,"gross_charge":1183,"discounted_cash":350.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":958.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":958.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":958.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":406.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":314.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":207.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":230.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"TRANSCR DOPP INTRACRAN ART;COM","code_information":[{"code":"93886","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":718.47,"maximum":718.47,"gross_charge":887,"discounted_cash":262.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":718.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":718.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":718.47,"methodology":"fee schedule"}]}]},{"description":"TRANSCR DOPP INTRACRAN ART;COM","code_information":[{"code":"93886","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":133.05,"maximum":950.49,"gross_charge":887,"discounted_cash":262.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":718.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":718.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":718.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":878.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":950.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":451.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":502.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"TRANSCR DOPP INTRACRAN ART;LIM","code_information":[{"code":"93888","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":344.25,"maximum":344.25,"gross_charge":425,"discounted_cash":125.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":344.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":344.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":344.25,"methodology":"fee schedule"}]}]},{"description":"TRANSCR DOPP INTRACRAN ART;LIM","code_information":[{"code":"93888","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":63.75,"maximum":545.89,"gross_charge":425,"discounted_cash":125.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":344.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":344.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":344.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":545.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":272.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":303.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"TRANSCR DOPP INTRACRAN ART;EMBOLI W/O INJ","code_information":[{"code":"93892","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":499.77,"maximum":499.77,"gross_charge":617,"discounted_cash":182.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":499.77,"methodology":"fee schedule"}]}]},{"description":"TRANSCR DOPP INTRACRAN ART;EMBOLI W/O INJ","code_information":[{"code":"93892","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":92.55,"maximum":985.6,"gross_charge":617,"discounted_cash":182.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":985.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":850.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"TRANSCR DOPP INTRACR;EMB W/INJ","code_information":[{"code":"93893","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":499.77,"maximum":499.77,"gross_charge":617,"discounted_cash":182.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":499.77,"methodology":"fee schedule"}]}]},{"description":"TRANSCR DOPP INTRACR;EMB W/INJ","code_information":[{"code":"93893","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":92.55,"maximum":1124.57,"gross_charge":617,"discounted_cash":182.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":499.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1124.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":882.86,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC VSRCTV STD TCD ICR ART COMPL","code_information":[{"code":"93896","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":371.79,"maximum":371.79,"gross_charge":459,"discounted_cash":135.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":371.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":371.79,"methodology":"fee schedule"}]}]},{"description":"HC VSRCTV STD TCD ICR ART COMPL","code_information":[{"code":"93896","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":619,"gross_charge":459,"discounted_cash":135.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":371.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":371.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":371.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.8,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"minimum":15784,"maximum":47137,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28531,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26973,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18267,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36277,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34012,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40182.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33477,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39912,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33947,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":42297.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47137,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":29267,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":29267,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15784,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23498.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25143.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24203.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24673.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24908.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24673.41,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL(ABI W DOPPLER)ONLY","code_information":[{"code":"93922","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":445.5,"maximum":445.5,"gross_charge":550,"discounted_cash":162.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.5,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL(ABI W DOPPLER)ONLY","code_information":[{"code":"93922","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":82.5,"maximum":619,"gross_charge":550,"discounted_cash":162.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":288.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":144.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":161.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC ART DOP SEG PRESS UNILAT","code_information":[{"code":"93923","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":645.57,"maximum":645.57,"gross_charge":797,"discounted_cash":235.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":645.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":645.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":645.57,"methodology":"fee schedule"}]}]},{"description":"HC ART DOP SEG PRESS UNILAT","code_information":[{"code":"93923","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":119.55,"maximum":645.57,"gross_charge":797,"discounted_cash":235.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":645.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":645.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":645.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":436.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":357.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":220.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":245.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL PRESSURES UPR/LXTR","code_information":[{"code":"93923","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":741.96,"maximum":741.96,"gross_charge":916,"discounted_cash":271.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":741.96,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL PRESSURES UPR/LXTR","code_information":[{"code":"93923","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":137.4,"maximum":741.96,"gross_charge":916,"discounted_cash":271.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":436.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":357.24,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":220.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":245.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL LXTR EXERCISE","code_information":[{"code":"93924","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":741.96,"maximum":741.96,"gross_charge":916,"discounted_cash":271.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":741.96,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL LXTR EXERCISE","code_information":[{"code":"93924","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":137.4,"maximum":741.96,"gross_charge":916,"discounted_cash":271.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":741.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":550.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":458.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":278.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":310.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL DOPPLER LEGS BIL","code_information":[{"code":"93925","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":810.81,"maximum":810.81,"gross_charge":1001,"discounted_cash":296.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810.81,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL DOPPLER LEGS BIL","code_information":[{"code":"93925","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":150.15,"maximum":850.18,"gross_charge":1001,"discounted_cash":296.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":850.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":630.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":430.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":479.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL DOPPLER LEG UNI","code_information":[{"code":"93926","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1362.42,"maximum":1362.42,"gross_charge":1682,"discounted_cash":497.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1362.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1362.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1362.42,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL DOPPLER LEG UNI","code_information":[{"code":"93926","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1362.42,"gross_charge":1682,"discounted_cash":497.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1362.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1362.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1362.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":494.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":355.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":252.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":280.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL DOPPLER ARMS BIL","code_information":[{"code":"93930","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1143.72,"maximum":1143.72,"gross_charge":1412,"discounted_cash":417.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1143.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1143.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1143.72,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL DOPPLER ARMS BIL","code_information":[{"code":"93930","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":211.8,"maximum":1143.72,"gross_charge":1412,"discounted_cash":417.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1143.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1143.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1143.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":650.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":633.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":333.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":371.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC ARTERIAL DOPPLER ARM UNI","code_information":[{"code":"93931","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":571.86,"maximum":571.86,"gross_charge":706,"discounted_cash":208.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":571.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":571.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":571.86,"methodology":"fee schedule"}]}]},{"description":"HC ARTERIAL DOPPLER ARM UNI","code_information":[{"code":"93931","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":619,"gross_charge":706,"discounted_cash":208.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":571.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":571.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":571.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":406.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":433.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":208.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":232.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC VENOUS DOPPLER EXT BIL","code_information":[{"code":"93970","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":986.58,"maximum":986.58,"gross_charge":1218,"discounted_cash":360.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":986.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":986.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":986.58,"methodology":"fee schedule"}]}]},{"description":"HC VENOUS DOPPLER EXT BIL","code_information":[{"code":"93970","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":182.7,"maximum":986.58,"gross_charge":1218,"discounted_cash":360.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":986.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":986.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":986.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":629.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":465.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":322.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":358.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC VENOUS DOPPLER EXT UNI","code_information":[{"code":"93971","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":710.37,"maximum":710.37,"gross_charge":877,"discounted_cash":259.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":710.37,"methodology":"fee schedule"}]}]},{"description":"HC VENOUS DOPPLER EXT UNI","code_information":[{"code":"93971","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":710.37,"gross_charge":877,"discounted_cash":259.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":385.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":278.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":199.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":222.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC DUPLEX DOPPLER COMPL","code_information":[{"code":"93975","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1437.75,"maximum":1437.75,"gross_charge":1775,"discounted_cash":525.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1437.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1437.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1437.75,"methodology":"fee schedule"}]}]},{"description":"HC DUPLEX DOPPLER COMPL","code_information":[{"code":"93975","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":1437.75,"gross_charge":1775,"discounted_cash":525.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1437.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1437.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1437.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":866.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":823.06,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":440.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":490.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":355,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":355,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC DUPLEX DOPPLER LTD","code_information":[{"code":"93976","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1236.87,"maximum":1236.87,"gross_charge":1527,"discounted_cash":452,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1236.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1236.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1236.87,"methodology":"fee schedule"}]}]},{"description":"HC DUPLEX DOPPLER LTD","code_information":[{"code":"93976","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":1236.87,"gross_charge":1527,"discounted_cash":452,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1236.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1236.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1236.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":487.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":461.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":249.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":277.7,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC DUPLXX A IVC IL/BPG COMPL","code_information":[{"code":"93978","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":1409.4,"maximum":1409.4,"gross_charge":1740,"discounted_cash":515.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1409.4,"methodology":"fee schedule"}]}]},{"description":"HC DUPLXX A IVC IL/BPG COMPL","code_information":[{"code":"93978","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":1409.4,"gross_charge":1740,"discounted_cash":515.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1409.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":585.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":589.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":298.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":332.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":348,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":261,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":348,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC DUPLEX A IVC IL/BPG LTD","code_information":[{"code":"93979","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":532.17,"maximum":532.17,"gross_charge":657,"discounted_cash":194.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.17,"methodology":"fee schedule"}]}]},{"description":"HC DUPLEX A IVC IL/BPG LTD","code_information":[{"code":"93979","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":619,"gross_charge":657,"discounted_cash":194.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":374.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":410.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":193.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":215.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"PRE-OP DIALYS FIS PL BIL-ECVAS","code_information":[{"code":"93985","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":780.84,"maximum":780.84,"gross_charge":964,"discounted_cash":285.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":780.84,"methodology":"fee schedule"}]}]},{"description":"PRE-OP DIALYS FIS PL BIL-ECVAS","code_information":[{"code":"93985","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":144.6,"maximum":889.08,"gross_charge":964,"discounted_cash":285.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":889.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":704.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":457.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":508.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"PRE-OP DIALYS FIS PL UNI-ECVAS","code_information":[{"code":"93986","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":375.84,"maximum":375.84,"gross_charge":464,"discounted_cash":137.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.84,"methodology":"fee schedule"}]}]},{"description":"PRE-OP DIALYS FIS PL UNI-ECVAS","code_information":[{"code":"93986","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":69.6,"maximum":619,"gross_charge":464,"discounted_cash":137.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":505.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":400.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":260.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":289.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"HC DUPLEX HEMODIALYSIS ACCCESS","code_information":[{"code":"93990","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":605.07,"maximum":605.07,"gross_charge":747,"discounted_cash":221.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":605.07,"methodology":"fee schedule"}]}]},{"description":"HC DUPLEX HEMODIALYSIS ACCCESS","code_information":[{"code":"93990","type":"CPT"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":95.07,"maximum":619,"gross_charge":747,"discounted_cash":221.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":232.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":160.41,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":515.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":556.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":162.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":261.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":291.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":95.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":101.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":97.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":99.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":104.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":100.77,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"minimum":10426,"maximum":31357,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18979,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17943,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12309,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26654,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":24990,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28509.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23815,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28394,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22875,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":30010.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31357,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19469,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19469,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10426,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16672.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17839.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17172.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17505.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17672.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17505.91,"methodology":"case rate"}]}]},{"description":"HC VENT MGMT INIT DAY","code_information":[{"code":"94002","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":1863,"maximum":1863,"gross_charge":2300,"discounted_cash":680.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1863,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1863,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1863,"methodology":"fee schedule"}]}]},{"description":"HC VENT MGMT INIT DAY","code_information":[{"code":"94002","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":121,"maximum":1863,"gross_charge":2300,"discounted_cash":680.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1863,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1863,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1863,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1447.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1447.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":914.32,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1010.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":437,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":460,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":345,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":460,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":591.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":632.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":608.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":620.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":650.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":626.51,"methodology":"case rate"}]}]},{"description":"HC VENT MGMT SUBQ DAY","code_information":[{"code":"94003","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":1791.72,"maximum":1791.72,"gross_charge":2212,"discounted_cash":654.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1791.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1791.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1791.72,"methodology":"fee schedule"}]}]},{"description":"HC VENT MGMT SUBQ DAY","code_information":[{"code":"94003","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":121,"maximum":1791.72,"gross_charge":2212,"discounted_cash":654.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1791.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1791.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1791.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1447.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1447.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":914.32,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1010.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":420.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":591.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":632.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":608.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":620.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":650.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":626.51,"methodology":"case rate"}]}]},{"description":"HC SPIROMETRY W/O BRONCH","code_information":[{"code":"94010","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":607.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"}]}]},{"description":"HC SPIROMETRY W/O BRONCH","code_information":[{"code":"94010","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":83.53,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":105.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":83.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC SPIROMETRY W/BRONCHODILATOR","code_information":[{"code":"94060","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":803.52,"maximum":803.52,"gross_charge":992,"discounted_cash":293.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":803.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":803.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":803.52,"methodology":"fee schedule"}]}]},{"description":"HC SPIROMETRY W/BRONCHODILATOR","code_information":[{"code":"94060","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":144.58,"maximum":803.52,"gross_charge":992,"discounted_cash":293.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":803.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":803.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":803.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":181.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":144.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC METHACOLINE STUDY","code_information":[{"code":"94070","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":3158.19,"maximum":3158.19,"gross_charge":3899,"discounted_cash":1154.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3158.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3158.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3158.19,"methodology":"fee schedule"}]}]},{"description":"HC METHACOLINE STUDY","code_information":[{"code":"94070","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":93.33,"maximum":3158.19,"gross_charge":3899,"discounted_cash":1154.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3158.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3158.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3158.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":120.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":93.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":740.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":584.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":779.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"minimum":7886,"maximum":29023,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17567,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16608,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10545,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16290,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15273,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26783.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20401,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":24323,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19596,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":28193.55,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29023,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":18021,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":18021,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7886,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15663.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16759.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16132.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16446.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16602.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16446.24,"methodology":"case rate"}]}]},{"description":"HC TOTAL VITAL CAPACITY","code_information":[{"code":"94150","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":442.26,"maximum":442.26,"gross_charge":546,"discounted_cash":161.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"}]}]},{"description":"HC TOTAL VITAL CAPACITY","code_information":[{"code":"94150","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":64.99,"maximum":442.26,"gross_charge":546,"discounted_cash":161.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":442.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":84.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"REHABILITATION WITH CC/MCC","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"minimum":12914.87,"maximum":31541,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31541,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":29572,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":22084.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16270,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19398,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15937,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":23246.77,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22670,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":14076,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":14076,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21116,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12914.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13818.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13302.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13560.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13689.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13560.62,"methodology":"case rate"}]}]},{"description":"REHABILITATION WITHOUT CC/MCC","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"minimum":4806,"maximum":21394,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_percentage":53,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21394,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20059,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17580.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12134,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14467,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10692,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18505.84,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16581,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10295,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10295,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4806,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10281.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11000.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10589.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10795.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10897.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10795.08,"methodology":"case rate"}]}]},{"description":"HC PULM STRESS TEST 6MWT","code_information":[{"code":"94618","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":386.37,"maximum":386.37,"gross_charge":477,"discounted_cash":141.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":386.37,"methodology":"fee schedule"}]}]},{"description":"HC PULM STRESS TEST 6MWT","code_information":[{"code":"94618","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":34.71,"maximum":386.37,"gross_charge":477,"discounted_cash":141.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":42.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"CARDIOPULMONARY EXERCISE TEST","code_information":[{"code":"94621","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":836.73,"maximum":836.73,"gross_charge":1033,"discounted_cash":305.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":836.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":836.73,"methodology":"fee schedule"}]}]},{"description":"CARDIOPULMONARY EXERCISE TEST","code_information":[{"code":"94621","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":154.95,"maximum":836.73,"gross_charge":1033,"discounted_cash":305.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":836.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":836.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":836.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":357.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":287.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"PULM RHB W/O CONT OXIM MONI","code_information":[{"code":"94625","type":"CPT"},{"code":"0948","type":"RC"}],"standard_charges":[{"minimum":187.11,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"}]}]},{"description":"PULM RHB W/O CONT OXIM MONI","code_information":[{"code":"94625","type":"CPT"},{"code":"0948","type":"RC"}],"standard_charges":[{"minimum":34.65,"maximum":285,"gross_charge":231,"discounted_cash":68.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"}]}]},{"description":"PULM RHB W/CONT OXIM MONITOR","code_information":[{"code":"94626","type":"CPT"},{"code":"0948","type":"RC"}],"standard_charges":[{"minimum":187.11,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"}]}]},{"description":"PULM RHB W/CONT OXIM MONITOR","code_information":[{"code":"94626","type":"CPT"},{"code":"0948","type":"RC"}],"standard_charges":[{"minimum":34.65,"maximum":285,"gross_charge":231,"discounted_cash":68.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"}]}]},{"description":"HC AIRWAY INHALATION INIT TX","code_information":[{"code":"94640","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":390.42,"maximum":390.42,"gross_charge":482,"discounted_cash":142.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":390.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.42,"methodology":"fee schedule"}]}]},{"description":"HC AIRWAY INHALATION INIT TX","code_information":[{"code":"94640","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":55.16,"maximum":445.3,"gross_charge":482,"discounted_cash":142.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":390.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":311.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":70.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":55.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":310.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":181.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":194.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":187.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":200.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":192.75,"methodology":"case rate"}]}]},{"description":"HC AEROSOL PENTAMIDINE TX","code_information":[{"code":"94642","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":1063.53,"maximum":1063.53,"gross_charge":1313,"discounted_cash":388.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1063.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1063.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1063.53,"methodology":"fee schedule"}]}]},{"description":"HC AEROSOL PENTAMIDINE TX","code_information":[{"code":"94642","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":75.8,"maximum":1063.53,"gross_charge":1313,"discounted_cash":388.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1063.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1063.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1063.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":311.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":310.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":181.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":194.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":187.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":200.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":192.75,"methodology":"case rate"}]}]},{"description":"HC CONT NEB INITIAL HR","code_information":[{"code":"94644","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":200.88,"maximum":200.88,"gross_charge":248,"discounted_cash":73.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.88,"methodology":"fee schedule"}]}]},{"description":"HC CONT NEB INITIAL HR","code_information":[{"code":"94644","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":37.2,"maximum":282.21,"gross_charge":248,"discounted_cash":73.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":193.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":165.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC CONT NEB EA ADDL HR","code_information":[{"code":"94645","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC CONT NEB EA ADDL HR","code_information":[{"code":"94645","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":21.3,"maximum":189.52,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":64.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"}]}]},{"description":"HC NASAL CPAP/BIPAP SUBQ DAY","code_information":[{"code":"94660","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":396.9,"maximum":396.9,"gross_charge":490,"discounted_cash":145.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"}]}]},{"description":"HC NASAL CPAP/BIPAP SUBQ DAY","code_information":[{"code":"94660","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":73.5,"maximum":445.3,"gross_charge":490,"discounted_cash":145.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":311.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":259.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":200.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":310.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":181.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":194.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":187.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":200.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":192.75,"methodology":"case rate"}]}]},{"description":"HC EVAL PT USE OF INHALER/NEB/IPPB","code_information":[{"code":"94664","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":319.14,"maximum":319.14,"gross_charge":394,"discounted_cash":116.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.14,"methodology":"fee schedule"}]}]},{"description":"HC EVAL PT USE OF INHALER/NEB/IPPB","code_information":[{"code":"94664","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":51.9,"maximum":445.3,"gross_charge":394,"discounted_cash":116.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":311.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66.13,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":310.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":181.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":194.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":187.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":200.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":192.75,"methodology":"case rate"}]}]},{"description":"HC CHEST PT INIT OR EVAL","code_information":[{"code":"94667","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":211.41,"maximum":211.41,"gross_charge":261,"discounted_cash":77.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":211.41,"methodology":"fee schedule"}]}]},{"description":"HC CHEST PT INIT OR EVAL","code_information":[{"code":"94667","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":39.15,"maximum":282.21,"gross_charge":261,"discounted_cash":77.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":211.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":97.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":76.99,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC CHEST PT SUBSEQ","code_information":[{"code":"94668","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":157.95,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"}]}]},{"description":"HC CHEST PT SUBSEQ","code_information":[{"code":"94668","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":29.25,"maximum":282.21,"gross_charge":195,"discounted_cash":57.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":126.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":88.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC MECHANICAL CHEST WALL OSCILL","code_information":[{"code":"94669","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":625.32,"maximum":625.32,"gross_charge":772,"discounted_cash":228.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":625.32,"methodology":"fee schedule"}]}]},{"description":"HC MECHANICAL CHEST WALL OSCILL","code_information":[{"code":"94669","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":107.5,"maximum":625.32,"gross_charge":772,"discounted_cash":228.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":625.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":445.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":311.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":123.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":107.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":310.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":181.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":194.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":187.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":190.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":200.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":192.75,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS WITH MCC","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"minimum":7111,"maximum":20468.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11562,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10930,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7111,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10775,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":10102,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19444.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13139,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15665,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13214,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":20468.13,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19101,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":11860,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":11860,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9078,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11371.18,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12167.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":11712.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11939.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12053.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11939.74,"methodology":"case rate"}]}]},{"description":"HC PUL FT PLETHYSMGRPH W/BD","code_information":[{"code":"94726","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":439.02,"maximum":439.02,"gross_charge":542,"discounted_cash":160.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.02,"methodology":"fee schedule"}]}]},{"description":"HC PUL FT PLETHYSMGRPH W/BD","code_information":[{"code":"94726","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":81.3,"maximum":681.75,"gross_charge":542,"discounted_cash":160.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":439.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":162.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":123.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC DLCO (SINGLE BREATH DIFF)","code_information":[{"code":"94729","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":571.05,"maximum":571.05,"gross_charge":705,"discounted_cash":208.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":571.05,"methodology":"fee schedule"}]}]},{"description":"HC DLCO (SINGLE BREATH DIFF)","code_information":[{"code":"94729","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":105.75,"maximum":571.05,"gross_charge":705,"discounted_cash":208.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":571.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":180.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"}]}]},{"description":"HC EXERCISE DESAT STUDY","code_information":[{"code":"94761","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC EXERCISE DESAT STUDY","code_information":[{"code":"94761","type":"CPT"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":14.81,"maximum":189.52,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"}]}]},{"description":"HC EXERCISE DESAT STUDY","code_information":[{"code":"94761","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC EXERCISE DESAT STUDY","code_information":[{"code":"94761","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":14.81,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"}]}]},{"description":"HC PULSE OXIMETRY OVERNIGHT","code_information":[{"code":"94762","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":405,"maximum":405,"gross_charge":500,"discounted_cash":148,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405,"methodology":"fee schedule"}]}]},{"description":"HC PULSE OXIMETRY OVERNIGHT","code_information":[{"code":"94762","type":"CPT"},{"code":"0460","type":"RC"}],"standard_charges":[{"minimum":74.78,"maximum":405,"gross_charge":500,"discounted_cash":148,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":98.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS WITHOUT MCC","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":4551,"maximum":14782.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7142,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6752,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4551,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":7594,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7120,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":14043.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8405,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10021,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8457,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":14782.45,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11799,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":7326,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":7326,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4888,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8212.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":8787.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":8458.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":8623.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":8705.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":8623.1,"methodology":"case rate"}]}]},{"description":"AFTERCARE WITH CC/MCC","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"minimum":6095,"maximum":18072.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9699,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9169,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6095,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10462,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9809,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17168.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12884,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15361,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11327,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18072.2,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16024,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9949,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9949,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13084,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10040.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10742.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10341.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10542.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10642.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10542.12,"methodology":"case rate"}]}]},{"description":"AFTERCARE WITHOUT CC/MCC","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"minimum":3628,"maximum":12372.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5268,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4981,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3628,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9096,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8528,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11754.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7669,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9143,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6742,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12372.66,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8704,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5404,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4569,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6873.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7354.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7079.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7217.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7286.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7217.39,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9501","type":"APR-DRG"}],"standard_charges":[{"minimum":10154,"maximum":10154,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10154,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10154,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10154,"methodology":"case rate"}]}]},{"description":"HC ALLERGY TESTING (PRE-PEN)","code_information":[{"code":"95018","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":108.54,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"}]}]},{"description":"HC ALLERGY TESTING (PRE-PEN)","code_information":[{"code":"95018","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":20.1,"maximum":259,"gross_charge":134,"discounted_cash":39.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":259,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9502","type":"APR-DRG"}],"standard_charges":[{"minimum":18337,"maximum":18337,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18337,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18337,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18337,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9503","type":"APR-DRG"}],"standard_charges":[{"minimum":30984,"maximum":30984,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30984,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30984,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30984,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9504","type":"APR-DRG"}],"standard_charges":[{"minimum":75128,"maximum":75128,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75128,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75128,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75128,"methodology":"case rate"}]}]},{"description":"OTHER FACTORS INFLUENCING HEALTH STATUS","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"minimum":3032,"maximum":12151.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5097,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4818,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3352,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8934,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8376,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11544.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6152,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7335,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6229,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":12151.82,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8421,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5228,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5228,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3032,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6751.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7223.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6953.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7088.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7156.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7088.57,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9511","type":"APR-DRG"}],"standard_charges":[{"minimum":6637,"maximum":6637,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6637,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6637,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6637,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9512","type":"APR-DRG"}],"standard_charges":[{"minimum":14476,"maximum":14476,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14476,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14476,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14476,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9513","type":"APR-DRG"}],"standard_charges":[{"minimum":24520,"maximum":24520,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24520,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24520,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24520,"methodology":"case rate"}]}]},{"description":"MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9514","type":"APR-DRG"}],"standard_charges":[{"minimum":28475,"maximum":28475,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28475,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28475,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28475,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9521","type":"APR-DRG"}],"standard_charges":[{"minimum":6654,"maximum":6654,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6654,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6654,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6654,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9522","type":"APR-DRG"}],"standard_charges":[{"minimum":12155,"maximum":12155,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12155,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12155,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12155,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9523","type":"APR-DRG"}],"standard_charges":[{"minimum":19003,"maximum":19003,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19003,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19003,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19003,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS","code_information":[{"code":"9524","type":"APR-DRG"}],"standard_charges":[{"minimum":25531,"maximum":25531,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25531,"methodology":"case rate"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25531,"methodology":"case rate"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25531,"methodology":"case rate"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"minimum":34600,"maximum":104938,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61379,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":58027,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34600,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":104938,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":98387,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":80325.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":72809,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86807,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64300,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":84552.93,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101407,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":62964,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":62964,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35329,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46973.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":50262.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":48383.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":49322.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":49792.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":49322.55,"methodology":"case rate"}]}]},{"description":"LIMB REATTACHMENT HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"minimum":22033,"maximum":142554,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34359,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32483,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22033,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":142554,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":133655,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":47305.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41120,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49025,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40946,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":49794.9,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56767,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35246,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35246,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33194,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27663.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29600.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28493.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":29047.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29323.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":29047.03,"methodology":"case rate"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"minimum":41090,"maximum":110851,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67096,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":63431,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":41090,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106713,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":100051,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":87310.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":80100,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":95499,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76361,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":91906.01,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110851,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":68827,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":68827,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50331,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":51058.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":54633.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":52590.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":53611.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":54122.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":53611.84,"methodology":"case rate"}]}]},{"description":"TECH SETUP","code_information":[{"code":"95700","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":851.31,"maximum":851.31,"gross_charge":1051,"discounted_cash":311.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":851.31,"methodology":"fee schedule"}]}]},{"description":"TECH SETUP","code_information":[{"code":"95700","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":139.88,"maximum":1246,"gross_charge":1051,"discounted_cash":311.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1083.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":858.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"EEG W/O VID INC 12-26 HRS; UNM","code_information":[{"code":"95708","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1631.34,"maximum":1631.34,"gross_charge":2014,"discounted_cash":596.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.34,"methodology":"fee schedule"}]}]},{"description":"EEG W/O VID INC 12-26 HRS; UNM","code_information":[{"code":"95708","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":302.1,"maximum":2078.41,"gross_charge":2014,"discounted_cash":596.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1631.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2078.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1646.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":402.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"EEG/W-VIDEO 120-720 MIN","code_information":[{"code":"95711","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":906.39,"maximum":906.39,"gross_charge":1119,"discounted_cash":331.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":906.39,"methodology":"fee schedule"}]}]},{"description":"EEG/W-VIDEO 120-720 MIN","code_information":[{"code":"95711","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":167.85,"maximum":1246,"gross_charge":1119,"discounted_cash":331.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1083.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":858.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"EEG W/VIDEO 12-26 HRS UNMONITORED","code_information":[{"code":"95714","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1812.78,"maximum":1812.78,"gross_charge":2238,"discounted_cash":662.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1812.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1812.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1812.78,"methodology":"fee schedule"}]}]},{"description":"EEG W/VIDEO 12-26 HRS UNMONITORED","code_information":[{"code":"95714","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":335.7,"maximum":2078.41,"gross_charge":2238,"discounted_cash":662.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1812.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1812.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1812.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2078.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1646.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"minimum":20738,"maximum":71966,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36943,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":34925,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22980,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":71966,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":67473,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50462.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45079,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53745,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42705,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":53118.17,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61035,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":37896,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":37896,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20738,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29510.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31575.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30395.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30985.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31280.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30985.6,"methodology":"case rate"}]}]},{"description":"HC SLEEP STUDY UNATTENDED","code_information":[{"code":"95800","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":465.75,"maximum":465.75,"gross_charge":575,"discounted_cash":170.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.75,"methodology":"fee schedule"}]}]},{"description":"HC SLEEP STUDY UNATTENDED","code_information":[{"code":"95800","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":86.25,"maximum":711,"gross_charge":575,"discounted_cash":170.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":498.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":385.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":115,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC SLEEP STUDY UNATND W/ANAL","code_information":[{"code":"95801","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":174.15,"maximum":174.15,"gross_charge":215,"discounted_cash":63.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"}]}]},{"description":"HC SLEEP STUDY UNATND W/ANAL","code_information":[{"code":"95801","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":32.25,"maximum":711,"gross_charge":215,"discounted_cash":63.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":191.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":139.13,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC SLEEP LATENCY/WAKEFUL TEST","code_information":[{"code":"95805","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":9945.18,"maximum":9945.18,"gross_charge":12278,"discounted_cash":3634.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9945.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9945.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9945.18,"methodology":"fee schedule"}]}]},{"description":"HC SLEEP LATENCY/WAKEFUL TEST","code_information":[{"code":"95805","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":474.38,"maximum":9945.18,"gross_charge":12278,"discounted_cash":3634.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9945.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9945.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9945.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1412.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1102.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2332.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2455.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1841.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2455.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"HC HOME SLEEP TESTING","code_information":[{"code":"95806","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":696.6,"maximum":696.6,"gross_charge":860,"discounted_cash":254.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.6,"methodology":"fee schedule"}]}]},{"description":"HC HOME SLEEP TESTING","code_information":[{"code":"95806","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":129,"maximum":711,"gross_charge":860,"discounted_cash":254.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":345.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":335.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":172,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC MSLT-REDUCED","code_information":[{"code":"95810","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":2702.97,"maximum":2702.97,"gross_charge":3337,"discounted_cash":987.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2702.97,"methodology":"fee schedule"}]}]},{"description":"HC MSLT-REDUCED","code_information":[{"code":"95810","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":500.55,"maximum":2702.97,"gross_charge":3337,"discounted_cash":987.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1525.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1926.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1508.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1555.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":909.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":973.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":936.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":955.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1000.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":964.17,"methodology":"case rate"}]}]},{"description":"HC POLYSOMNOGRAPHY","code_information":[{"code":"95810","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":6006.96,"maximum":6006.96,"gross_charge":7416,"discounted_cash":2195.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6006.96,"methodology":"fee schedule"}]}]},{"description":"HC POLYSOMNOGRAPHY","code_information":[{"code":"95810","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":909.59,"maximum":6006.96,"gross_charge":7416,"discounted_cash":2195.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1525.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1926.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1508.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1555.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1409.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":909.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":973.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":936.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":955.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1000.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":964.17,"methodology":"case rate"}]}]},{"description":"HC POLYSOMNOGRAPHY W/CPAP","code_information":[{"code":"95811","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":6006.96,"maximum":6006.96,"gross_charge":7416,"discounted_cash":2195.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6006.96,"methodology":"fee schedule"}]}]},{"description":"HC POLYSOMNOGRAPHY W/CPAP","code_information":[{"code":"95811","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":909.59,"maximum":6006.96,"gross_charge":7416,"discounted_cash":2195.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6006.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1525.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2024.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1586.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1555.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1409.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1112.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1483.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":909.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":973.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":936.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":955.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1000.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":964.17,"methodology":"case rate"}]}]},{"description":"REDUCED CPAP UNDER 6 HOURS","code_information":[{"code":"95811","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":2702.97,"maximum":2702.97,"gross_charge":3337,"discounted_cash":987.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2702.97,"methodology":"fee schedule"}]}]},{"description":"REDUCED CPAP UNDER 6 HOURS","code_information":[{"code":"95811","type":"CPT"},{"code":"0920","type":"RC"}],"standard_charges":[{"minimum":500.55,"maximum":2702.97,"gross_charge":3337,"discounted_cash":987.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2702.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2227.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1525.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2024.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1586.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1555.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1422,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":909.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":973.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":936.88,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":955.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1000.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":964.17,"methodology":"case rate"}]}]},{"description":"HC EEG EXT MONITORING40-60MIN","code_information":[{"code":"95812","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1589.22,"maximum":1589.22,"gross_charge":1962,"discounted_cash":580.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1589.22,"methodology":"fee schedule"}]}]},{"description":"HC EEG EXT MONITORING40-60MIN","code_information":[{"code":"95812","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":278.4,"maximum":1589.22,"gross_charge":1962,"discounted_cash":580.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1046.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1142.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC EEG EXT MONITORING 61-119 MIN","code_information":[{"code":"95813","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1589.22,"maximum":1589.22,"gross_charge":1962,"discounted_cash":580.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1589.22,"methodology":"fee schedule"}]}]},{"description":"HC EEG EXT MONITORING 61-119 MIN","code_information":[{"code":"95813","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":278.4,"maximum":1589.22,"gross_charge":1962,"discounted_cash":580.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1589.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1240.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1259.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC EEG AWAKE AND DROWSY","code_information":[{"code":"95816","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1268.46,"maximum":1268.46,"gross_charge":1566,"discounted_cash":463.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1268.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1268.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1268.46,"methodology":"fee schedule"}]}]},{"description":"HC EEG AWAKE AND DROWSY","code_information":[{"code":"95816","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":234.9,"maximum":1268.46,"gross_charge":1566,"discounted_cash":463.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1268.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1268.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1268.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1196.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":900.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC EEG AWAKE/ASLEEP & SLEEP","code_information":[{"code":"95819","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1509.84,"maximum":1509.84,"gross_charge":1864,"discounted_cash":551.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1509.84,"methodology":"fee schedule"}]}]},{"description":"HC EEG AWAKE/ASLEEP & SLEEP","code_information":[{"code":"95819","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":278.4,"maximum":1509.84,"gross_charge":1864,"discounted_cash":551.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1509.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1447.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1054.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":372.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"EEG SLEEP OR COMA","code_information":[{"code":"95822","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":1510.65,"maximum":1510.65,"gross_charge":1865,"discounted_cash":552.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1510.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1510.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1510.65,"methodology":"fee schedule"}]}]},{"description":"EEG SLEEP OR COMA","code_information":[{"code":"95822","type":"CPT"},{"code":"0740","type":"RC"}],"standard_charges":[{"minimum":278.4,"maximum":1510.65,"gross_charge":1865,"discounted_cash":552.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1510.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1510.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1510.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1282.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":920.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1246,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":373,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":373,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC EMG 1 EXTREMITY","code_information":[{"code":"95860","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":1257.12,"maximum":1257.12,"gross_charge":1552,"discounted_cash":459.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1257.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1257.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1257.12,"methodology":"fee schedule"}]}]},{"description":"HC EMG 1 EXTREMITY","code_information":[{"code":"95860","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":115.24,"maximum":1257.12,"gross_charge":1552,"discounted_cash":459.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1257.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1257.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1257.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":271.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":221.64,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":232.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC EMG 2 EXTREMITY","code_information":[{"code":"95861","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":2664.9,"maximum":2664.9,"gross_charge":3290,"discounted_cash":973.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2664.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2664.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2664.9,"methodology":"fee schedule"}]}]},{"description":"HC EMG 2 EXTREMITY","code_information":[{"code":"95861","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":115.24,"maximum":2664.9,"gross_charge":3290,"discounted_cash":973.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2664.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2664.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2664.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":352.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":285.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":625.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":658,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":658,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC EMG 3 EXTREMITY","code_information":[{"code":"95863","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":3347.73,"maximum":3347.73,"gross_charge":4133,"discounted_cash":1223.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3347.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3347.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3347.73,"methodology":"fee schedule"}]}]},{"description":"HC EMG 3 EXTREMITY","code_information":[{"code":"95863","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":139.88,"maximum":3347.73,"gross_charge":4133,"discounted_cash":1223.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3347.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3347.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3347.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":458.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":382.19,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":785.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":619.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":826.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC EMG 4 EXTREMITY","code_information":[{"code":"95864","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":5311.17,"maximum":5311.17,"gross_charge":6557,"discounted_cash":1940.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5311.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5311.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5311.17,"methodology":"fee schedule"}]}]},{"description":"HC EMG 4 EXTREMITY","code_information":[{"code":"95864","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":139.88,"maximum":5311.17,"gross_charge":6557,"discounted_cash":1940.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5311.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5311.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5311.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":558.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":443.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1245.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1311.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC LIM STUDIES-ONE EXTREM UNI/BI","code_information":[{"code":"95870","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":248.67,"maximum":248.67,"gross_charge":307,"discounted_cash":90.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.67,"methodology":"fee schedule"}]}]},{"description":"HC LIM STUDIES-ONE EXTREM UNI/BI","code_information":[{"code":"95870","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":46.05,"maximum":710,"gross_charge":307,"discounted_cash":90.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":278.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":233.74,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC EMG EACH EXTREMITY LIMITED","code_information":[{"code":"95885","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":977.67,"maximum":977.67,"gross_charge":1207,"discounted_cash":357.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":977.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":977.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":977.67,"methodology":"fee schedule"}]}]},{"description":"HC EMG EACH EXTREMITY LIMITED","code_information":[{"code":"95885","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":120.58,"maximum":977.67,"gross_charge":1207,"discounted_cash":357.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":977.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":977.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":977.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":165.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":120.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.4,"methodology":"fee schedule"}]}]},{"description":"HC EMG EA EXTRM 5/MORE MUSCLES","code_information":[{"code":"95886","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":2715.93,"maximum":2715.93,"gross_charge":3353,"discounted_cash":992.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2715.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2715.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2715.93,"methodology":"fee schedule"}]}]},{"description":"HC EMG EA EXTRM 5/MORE MUSCLES","code_information":[{"code":"95886","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":136.96,"maximum":2715.93,"gross_charge":3353,"discounted_cash":992.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2715.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2715.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2715.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":189,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":637.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.6,"methodology":"fee schedule"}]}]},{"description":"HC EMG NON-EXTRM CRANIAL","code_information":[{"code":"95887","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":163.62,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"}]}]},{"description":"HC EMG NON-EXTRM CRANIAL","code_information":[{"code":"95887","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":30.3,"maximum":710,"gross_charge":202,"discounted_cash":59.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":173.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":146.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"minimum":12773,"maximum":48126,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23766,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22468,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14387,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48126,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45122,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34359.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27765,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33103,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26737,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36167.57,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39265,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24379,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24379,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12773,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20093.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21499.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20695.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21097.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21298.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21097.75,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDT STDY 1-2 STDS","code_information":[{"code":"95907","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":523.26,"maximum":523.26,"gross_charge":646,"discounted_cash":191.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":523.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":523.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":523.26,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDT STDY 1-2 STDS","code_information":[{"code":"95907","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":96.9,"maximum":710,"gross_charge":646,"discounted_cash":191.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":523.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":523.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":523.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":164.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":125.12,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDT STDY 3-4 STDS","code_information":[{"code":"95908","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":613.17,"maximum":613.17,"gross_charge":757,"discounted_cash":224.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":613.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":613.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":613.17,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDT STDY 3-4 STDS","code_information":[{"code":"95908","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":113.55,"maximum":710,"gross_charge":757,"discounted_cash":224.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":613.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":613.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":613.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":220.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDUCTION 5-6 STUDIES","code_information":[{"code":"95909","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":1052.19,"maximum":1052.19,"gross_charge":1299,"discounted_cash":384.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1052.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1052.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1052.19,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDUCTION 5-6 STUDIES","code_information":[{"code":"95909","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":184.21,"maximum":1052.19,"gross_charge":1299,"discounted_cash":384.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1052.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1052.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1052.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":263.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":184.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":259.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDT STDY 7-8 STDS","code_information":[{"code":"95910","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":696.6,"maximum":696.6,"gross_charge":860,"discounted_cash":254.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.6,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDT STDY 7-8 STDS","code_information":[{"code":"95910","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":129,"maximum":710,"gross_charge":860,"discounted_cash":254.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":681.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":457.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":338.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":237.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":476.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":172,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":129,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":278.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":297.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":286.75,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":292.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":306.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":295.1,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDT STDY 9-10 STDS","code_information":[{"code":"95911","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":780.84,"maximum":780.84,"gross_charge":964,"discounted_cash":285.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":780.84,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDT STDY 9-10 STDS","code_information":[{"code":"95911","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":144.6,"maximum":1161.66,"gross_charge":964,"discounted_cash":285.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":780.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":387.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":276.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDT STDY 11-12 STDS","code_information":[{"code":"95912","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":843.21,"maximum":843.21,"gross_charge":1041,"discounted_cash":308.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.21,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDT STDY 11-12 STDS","code_information":[{"code":"95912","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":156.15,"maximum":1161.66,"gross_charge":1041,"discounted_cash":308.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":843.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":399.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":315.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"HC NERVE CONDT STDY 13/+ STDS","code_information":[{"code":"95913","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":912.87,"maximum":912.87,"gross_charge":1127,"discounted_cash":333.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":912.87,"methodology":"fee schedule"}]}]},{"description":"HC NERVE CONDT STDY 13/+ STDS","code_information":[{"code":"95913","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":169.05,"maximum":1161.66,"gross_charge":1127,"discounted_cash":333.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":912.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1161.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":782.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":442.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":351.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":811.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":474.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":507.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":488.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":498.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":521.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":502.84,"methodology":"case rate"}]}]},{"description":"HC NEUROMUSC JUNCT(REP STIM)EA","code_information":[{"code":"95937","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":381.51,"maximum":381.51,"gross_charge":471,"discounted_cash":139.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.51,"methodology":"fee schedule"}]}]},{"description":"HC NEUROMUSC JUNCT(REP STIM)EA","code_information":[{"code":"95937","type":"CPT"},{"code":"0922","type":"RC"}],"standard_charges":[{"minimum":70.65,"maximum":710,"gross_charge":471,"discounted_cash":139.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":342.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":227.91,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":207.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":140.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":239.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":710,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":139.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":149.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":144.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":146.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":153.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":148.27,"methodology":"case rate"}]}]},{"description":"HC INTRATHECAL PUMP REFILL","code_information":[{"code":"95990","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1034.37,"maximum":1034.37,"gross_charge":1277,"discounted_cash":378,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1034.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1034.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1034.37,"methodology":"fee schedule"}]}]},{"description":"HC INTRATHECAL PUMP REFILL","code_information":[{"code":"95990","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":191.55,"maximum":3642,"gross_charge":1277,"discounted_cash":378,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1034.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1034.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1034.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":362.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":281.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"minimum":15534,"maximum":61092,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24420,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23086,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15534,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61092,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57278,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35158.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29976,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35738,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28869,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":37009.37,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40346,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":25051,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":25051,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19313,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20560.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22000.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21177.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21588.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21794.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21588.8,"methodology":"case rate"}]}]},{"description":"HC IV INF HYDRA INIT 31-60M","code_information":[{"code":"96360","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":617.22,"maximum":617.22,"gross_charge":762,"discounted_cash":225.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":617.22,"methodology":"fee schedule"}]}]},{"description":"HC IV INF HYDRA INIT 31-60M","code_information":[{"code":"96360","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":617.22,"gross_charge":762,"discounted_cash":225.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":312.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":322.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":201.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":194.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":197.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":207.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":199.67,"methodology":"case rate"}]}]},{"description":"HC IV INF HYDRA EA ADDL HR","code_information":[{"code":"96361","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":374.22,"maximum":374.22,"gross_charge":462,"discounted_cash":136.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.22,"methodology":"fee schedule"}]}]},{"description":"HC IV INF HYDRA EA ADDL HR","code_information":[{"code":"96361","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":41.25,"maximum":389,"gross_charge":462,"discounted_cash":136.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":101.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":69.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.73,"methodology":"case rate"}]}]},{"description":"HC IV INF TX PROP DX INITIAL","code_information":[{"code":"96365","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":763.02,"maximum":763.02,"gross_charge":942,"discounted_cash":278.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":763.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":763.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":763.02,"methodology":"fee schedule"}]}]},{"description":"HC IV INF TX PROP DX INITIAL","code_information":[{"code":"96365","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":763.02,"gross_charge":942,"discounted_cash":278.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":763.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":763.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":763.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":312.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":322.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":201.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":194.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":197.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":207.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":199.67,"methodology":"case rate"}]}]},{"description":"HC IV INF TX PROP DX EA ADD HR","code_information":[{"code":"96366","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":299.7,"maximum":299.7,"gross_charge":370,"discounted_cash":109.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"}]}]},{"description":"HC IV INF TX PROP DX EA ADD HR","code_information":[{"code":"96366","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":41.25,"maximum":389,"gross_charge":370,"discounted_cash":109.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":101.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":69.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.73,"methodology":"case rate"}]}]},{"description":"HC IV INF TX PROP DX ADDL SQ","code_information":[{"code":"96367","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":228.42,"maximum":228.42,"gross_charge":282,"discounted_cash":83.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.42,"methodology":"fee schedule"}]}]},{"description":"HC IV INF TX PROP DX ADDL SQ","code_information":[{"code":"96367","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":42.3,"maximum":389,"gross_charge":282,"discounted_cash":83.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC IV INF TX PROP DX CONCURR","code_information":[{"code":"96368","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":186.3,"maximum":186.3,"gross_charge":230,"discounted_cash":68.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"}]}]},{"description":"HC IV INF TX PROP DX CONCURR","code_information":[{"code":"96368","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":34.5,"maximum":389,"gross_charge":230,"discounted_cash":68.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46,"methodology":"fee schedule"}]}]},{"description":"HC INJ IM/SQ","code_information":[{"code":"96372","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":250.29,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"}]}]},{"description":"HC INJ IM/SQ","code_information":[{"code":"96372","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":46.35,"maximum":389,"gross_charge":309,"discounted_cash":91.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"THYROGEN INJECTION","code_information":[{"code":"96372","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":238.14,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"}]}]},{"description":"THYROGEN INJECTION","code_information":[{"code":"96372","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":44.1,"maximum":389,"gross_charge":294,"discounted_cash":87.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC IVP INJ TX PROP DX SGL/INIT","code_information":[{"code":"96374","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":403.38,"maximum":403.38,"gross_charge":498,"discounted_cash":147.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":403.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":403.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":403.38,"methodology":"fee schedule"}]}]},{"description":"HC IVP INJ TX PROP DX SGL/INIT","code_information":[{"code":"96374","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":74.7,"maximum":461.27,"gross_charge":498,"discounted_cash":147.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":403.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":403.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":403.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":312.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":322.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":201.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":194.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":197.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":207.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":199.67,"methodology":"case rate"}]}]},{"description":"HC IVP INJ TX PROP DX EA AD SQ","code_information":[{"code":"96375","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":258.39,"maximum":258.39,"gross_charge":319,"discounted_cash":94.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":258.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":258.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":258.39,"methodology":"fee schedule"}]}]},{"description":"HC IVP INJ TX PROP DX EA AD SQ","code_information":[{"code":"96375","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":41.25,"maximum":389,"gross_charge":319,"discounted_cash":94.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":258.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":258.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":258.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":101.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":69.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":70.54,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.25,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":42.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":45.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":43.73,"methodology":"case rate"}]}]},{"description":"HC IVP DX/THER INJ EA AD SQ SAME DRUG","code_information":[{"code":"96376","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":123.12,"maximum":123.12,"gross_charge":152,"discounted_cash":45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.12,"methodology":"fee schedule"}]}]},{"description":"HC IVP DX/THER INJ EA AD SQ SAME DRUG","code_information":[{"code":"96376","type":"CPT"},{"code":"0260","type":"RC"}],"standard_charges":[{"minimum":22.8,"maximum":389,"gross_charge":152,"discounted_cash":45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":389,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"minimum":8528,"maximum":28486,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13484,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12748,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8528,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28486,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26708,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21794.43,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15830,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18873,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15848,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22941.51,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22278,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13832,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13832,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10817,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12745.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13637.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":13127.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":13382.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13510,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":13382.55,"methodology":"case rate"}]}]},{"description":"HC CHEMO IM/SQ INJ NON-HRMN","code_information":[{"code":"96401","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":281.88,"maximum":281.88,"gross_charge":348,"discounted_cash":103.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.88,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IM/SQ INJ NON-HRMN","code_information":[{"code":"96401","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":52.2,"maximum":1094,"gross_charge":348,"discounted_cash":103.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":225.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IM/SQ INJ HORMONAL","code_information":[{"code":"96402","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":281.88,"maximum":281.88,"gross_charge":348,"discounted_cash":103.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.88,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IM/SQ INJ HORMONAL","code_information":[{"code":"96402","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":52.2,"maximum":1094,"gross_charge":348,"discounted_cash":103.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":98.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IVP INJ SGL /INIT DRUG","code_information":[{"code":"96409","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":797.04,"maximum":797.04,"gross_charge":984,"discounted_cash":291.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.04,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IVP INJ SGL /INIT DRUG","code_information":[{"code":"96409","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":1094,"gross_charge":984,"discounted_cash":291.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":332.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC CHEMO IVP INJ EA ADD DRUG","code_information":[{"code":"96411","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IVP INJ EA ADD DRUG","code_information":[{"code":"96411","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":45.75,"maximum":1094,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":187.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INFUSION INIT 1HR","code_information":[{"code":"96413","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":922.59,"maximum":922.59,"gross_charge":1139,"discounted_cash":337.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":922.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":922.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":922.59,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INFUSION INIT 1HR","code_information":[{"code":"96413","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":1094,"gross_charge":1139,"discounted_cash":337.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":922.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":922.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":922.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INFUSION INIT 1HR","code_information":[{"code":"96413","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":972.81,"maximum":972.81,"gross_charge":1201,"discounted_cash":355.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972.81,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INFUSION INIT 1HR","code_information":[{"code":"96413","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":1094,"gross_charge":1201,"discounted_cash":355.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INF EA ADD HR","code_information":[{"code":"96415","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":269.73,"maximum":269.73,"gross_charge":333,"discounted_cash":98.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":269.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":269.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":269.73,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INF EA ADD HR","code_information":[{"code":"96415","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":49.95,"maximum":1094,"gross_charge":333,"discounted_cash":98.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":269.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":269.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":269.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INF EA ADD HR","code_information":[{"code":"96415","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":281.07,"maximum":281.07,"gross_charge":347,"discounted_cash":102.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INF EA ADD HR","code_information":[{"code":"96415","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":52.05,"maximum":1094,"gross_charge":347,"discounted_cash":102.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86.95,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INF W/PMP>8HR INT","code_information":[{"code":"96416","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":822.15,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INF W/PMP>8HR INT","code_information":[{"code":"96416","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":1094,"gross_charge":1015,"discounted_cash":300.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":422.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INF W/PMP>8HR INT","code_information":[{"code":"96416","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":868.32,"maximum":868.32,"gross_charge":1072,"discounted_cash":317.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":868.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":868.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":868.32,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INF W/PMP>8HR INT","code_information":[{"code":"96416","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":1094,"gross_charge":1072,"discounted_cash":317.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":868.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":868.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":868.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":422.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC CHEM IV INF SEQ DIF DRG <1H","code_information":[{"code":"96417","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":389.61,"maximum":389.61,"gross_charge":481,"discounted_cash":142.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":389.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":389.61,"methodology":"fee schedule"}]}]},{"description":"HC CHEM IV INF SEQ DIF DRG <1H","code_information":[{"code":"96417","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":63.63,"maximum":1094,"gross_charge":481,"discounted_cash":142.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":389.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":389.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":389.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IV INF SEQ DIF DRG <1H","code_information":[{"code":"96417","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":408.24,"maximum":408.24,"gross_charge":504,"discounted_cash":149.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.24,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IV INF SEQ DIF DRG <1H","code_information":[{"code":"96417","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":63.63,"maximum":1094,"gross_charge":504,"discounted_cash":149.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":102.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.45,"methodology":"case rate"}]}]},{"description":"HC CHEMO IA PUSH TECHNIQUE","code_information":[{"code":"96420","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":374.22,"maximum":374.22,"gross_charge":462,"discounted_cash":136.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.22,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO IA PUSH TECHNIQUE","code_information":[{"code":"96420","type":"CPT"},{"code":"0335","type":"RC"}],"standard_charges":[{"minimum":69.3,"maximum":1094,"gross_charge":462,"discounted_cash":136.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":315.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"HC CHEMO INJ W/LUMBR PUNCT","code_information":[{"code":"96450","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":711.18,"maximum":711.18,"gross_charge":878,"discounted_cash":259.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":711.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":711.18,"methodology":"fee schedule"}]}]},{"description":"HC CHEMO INJ W/LUMBR PUNCT","code_information":[{"code":"96450","type":"CPT"},{"code":"0331","type":"RC"}],"standard_charges":[{"minimum":106,"maximum":1094,"gross_charge":878,"discounted_cash":259.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":711.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":711.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":711.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":726.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":494.12,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":567.93,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":507.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":124,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":135,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1094,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":296.54,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":317.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":305.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":311.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":326.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":314.33,"methodology":"case rate"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"minimum":5372,"maximum":21769,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8203,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":7755,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5431,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21769,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20410,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15340.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9835,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11726,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10092,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":16148.07,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13553,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":8415,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":8415,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5372,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":8971.15,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9599.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9240.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9419.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":9509.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9419.71,"methodology":"case rate"}]}]},{"description":"HC PUMP PORT REFIL/MAINT","code_information":[{"code":"96521","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":322.38,"maximum":322.38,"gross_charge":398,"discounted_cash":117.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":322.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":322.38,"methodology":"fee schedule"}]}]},{"description":"HC PUMP PORT REFIL/MAINT","code_information":[{"code":"96521","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":59.7,"maximum":572.54,"gross_charge":398,"discounted_cash":117.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":322.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":322.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":461.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":312.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":572.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":411.44,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":322.11,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":201.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":194.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":197.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":207.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":199.67,"methodology":"case rate"}]}]},{"description":"HC IRRIG DRUG DELIVERY DEVICE","code_information":[{"code":"96523","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":247.86,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"}]}]},{"description":"HC IRRIG DRUG DELIVERY DEVICE","code_information":[{"code":"96523","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":45.9,"maximum":306,"gross_charge":306,"discounted_cash":90.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":106.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"HC PHOTODYNAMIC THER FIRST 30 MIN","code_information":[{"code":"96570","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":754.11,"maximum":754.11,"gross_charge":931,"discounted_cash":275.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":754.11,"methodology":"fee schedule"}]}]},{"description":"HC PHOTODYNAMIC THER FIRST 30 MIN","code_information":[{"code":"96570","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":139.65,"maximum":754.11,"gross_charge":931,"discounted_cash":275.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":182.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.2,"methodology":"fee schedule"}]}]},{"description":"HC PHOTODYNAMIC THER EA ADD 15MIN","code_information":[{"code":"96571","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":754.11,"maximum":754.11,"gross_charge":931,"discounted_cash":275.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":754.11,"methodology":"fee schedule"}]}]},{"description":"HC PHOTODYNAMIC THER EA ADD 15MIN","code_information":[{"code":"96571","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":86.78,"maximum":754.11,"gross_charge":931,"discounted_cash":275.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":754.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":121.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.2,"methodology":"fee schedule"}]}]},{"description":"HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"minimum":25569,"maximum":93923,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56849,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53744,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39046,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":86030,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":80659,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":74788.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78339,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":93400,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72561,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":78725.04,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93923,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":58316,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":58316,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25569,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43736.13,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":46797.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45048.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45922.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":46360.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45922.94,"methodology":"case rate"}]}]},{"description":"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"minimum":15792,"maximum":61682,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23850,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":22548,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15792,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61682,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57831,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":34462.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33383,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39800,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29347,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":36276.27,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39404,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":24466,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":24466,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17186,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20153.48,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":21564.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":20758.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21161.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21362.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21161.16,"methodology":"case rate"}]}]},{"description":"HC COLD PACK-ICE MASSAGE","code_information":[{"code":"97010","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":101.25,"maximum":101.25,"gross_charge":125,"discounted_cash":37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"}]}]},{"description":"HC COLD PACK-ICE MASSAGE","code_information":[{"code":"97010","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":18.75,"maximum":189.52,"gross_charge":125,"discounted_cash":37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25,"methodology":"fee schedule"}]}]},{"description":"HC HYDROCOLLATOR PACKS","code_information":[{"code":"97010","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":101.25,"maximum":101.25,"gross_charge":125,"discounted_cash":37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"}]}]},{"description":"HC HYDROCOLLATOR PACKS","code_information":[{"code":"97010","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":18.75,"maximum":270,"gross_charge":125,"discounted_cash":37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25,"methodology":"fee schedule"}]}]},{"description":"HC INTERMITTANT TRACTION PELVIC","code_information":[{"code":"97012","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":176.58,"maximum":176.58,"gross_charge":218,"discounted_cash":64.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":176.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":176.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":176.58,"methodology":"fee schedule"}]}]},{"description":"HC INTERMITTANT TRACTION PELVIC","code_information":[{"code":"97012","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":14.57,"maximum":270,"gross_charge":218,"discounted_cash":64.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":176.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":176.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":176.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.6,"methodology":"fee schedule"}]}]},{"description":"HC PARAFFIN","code_information":[{"code":"97018","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":132.84,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"}]}]},{"description":"HC PARAFFIN","code_information":[{"code":"97018","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":5.76,"maximum":270,"gross_charge":164,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"}]}]},{"description":"HC FLUIDO THERAPY","code_information":[{"code":"97022","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC FLUIDO THERAPY","code_information":[{"code":"97022","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":270,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":73.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"}]}]},{"description":"HC FLUIDO THERAPY","code_information":[{"code":"97022","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC FLUIDO THERAPY","code_information":[{"code":"97022","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":17.27,"maximum":189.52,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":73.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRICAL STIM COMPLEX","code_information":[{"code":"97032","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRICAL STIM COMPLEX","code_information":[{"code":"97032","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":14.57,"maximum":189.52,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRICAL STIMUL COMPLEX","code_information":[{"code":"97032","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRICAL STIMUL COMPLEX","code_information":[{"code":"97032","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":14.57,"maximum":270,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC IONTOPHORESIS","code_information":[{"code":"97033","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":182.25,"maximum":182.25,"gross_charge":225,"discounted_cash":66.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"}]}]},{"description":"HC IONTOPHORESIS","code_information":[{"code":"97033","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":19.98,"maximum":270,"gross_charge":225,"discounted_cash":66.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":85.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":102.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"}]}]},{"description":"HC CONTRAST BATH","code_information":[{"code":"97034","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC CONTRAST BATH","code_information":[{"code":"97034","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":14.56,"maximum":270,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"}]}]},{"description":"HC PT ULTRASOUND TRT 15MIN","code_information":[{"code":"97035","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":145.8,"maximum":145.8,"gross_charge":180,"discounted_cash":53.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"}]}]},{"description":"HC PT ULTRASOUND TRT 15MIN","code_information":[{"code":"97035","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":14.56,"maximum":270,"gross_charge":180,"discounted_cash":53.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"}]}]},{"description":"HC ULTRASOUND","code_information":[{"code":"97035","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":145.8,"maximum":145.8,"gross_charge":180,"discounted_cash":53.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"}]}]},{"description":"HC ULTRASOUND","code_information":[{"code":"97035","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":14.56,"maximum":189.52,"gross_charge":180,"discounted_cash":53.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"}]}]},{"description":"HC OT THER EXERCISE 15 MIN","code_information":[{"code":"97110","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":247.86,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"}]}]},{"description":"HC OT THER EXERCISE 15 MIN","code_information":[{"code":"97110","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":29.8,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":126.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":103.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"}]}]},{"description":"HC PT THER EXERCISE 15 MIN","code_information":[{"code":"97110","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":247.86,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"}]}]},{"description":"HC PT THER EXERCISE 15 MIN","code_information":[{"code":"97110","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":29.8,"maximum":270,"gross_charge":306,"discounted_cash":90.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":126.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":103.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"}]}]},{"description":"HC OT NEUROMUSC EDUC 15 MIN","code_information":[{"code":"97112","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":213.03,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"}]}]},{"description":"HC OT NEUROMUSC EDUC 15 MIN","code_information":[{"code":"97112","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":34.2,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"}]}]},{"description":"HC PT NEUROMUSC EDUC 15 MIN","code_information":[{"code":"97112","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":213.03,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"}]}]},{"description":"HC PT NEUROMUSC EDUC 15 MIN","code_information":[{"code":"97112","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":34.2,"maximum":270,"gross_charge":263,"discounted_cash":77.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":107.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"}]}]},{"description":"HC AQUATIC THERAPY","code_information":[{"code":"97113","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":235.71,"maximum":235.71,"gross_charge":291,"discounted_cash":86.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.71,"methodology":"fee schedule"}]}]},{"description":"HC AQUATIC THERAPY","code_information":[{"code":"97113","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":37.24,"maximum":270,"gross_charge":291,"discounted_cash":86.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":159.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"}]}]},{"description":"HC PT GAIT TRAINING 15 MIN","code_information":[{"code":"97116","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC PT GAIT TRAINING 15 MIN","code_information":[{"code":"97116","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":15.75,"maximum":270,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":125.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":91.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"}]}]},{"description":"HC PT MASSAGE TRT 15 MIN","code_information":[{"code":"97124","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":105.3,"gross_charge":130,"discounted_cash":38.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"}]}]},{"description":"HC PT MASSAGE TRT 15 MIN","code_information":[{"code":"97124","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":19.5,"maximum":270,"gross_charge":130,"discounted_cash":38.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":30.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":84.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"}]}]},{"description":"HC OT COGN INTVN INITIAL 15","code_information":[{"code":"97129","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC OT COGN INTVN INITIAL 15","code_information":[{"code":"97129","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":99.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":79.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC ST COGN INTVN INITIAL 15","code_information":[{"code":"97129","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC ST COGN INTVN INITIAL 15","code_information":[{"code":"97129","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":270,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":99.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":79.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC OT COGN INTVN ADD 15","code_information":[{"code":"97130","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC OT COGN INTVN ADD 15","code_information":[{"code":"97130","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":95.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC ST COGN INTVN ADD 15","code_information":[{"code":"97130","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC ST COGN INTVN ADD 15","code_information":[{"code":"97130","type":"CPT"},{"code":"0440","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":270,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":95.44,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC OT MANUAL THRPY 15 MIN","code_information":[{"code":"97140","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":225.99,"maximum":225.99,"gross_charge":279,"discounted_cash":82.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.99,"methodology":"fee schedule"}]}]},{"description":"HC OT MANUAL THRPY 15 MIN","code_information":[{"code":"97140","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":27.43,"maximum":225.99,"gross_charge":279,"discounted_cash":82.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":115.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":96.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"}]}]},{"description":"HC PT MANUAL THRPY 15 MIN","code_information":[{"code":"97140","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":225.99,"maximum":225.99,"gross_charge":279,"discounted_cash":82.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.99,"methodology":"fee schedule"}]}]},{"description":"HC PT MANUAL THRPY 15 MIN","code_information":[{"code":"97140","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":27.43,"maximum":270,"gross_charge":279,"discounted_cash":82.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":115.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":96.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"}]}]},{"description":"HC PT THERAPEUTIC REHAB GRP","code_information":[{"code":"97150","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":175.77,"maximum":175.77,"gross_charge":217,"discounted_cash":64.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":175.77,"methodology":"fee schedule"}]}]},{"description":"HC PT THERAPEUTIC REHAB GRP","code_information":[{"code":"97150","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":17.95,"maximum":270,"gross_charge":217,"discounted_cash":64.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":175.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL LOW COMPLEX","code_information":[{"code":"97161","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":454.41,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL LOW COMPLEX","code_information":[{"code":"97161","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":84.15,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":348.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":259.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL MOD COMPLEX","code_information":[{"code":"97162","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":395.28,"maximum":395.28,"gross_charge":488,"discounted_cash":144.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.28,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL MOD COMPLEX","code_information":[{"code":"97162","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":73.2,"maximum":395.28,"gross_charge":488,"discounted_cash":144.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":348.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":259.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.6,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL HIGH COMPLEX","code_information":[{"code":"97163","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":454.41,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL HIGH COMPLEX","code_information":[{"code":"97163","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":84.15,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":348.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":259.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL HIGH COMPLEX 60 MIN","code_information":[{"code":"97163","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":540.27,"maximum":540.27,"gross_charge":667,"discounted_cash":197.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":540.27,"methodology":"fee schedule"}]}]},{"description":"HC PT EVAL HIGH COMPLEX 60 MIN","code_information":[{"code":"97163","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":100.05,"maximum":540.27,"gross_charge":667,"discounted_cash":197.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":348.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":259.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.4,"methodology":"fee schedule"}]}]},{"description":"HC PT RE-EVALUATION","code_information":[{"code":"97164","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":127.17,"maximum":127.17,"gross_charge":157,"discounted_cash":46.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.17,"methodology":"fee schedule"}]}]},{"description":"HC PT RE-EVALUATION","code_information":[{"code":"97164","type":"CPT"},{"code":"0424","type":"RC"}],"standard_charges":[{"minimum":23.55,"maximum":270,"gross_charge":157,"discounted_cash":46.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":236.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":175.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"}]}]},{"description":"HC OT EVAL LOW COMPLEX 30 MIN","code_information":[{"code":"97165","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":422.01,"maximum":422.01,"gross_charge":521,"discounted_cash":154.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.01,"methodology":"fee schedule"}]}]},{"description":"HC OT EVAL LOW COMPLEX 30 MIN","code_information":[{"code":"97165","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":78.15,"maximum":422.01,"gross_charge":521,"discounted_cash":154.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":373.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":252.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.2,"methodology":"fee schedule"}]}]},{"description":"HC OT EVAL MOD COMPLEX","code_information":[{"code":"97166","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":370.17,"maximum":370.17,"gross_charge":457,"discounted_cash":135.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.17,"methodology":"fee schedule"}]}]},{"description":"HC OT EVAL MOD COMPLEX","code_information":[{"code":"97166","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":68.55,"maximum":373.99,"gross_charge":457,"discounted_cash":135.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":373.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":252.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.4,"methodology":"fee schedule"}]}]},{"description":"HC OT EVAL HIGH COMPLEX","code_information":[{"code":"97167","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":429.3,"maximum":429.3,"gross_charge":530,"discounted_cash":156.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.3,"methodology":"fee schedule"}]}]},{"description":"HC OT EVAL HIGH COMPLEX","code_information":[{"code":"97167","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":79.5,"maximum":429.3,"gross_charge":530,"discounted_cash":156.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":101.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":373.99,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":252.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":106,"methodology":"fee schedule"}]}]},{"description":"HC OT RE-EVAL","code_information":[{"code":"97168","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":122.31,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"}]}]},{"description":"HC OT RE-EVAL","code_information":[{"code":"97168","type":"CPT"},{"code":"0434","type":"RC"}],"standard_charges":[{"minimum":22.65,"maximum":270,"gross_charge":151,"discounted_cash":44.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":255.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":166.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITH MCC","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"minimum":16570,"maximum":41346,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26843,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":25377,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16570,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36026,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":33777,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38119.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31054,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37024,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30792,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":40125.68,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41346,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":27536,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":27536,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16757,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22292.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23852.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22960.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23406.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":23629.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23406.65,"methodology":"case rate"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITH CC","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"minimum":7079,"maximum":22031.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12777,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12079,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7745,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18897,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17717,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20929.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14870,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17729,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14394,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22031.48,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19691,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13107,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13107,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7079,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12239.71,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13096.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12606.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12851.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12974.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12851.7,"methodology":"case rate"}]}]},{"description":"HC OT FUNCTIONAL ACTIV 15 MIN","code_information":[{"code":"97530","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":214.65,"maximum":214.65,"gross_charge":265,"discounted_cash":78.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.65,"methodology":"fee schedule"}]}]},{"description":"HC OT FUNCTIONAL ACTIV 15 MIN","code_information":[{"code":"97530","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":37.58,"maximum":214.65,"gross_charge":265,"discounted_cash":78.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":162.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"}]}]},{"description":"HC PT FUNCTIONAL ACTIV 15 MIN","code_information":[{"code":"97530","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":214.65,"maximum":214.65,"gross_charge":265,"discounted_cash":78.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.65,"methodology":"fee schedule"}]}]},{"description":"HC PT FUNCTIONAL ACTIV 15 MIN","code_information":[{"code":"97530","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":37.58,"maximum":270,"gross_charge":265,"discounted_cash":78.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":162.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"}]}]},{"description":"HC OT SELF CARE TRAINING 15 MIN","code_information":[{"code":"97535","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC OT SELF CARE TRAINING 15 MIN","code_information":[{"code":"97535","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":189.52,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":112.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"}]}]},{"description":"HC SELF CARE/HOME MGMT TRAINING","code_information":[{"code":"97535","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC SELF CARE/HOME MGMT TRAINING","code_information":[{"code":"97535","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":270,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":112.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR MANAGEMENT","code_information":[{"code":"97542","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR MANAGEMENT","code_information":[{"code":"97542","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":10.8,"maximum":270,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":136.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":98.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR MANAGEMENT","code_information":[{"code":"97542","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR MANAGEMENT","code_information":[{"code":"97542","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":10.8,"maximum":189.52,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":136.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":98.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"HC WORK HARDENING 1ST 2 HRS","code_information":[{"code":"97545","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":831.06,"maximum":831.06,"gross_charge":1026,"discounted_cash":303.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.06,"methodology":"fee schedule"}]}]},{"description":"HC WORK HARDENING 1ST 2 HRS","code_information":[{"code":"97545","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":121,"maximum":831.06,"gross_charge":1026,"discounted_cash":303.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":625.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":416.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"}]}]},{"description":"HC WORK HARDENING CONDT ADD HR","code_information":[{"code":"97546","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":332.91,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"}]}]},{"description":"HC WORK HARDENING CONDT ADD HR","code_information":[{"code":"97546","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":61.65,"maximum":332.91,"gross_charge":411,"discounted_cash":121.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":249.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":166.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"}]}]},{"description":"HC WND DEBRIDE INIT 20SQCM/ <","code_information":[{"code":"97597","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":588.87,"maximum":588.87,"gross_charge":727,"discounted_cash":215.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":588.87,"methodology":"fee schedule"}]}]},{"description":"HC WND DEBRIDE INIT 20SQCM/ <","code_information":[{"code":"97597","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":109.05,"maximum":2204,"gross_charge":727,"discounted_cash":215.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":588.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":356.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":238.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC DEBRIDE WOUND; ADDTL 20CM","code_information":[{"code":"97598","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":311.85,"maximum":311.85,"gross_charge":385,"discounted_cash":113.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":311.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.85,"methodology":"fee schedule"}]}]},{"description":"HC DEBRIDE WOUND; ADDTL 20CM","code_information":[{"code":"97598","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":57.75,"maximum":2204,"gross_charge":385,"discounted_cash":113.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":311.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":311.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":311.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":112.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":79.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77,"methodology":"fee schedule"}]}]},{"description":"HC WND DEBRIDE ADDL 20SQCM","code_information":[{"code":"97598","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":317.52,"maximum":317.52,"gross_charge":392,"discounted_cash":116.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.52,"methodology":"fee schedule"}]}]},{"description":"HC WND DEBRIDE ADDL 20SQCM","code_information":[{"code":"97598","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":58.8,"maximum":2204,"gross_charge":392,"discounted_cash":116.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":112.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":79.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.4,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"minimum":4802,"maximum":17193.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9016,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8523,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4802,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14349,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13453,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16333.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9975,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11892,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8925,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":17193.41,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14611,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":9249,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":9249,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5208,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9551.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10220.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9838.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10029.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10125.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10029.49,"methodology":"case rate"}]}]},{"description":"HC NSW DEBRIDEM WO A/SESSION","code_information":[{"code":"97602","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":491.67,"maximum":491.67,"gross_charge":607,"discounted_cash":179.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":491.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":491.67,"methodology":"fee schedule"}]}]},{"description":"HC NSW DEBRIDEM WO A/SESSION","code_information":[{"code":"97602","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":91.05,"maximum":3642,"gross_charge":607,"discounted_cash":179.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":491.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":491.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":491.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":161.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":117.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC NEG PRESS WOUND TX <=50 CM","code_information":[{"code":"97605","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":553.23,"maximum":553.23,"gross_charge":683,"discounted_cash":202.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":553.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":553.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":553.23,"methodology":"fee schedule"}]}]},{"description":"HC NEG PRESS WOUND TX <=50 CM","code_information":[{"code":"97605","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":102.45,"maximum":3642,"gross_charge":683,"discounted_cash":202.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":553.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":553.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":553.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":435.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":292.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":179.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":134.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":303.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":177.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":190.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":182.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":186.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":195.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":188.31,"methodology":"case rate"}]}]},{"description":"HC NEG PRESS WOUND TX >50 CM","code_information":[{"code":"97606","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1061.91,"maximum":1061.91,"gross_charge":1311,"discounted_cash":388.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1061.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1061.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1061.91,"methodology":"fee schedule"}]}]},{"description":"HC NEG PRESS WOUND TX >50 CM","code_information":[{"code":"97606","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":142.48,"maximum":3642,"gross_charge":1311,"discounted_cash":388.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1061.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1061.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1061.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":210.92,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":142.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HC NPWT DISPOSABLE <= 50 CM","code_information":[{"code":"97607","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1013.31,"maximum":1013.31,"gross_charge":1251,"discounted_cash":370.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1013.31,"methodology":"fee schedule"}]}]},{"description":"HC NPWT DISPOSABLE <= 50 CM","code_information":[{"code":"97607","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":164.39,"maximum":3642,"gross_charge":1251,"discounted_cash":370.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1013.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":874.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":581.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":164.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1053.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":610.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":357.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":382.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":367.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":375.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":392.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":378.63,"methodology":"case rate"}]}]},{"description":"HIV WITH OR WITHOUT OTHER RELATED CONDITION","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"minimum":7210,"maximum":22268.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12961,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":12253,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8045,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":14528,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13621,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":21155.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14051,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16752,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14951,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":22268.52,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21414,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":13296,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":13296,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7210,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12371.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":13237.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12742.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12989.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13113.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12989.97,"methodology":"case rate"}]}]},{"description":"HC PHYSICAL PERF TEST","code_information":[{"code":"97750","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":235.71,"maximum":235.71,"gross_charge":291,"discounted_cash":86.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.71,"methodology":"fee schedule"}]}]},{"description":"HC PHYSICAL PERF TEST","code_information":[{"code":"97750","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":34.19,"maximum":270,"gross_charge":291,"discounted_cash":86.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":143.29,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"}]}]},{"description":"HC OT ORTHC MGMT&TRAINJ 1ST ENC 15M","code_information":[{"code":"97760","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC OT ORTHC MGMT&TRAINJ 1ST ENC 15M","code_information":[{"code":"97760","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":13.5,"maximum":194.1,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":49.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":194.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":121.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"}]}]},{"description":"HC PT ORTHC MGMT&TRAINJ 1ST ENC 15M","code_information":[{"code":"97760","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC PT ORTHC MGMT&TRAINJ 1ST ENC 15M","code_information":[{"code":"97760","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":13.5,"maximum":270,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":49.08,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":194.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":121.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"}]}]},{"description":"HC PROSTHETIC TRAINING INITIAL 15","code_information":[{"code":"97761","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC PROSTHETIC TRAINING INITIAL 15","code_information":[{"code":"97761","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":29.7,"maximum":270,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":167.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"}]}]},{"description":"HC PROSTHETIC TRAINING INITIAL 15","code_information":[{"code":"97761","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"HC PROSTHETIC TRAINING INITIAL 15","code_information":[{"code":"97761","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":29.7,"maximum":189.52,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":42.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":167.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":106.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"}]}]},{"description":"HC ORTHOTIC/ROSTHETIC RECHECK","code_information":[{"code":"97763","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":173.34,"maximum":173.34,"gross_charge":214,"discounted_cash":63.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.34,"methodology":"fee schedule"}]}]},{"description":"HC ORTHOTIC/ROSTHETIC RECHECK","code_information":[{"code":"97763","type":"CPT"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":32.1,"maximum":204.93,"gross_charge":214,"discounted_cash":63.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":154.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"}]}]},{"description":"HC RECHECK ORTH/PROST","code_information":[{"code":"97763","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":173.34,"maximum":173.34,"gross_charge":214,"discounted_cash":63.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.34,"methodology":"fee schedule"}]}]},{"description":"HC RECHECK ORTH/PROST","code_information":[{"code":"97763","type":"CPT"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":32.1,"maximum":270,"gross_charge":214,"discounted_cash":63.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":154.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.8,"methodology":"fee schedule"}]}]},{"description":"HC MNT INITIAL EACH 15M","code_information":[{"code":"97802","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":37.26,"maximum":37.26,"gross_charge":46,"discounted_cash":13.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"}]}]},{"description":"HC MNT INITIAL EACH 15M","code_information":[{"code":"97802","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":6.9,"maximum":152.88,"gross_charge":46,"discounted_cash":13.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":152.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":112.48,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.51,"methodology":"fee schedule"}]}]},{"description":"HC MNT RE-ASSESS EACH 15M","code_information":[{"code":"97803","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":37.26,"maximum":37.26,"gross_charge":46,"discounted_cash":13.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"}]}]},{"description":"HC MNT RE-ASSESS EACH 15M","code_information":[{"code":"97803","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":6.9,"maximum":142,"gross_charge":46,"discounted_cash":13.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":132.17,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.95,"methodology":"fee schedule"}]}]},{"description":"HC NUTRITONAL GROUP EA 30M","code_information":[{"code":"97804","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":26.73,"maximum":26.73,"gross_charge":33,"discounted_cash":9.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.73,"methodology":"fee schedule"}]}]},{"description":"HC NUTRITONAL GROUP EA 30M","code_information":[{"code":"97804","type":"CPT"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":4.95,"maximum":142,"gross_charge":33,"discounted_cash":9.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":51.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.53,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":26932,"maximum":70600,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42733,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40399,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26932,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":66661,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62500,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":57537.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49510,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59028,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50049,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":60566.08,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70600,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":43836,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":43836,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30145,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33647.82,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":36003.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34657.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":35330.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35666.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35330.22,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":13659,"maximum":36360,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22008,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":20806,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14124,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30092,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28213,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32210.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27111,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32323,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26247,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":33905.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36360,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":22576,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":22576,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13659,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18836.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20155.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19401.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19778.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19966.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":19778.38,"methodology":"case rate"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"minimum":8286,"maximum":24885.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14995,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14176,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9290,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18386,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17238,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23641.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18053,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21524,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17264,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":24885.29,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24775,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15382,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15382,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8286,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13825.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14792.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14239.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14516.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14654.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14516.42,"methodology":"case rate"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"minimum":19184,"maximum":46098.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31486,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":29766,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19184,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":41255,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38679,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43793.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35869,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42764,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35651,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":46098.11,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":32298,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":32298,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23664,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25610.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27402.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26378.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26890.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27146.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26890.57,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"minimum":9641,"maximum":25438.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15425,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":14583,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9641,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22834,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21408,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24166.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18336,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":21862,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17917,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":25438.02,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":15823,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":15823,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10339,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14132.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15121.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14556.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14838.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":14980.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14838.85,"methodology":"case rate"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"minimum":5789,"maximum":18956.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10387,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":9819,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6138,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":15721,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14740,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":18008.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11916,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14207,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11406,"methodology":"case rate"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":18956.79,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10655,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10655,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5789,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10531.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":11268.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10847.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":11058.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11163.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":11058.13,"methodology":"case rate"}]}]},{"description":"HC NEW ENROLLEE FEE","code_information":[{"code":"99071","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":17.01,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"}]}]},{"description":"HC NEW ENROLLEE FEE","code_information":[{"code":"99071","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":110,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"CLIENT NAVIGATION 15-29 MIN","code_information":[{"code":"99080","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":8.1,"gross_charge":10,"discounted_cash":2.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"CLIENT NAVIGATION 15-29 MIN","code_information":[{"code":"99080","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":1.5,"maximum":110,"gross_charge":10,"discounted_cash":2.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"CLIENT NAVIGATION 30+ MIN","code_information":[{"code":"99080","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"CLIENT NAVIGATION 30+ MIN","code_information":[{"code":"99080","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":3,"maximum":110,"gross_charge":20,"discounted_cash":5.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"}]}]},{"description":"HC MOD SED SAME PHYS/QHP 5/>YRS","code_information":[{"code":"99152","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":33.21,"maximum":33.21,"gross_charge":41,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"}]}]},{"description":"HC MOD SED SAME PHYS/QHP 5/>YRS","code_information":[{"code":"99152","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":6.15,"maximum":2204,"gross_charge":41,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"}]}]},{"description":"HC MOD SED SAME PHYS/QHP EA","code_information":[{"code":"99153","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC MOD SED SAME PHYS/QHP EA","code_information":[{"code":"99153","type":"CPT"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":2204,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"HC PHLEBOTOMY THERAPEUTIC","code_information":[{"code":"99195","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":140.13,"maximum":140.13,"gross_charge":173,"discounted_cash":51.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"}]}]},{"description":"HC PHLEBOTOMY THERAPEUTIC","code_information":[{"code":"99195","type":"CPT"},{"code":"0940","type":"RC"}],"standard_charges":[{"minimum":25.95,"maximum":394.02,"gross_charge":173,"discounted_cash":51.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":186.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":394.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":298.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.06,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":121,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.15,"methodology":"case rate"}]}]},{"description":"HC CLINIC VISIT LEVEL 2 NEW","code_information":[{"code":"99202","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":289.17,"maximum":289.17,"gross_charge":357,"discounted_cash":105.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.17,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 2 NEW","code_information":[{"code":"99202","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":53.55,"maximum":289.17,"gross_charge":357,"discounted_cash":105.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.4,"methodology":"fee schedule"}]}]},{"description":"REMOVAL PEG TUBE W/O ENDO","code_information":[{"code":"99202","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":851.31,"maximum":851.31,"gross_charge":1051,"discounted_cash":311.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":851.31,"methodology":"fee schedule"}]}]},{"description":"REMOVAL PEG TUBE W/O ENDO","code_information":[{"code":"99202","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":157.65,"maximum":3642,"gross_charge":1051,"discounted_cash":311.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":851.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.2,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 3 NEW","code_information":[{"code":"99203","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":426.06,"maximum":426.06,"gross_charge":526,"discounted_cash":155.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":426.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":426.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":426.06,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 3 NEW","code_information":[{"code":"99203","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":78.9,"maximum":426.06,"gross_charge":526,"discounted_cash":155.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":426.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":426.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":426.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.2,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 4 NEW","code_information":[{"code":"99204","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":619.65,"maximum":619.65,"gross_charge":765,"discounted_cash":226.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":619.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":619.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":619.65,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 4 NEW","code_information":[{"code":"99204","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":94.76,"maximum":619.65,"gross_charge":765,"discounted_cash":226.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":619.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":619.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":619.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":153,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":153,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 5 NEW","code_information":[{"code":"99205","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":787.32,"maximum":787.32,"gross_charge":972,"discounted_cash":287.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":787.32,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 5 NEW","code_information":[{"code":"99205","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":94.76,"maximum":787.32,"gross_charge":972,"discounted_cash":287.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"}]}]},{"description":"HC EST. PATIENT LEVEL 1","code_information":[{"code":"99211","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":148.23,"maximum":148.23,"gross_charge":183,"discounted_cash":54.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.23,"methodology":"fee schedule"}]}]},{"description":"HC EST. PATIENT LEVEL 1","code_information":[{"code":"99211","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":27.45,"maximum":148.23,"gross_charge":183,"discounted_cash":54.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"}]}]},{"description":"HC PICC DRESSING CHANGE","code_information":[{"code":"99211","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":148.23,"maximum":148.23,"gross_charge":183,"discounted_cash":54.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.23,"methodology":"fee schedule"}]}]},{"description":"HC PICC DRESSING CHANGE","code_information":[{"code":"99211","type":"CPT"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":27.45,"maximum":3642,"gross_charge":183,"discounted_cash":54.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 2 EST","code_information":[{"code":"99212","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":183.87,"maximum":183.87,"gross_charge":227,"discounted_cash":67.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.87,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 2 EST","code_information":[{"code":"99212","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":34.05,"maximum":183.87,"gross_charge":227,"discounted_cash":67.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.4,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 3 EST","code_information":[{"code":"99213","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":194.4,"maximum":194.4,"gross_charge":240,"discounted_cash":71.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":194.4,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 3 EST","code_information":[{"code":"99213","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":36,"maximum":194.4,"gross_charge":240,"discounted_cash":71.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 4 EST","code_information":[{"code":"99214","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":299.7,"maximum":299.7,"gross_charge":370,"discounted_cash":109.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 4 EST","code_information":[{"code":"99214","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":55.5,"maximum":299.7,"gross_charge":370,"discounted_cash":109.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":299.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 5 EST","code_information":[{"code":"99215","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":765.45,"maximum":765.45,"gross_charge":945,"discounted_cash":279.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":765.45,"methodology":"fee schedule"}]}]},{"description":"HC CLINIC VISIT LEVEL 5 EST","code_information":[{"code":"99215","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":94.76,"maximum":765.45,"gross_charge":945,"discounted_cash":279.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":765.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189,"methodology":"fee schedule"}]}]},{"description":"HC ED LEVEL 1","code_information":[{"code":"99281","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":454.41,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"}]}]},{"description":"HC ED LEVEL 1","code_information":[{"code":"99281","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":67,"maximum":1222,"gross_charge":561,"discounted_cash":166.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":192.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":129.53,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":502,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":389,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":134.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":276,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":308,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":283,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":179,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":78.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":84.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":81.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":82.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":86.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":83.44,"methodology":"case rate"}]}]},{"description":"HC ED LEVEL 2","code_information":[{"code":"99282","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":972,"maximum":972,"gross_charge":1200,"discounted_cash":355.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972,"methodology":"fee schedule"}]}]},{"description":"HC ED LEVEL 2","code_information":[{"code":"99282","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":141.58,"maximum":1222,"gross_charge":1200,"discounted_cash":355.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":346.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":346.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":238.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1024,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":791,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":242.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":456,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":508,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":479.98,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":224,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":543,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":543,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":168,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":240,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":180,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":240,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":141.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":151.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":145.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":148.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":155.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":150.07,"methodology":"case rate"}]}]},{"description":"HC ED LEVEL 3","code_information":[{"code":"99283","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1232.01,"maximum":1232.01,"gross_charge":1521,"discounted_cash":450.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1232.01,"methodology":"fee schedule"}]}]},{"description":"HC ED LEVEL 3","code_information":[{"code":"99283","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":228.15,"maximum":1282,"gross_charge":1521,"discounted_cash":450.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":606.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":606.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":416.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1282,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":987,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":423.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":730,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":813,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":699,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":304,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":812,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":812,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":247.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":264.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":254.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":259.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":272.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":262.4,"methodology":"case rate"}]}]},{"description":"HC ED LEVEL 4","code_information":[{"code":"99284","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":1448.28,"maximum":1448.28,"gross_charge":1788,"discounted_cash":529.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1448.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1448.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1448.28,"methodology":"fee schedule"}]}]},{"description":"HC ED LEVEL 4","code_information":[{"code":"99284","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":268.2,"maximum":1521,"gross_charge":1788,"discounted_cash":529.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1448.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1448.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1448.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":932.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":932.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":646.22,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1521,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1174,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":651,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1095,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1219,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1023.82,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":614,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":692,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1354,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1354,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":420,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":380.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":407.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":392.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":399.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":418.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":403.54,"methodology":"case rate"}]}]},{"description":"HC ED LEVEL 5","code_information":[{"code":"99285","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2161.08,"maximum":2161.08,"gross_charge":2668,"discounted_cash":789.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2161.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2161.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2161.08,"methodology":"fee schedule"}]}]},{"description":"HC ED LEVEL 5","code_information":[{"code":"99285","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":400.2,"maximum":2161.08,"gross_charge":2668,"discounted_cash":789.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2161.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2161.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2161.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1342.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1342.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":937.15,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1745,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1346,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":937.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1459,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1626,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1390,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":912,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":959,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2030,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2030,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":420,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":548.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":586.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":564.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":575.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":581.03,"methodology":"case rate"}]}]},{"description":"HC ED CRITICAL CARE","code_information":[{"code":"99291","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":2073.6,"maximum":2073.6,"gross_charge":2560,"discounted_cash":757.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2073.6,"methodology":"fee schedule"}]}]},{"description":"HC ED CRITICAL CARE","code_information":[{"code":"99291","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":384,"maximum":2489,"gross_charge":2560,"discounted_cash":757.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1844.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1844.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1294.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1839,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1386,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1288.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1405,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1566,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1313,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1164,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":2489,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":2489,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":512,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":384,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":512,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":753.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":806.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":775.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":791,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":828.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":798.53,"methodology":"case rate"}]}]},{"description":"HC ED CRITICAL CARE ADDL","code_information":[{"code":"99292","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":725.76,"maximum":725.76,"gross_charge":896,"discounted_cash":265.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":725.76,"methodology":"fee schedule"}]}]},{"description":"HC ED CRITICAL CARE ADDL","code_information":[{"code":"99292","type":"CPT"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":134.4,"maximum":1313,"gross_charge":896,"discounted_cash":265.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":725.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":841,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":977,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1313,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1222,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.2,"methodology":"fee schedule"}]}]},{"description":"HC TRANSITIONAL CARE MGMT SERV","code_information":[{"code":"99496","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":382.32,"maximum":382.32,"gross_charge":472,"discounted_cash":139.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.32,"methodology":"fee schedule"}]}]},{"description":"HC TRANSITIONAL CARE MGMT SERV","code_information":[{"code":"99496","type":"CPT"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":70.8,"maximum":382.32,"gross_charge":472,"discounted_cash":139.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":282.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":192.87,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":197.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":115.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":123.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":118.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":120.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":126.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":122.12,"methodology":"case rate"}]}]},{"description":"PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"UNGROUPABLE","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":70,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC WHEELCHAIR VAN ONE-WAY","code_information":[{"code":"A0130","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":93.96,"maximum":93.96,"gross_charge":116,"discounted_cash":34.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR VAN ONE-WAY","code_information":[{"code":"A0130","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":17.4,"maximum":358,"gross_charge":116,"discounted_cash":34.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.2,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR VAN ROUND TRIP","code_information":[{"code":"A0130","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR VAN ROUND TRIP","code_information":[{"code":"A0130","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":29.1,"maximum":358,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"}]}]},{"description":"HC ALS/BLS MILEAGE","code_information":[{"code":"A0425","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC ALS/BLS MILEAGE","code_information":[{"code":"A0425","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":5.1,"maximum":358,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.72,"standard_charge_algorithm": "Lesser of $16.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.94,"standard_charge_algorithm": "Lesser of $8.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"}]}]},{"description":"HC ALS NONEMERGENCY","code_information":[{"code":"A0426","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":906.39,"maximum":906.39,"gross_charge":1119,"discounted_cash":331.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":906.39,"methodology":"fee schedule"}]}]},{"description":"HC ALS NONEMERGENCY","code_information":[{"code":"A0426","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":167.85,"maximum":906.39,"gross_charge":1119,"discounted_cash":331.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":906.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":578.19,"standard_charge_algorithm": "Lesser of $578.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":309.19,"standard_charge_algorithm": "Lesser of $309.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.8,"methodology":"fee schedule"}]}]},{"description":"HC ALS EMERGENCY","code_information":[{"code":"A0427","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":1438.56,"maximum":1438.56,"gross_charge":1776,"discounted_cash":525.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1438.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1438.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1438.56,"methodology":"fee schedule"}]}]},{"description":"HC ALS EMERGENCY","code_information":[{"code":"A0427","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":266.4,"maximum":1438.56,"gross_charge":1776,"discounted_cash":525.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1438.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1438.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1438.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":915.46,"standard_charge_algorithm": "Lesser of $915.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":489.55,"standard_charge_algorithm": "Lesser of $489.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":266.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.2,"methodology":"fee schedule"}]}]},{"description":"HC BLS NONEMERGENCY","code_information":[{"code":"A0428","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":759.78,"maximum":759.78,"gross_charge":938,"discounted_cash":277.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":759.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":759.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":759.78,"methodology":"fee schedule"}]}]},{"description":"HC BLS NONEMERGENCY","code_information":[{"code":"A0428","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":140.7,"maximum":759.78,"gross_charge":938,"discounted_cash":277.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":759.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":759.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":759.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":481.82,"standard_charge_algorithm": "Lesser of $481.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":257.66,"standard_charge_algorithm": "Lesser of $257.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.6,"methodology":"fee schedule"}]}]},{"description":"HC CAMPUS TRANSPORT MEDICAL","code_information":[{"code":"A0428","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":797.85,"maximum":797.85,"gross_charge":985,"discounted_cash":291.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.85,"methodology":"fee schedule"}]}]},{"description":"HC CAMPUS TRANSPORT MEDICAL","code_information":[{"code":"A0428","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":147.75,"maximum":797.85,"gross_charge":985,"discounted_cash":291.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":797.85,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":481.82,"standard_charge_algorithm": "Lesser of $481.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":257.66,"standard_charge_algorithm": "Lesser of $257.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":197,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":197,"methodology":"fee schedule"}]}]},{"description":"HC BLS EMERGENCY","code_information":[{"code":"A0429","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":1210.14,"maximum":1210.14,"gross_charge":1494,"discounted_cash":442.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1210.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1210.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1210.14,"methodology":"fee schedule"}]}]},{"description":"HC BLS EMERGENCY","code_information":[{"code":"A0429","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":224.1,"maximum":1210.14,"gross_charge":1494,"discounted_cash":442.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1210.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1210.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1210.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":770.91,"standard_charge_algorithm": "Lesser of $770.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":412.25,"standard_charge_algorithm": "Lesser of $412.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.8,"methodology":"fee schedule"}]}]},{"description":"HC EMS FIXED WING TRANSFER-DISTAN","code_information":[{"code":"A0430","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":678.78,"maximum":678.78,"gross_charge":838,"discounted_cash":248.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":678.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":678.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":678.78,"methodology":"fee schedule"}]}]},{"description":"HC EMS FIXED WING TRANSFER-DISTAN","code_information":[{"code":"A0430","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":125.7,"maximum":838,"gross_charge":838,"discounted_cash":248.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":678.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":678.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":678.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":838,"standard_charge_algorithm": "Lesser of $6554.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":838,"standard_charge_algorithm": "Lesser of $3504.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.6,"methodology":"fee schedule"}]}]},{"description":"HC EMS FIXED WING TRANSFER-LOCAL","code_information":[{"code":"A0430","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":434.16,"maximum":434.16,"gross_charge":536,"discounted_cash":158.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"}]}]},{"description":"HC EMS FIXED WING TRANSFER-LOCAL","code_information":[{"code":"A0430","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":80.4,"maximum":536,"gross_charge":536,"discounted_cash":158.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":434.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":536,"standard_charge_algorithm": "Lesser of $6554.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":536,"standard_charge_algorithm": "Lesser of $3504.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.2,"methodology":"fee schedule"}]}]},{"description":"HC ALS2 TRANSPORT","code_information":[{"code":"A0433","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":2080.89,"maximum":2080.89,"gross_charge":2569,"discounted_cash":760.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.89,"methodology":"fee schedule"}]}]},{"description":"HC ALS2 TRANSPORT","code_information":[{"code":"A0433","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":358,"maximum":2080.89,"gross_charge":2569,"discounted_cash":760.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2080.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2080.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2080.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1325.01,"standard_charge_algorithm": "Lesser of $1325.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":708.56,"standard_charge_algorithm": "Lesser of $708.56 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":488.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":513.8,"methodology":"fee schedule"}]}]},{"description":"HC SCT TRANSPORT","code_information":[{"code":"A0434","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":2460.78,"maximum":2460.78,"gross_charge":3038,"discounted_cash":899.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2460.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2460.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2460.78,"methodology":"fee schedule"}]}]},{"description":"HC SCT TRANSPORT","code_information":[{"code":"A0434","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":358,"maximum":2460.78,"gross_charge":3038,"discounted_cash":899.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2460.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2460.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2460.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1565.92,"standard_charge_algorithm": "Lesser of $1565.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":837.39,"standard_charge_algorithm": "Lesser of $837.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.6,"methodology":"fee schedule"}]}]},{"description":"HC BLS NON-COVERED MILEAGE","code_information":[{"code":"A0888","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC BLS NON-COVERED MILEAGE","code_information":[{"code":"A0888","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":5.1,"maximum":358,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"}]}]},{"description":"HC EMS TREATMENT W/O TRANSPORT","code_information":[{"code":"A0998","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":230.04,"maximum":230.04,"gross_charge":284,"discounted_cash":84.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.04,"methodology":"fee schedule"}]}]},{"description":"HC EMS TREATMENT W/O TRANSPORT","code_information":[{"code":"A0998","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":42.6,"maximum":358,"gross_charge":284,"discounted_cash":84.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.8,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 18 PER SQ. CM 31D018-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":335.4,"maximum":452.79,"gross_charge":559,"discounted_cash":165.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":452.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":452.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":452.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":363.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":391.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":335.4,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 18 PER SQ. CM 31D018-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":83.85,"maximum":452.79,"gross_charge":559,"discounted_cash":165.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":452.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":452.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":452.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":357.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":279.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":279.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":251.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":391.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":335.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.8,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 2X2 PER SQ. CM 310202-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":359.4,"maximum":485.19,"gross_charge":599,"discounted_cash":177.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":485.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":485.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":485.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":389.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":419.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":359.4,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 2X2 PER SQ. CM 310202-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":89.85,"maximum":485.19,"gross_charge":599,"discounted_cash":177.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":485.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":485.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":485.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":383.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":299.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":299.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":269.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":419.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":359.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 5.1X5.1 PER SQ. CM 310505-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":109.2,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":127.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 5.1X5.1 PER SQ. CM 310505-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.3,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":116.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":127.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 9X9 PER SQ. CM 310909-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.4,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.4,"methodology":"fee schedule"}]}]},{"description":"SUPRA SDRM 9X9 PER SQ. CM 310909-US","code_information":[{"code":"A2011","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BIO HYDRO 4010-02-15-T3","code_information":[{"code":"A4648","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":146.4,"maximum":197.64,"gross_charge":244,"discounted_cash":72.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":158.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":170.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BIO HYDRO 4010-02-15-T3","code_information":[{"code":"A4648","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":36.6,"maximum":197.64,"gross_charge":244,"discounted_cash":72.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":156.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":85.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":97.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":109.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":170.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"}]}]},{"description":"HC MARKER GELMARK BIOPSY MK2011","code_information":[{"code":"A4648","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":166.2,"maximum":224.37,"gross_charge":277,"discounted_cash":82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":193.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.2,"methodology":"fee schedule"}]}]},{"description":"HC MARKER GELMARK BIOPSY MK2011","code_information":[{"code":"A4648","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":41.55,"maximum":224.37,"gross_charge":277,"discounted_cash":82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":177.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":96.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":124.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":193.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":166.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"}]}]},{"description":"SENOMARK ULTRACOR USCOIL14X13","code_information":[{"code":"A4648","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":111,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111,"methodology":"fee schedule"}]}]},{"description":"SENOMARK ULTRACOR USCOIL14X13","code_information":[{"code":"A4648","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":27.75,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":74,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"}]}]},{"description":"HC PARATHYROID NUCLIDE","code_information":[{"code":"A9500","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":70.85,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.85,"methodology":"fee schedule"}]}]},{"description":"HC PARATHYROID NUCLIDE","code_information":[{"code":"A9500","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":16.35,"maximum":109,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":109,"standard_charge_algorithm": "Lesser of $113.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"}]}]},{"description":"HC SESTAMIBI NUCLIDE (CARDIOLITE)","code_information":[{"code":"A9500","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":86.45,"maximum":107.73,"gross_charge":133,"discounted_cash":39.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.45,"methodology":"fee schedule"}]}]},{"description":"HC SESTAMIBI NUCLIDE (CARDIOLITE)","code_information":[{"code":"A9500","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":19.95,"maximum":113.35,"gross_charge":133,"discounted_cash":39.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":113.35,"standard_charge_algorithm": "Lesser of $113.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"}]}]},{"description":"HC TETRAFOSMIN NUCLIDE (MYOVIEW)","code_information":[{"code":"A9502","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":154.7,"maximum":192.78,"gross_charge":238,"discounted_cash":70.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":154.7,"methodology":"fee schedule"}]}]},{"description":"HC TETRAFOSMIN NUCLIDE (MYOVIEW)","code_information":[{"code":"A9502","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":35.7,"maximum":192.78,"gross_charge":238,"discounted_cash":70.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":192.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":152.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":98.29,"standard_charge_algorithm": "Lesser of $98.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":119,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":107.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"}]}]},{"description":"HC THALLIUM NUCLIDE","code_information":[{"code":"A9505","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":62.4,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.4,"methodology":"fee schedule"}]}]},{"description":"HC THALLIUM NUCLIDE","code_information":[{"code":"A9505","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":14.4,"maximum":96,"gross_charge":96,"discounted_cash":28.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":96,"standard_charge_algorithm": "Lesser of $156.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"}]}]},{"description":"HC ADRENAL NUC(MIBG) PER .5 MCI","code_information":[{"code":"A9508","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1631.5,"maximum":2033.1,"gross_charge":2510,"discounted_cash":742.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2033.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2033.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2033.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1631.5,"methodology":"fee schedule"}]}]},{"description":"HC ADRENAL NUC(MIBG) PER .5 MCI","code_information":[{"code":"A9508","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":376.5,"maximum":2033.1,"gross_charge":2510,"discounted_cash":742.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2033.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2033.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2033.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1606.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":952.64,"standard_charge_algorithm": "Lesser of $952.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1255,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1129.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":476.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":502,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":502,"methodology":"fee schedule"}]}]},{"description":"HC I-123 DX PER MILLICURIE","code_information":[{"code":"A9509","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":487.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":487.5,"methodology":"fee schedule"}]}]},{"description":"HC I-123 DX PER MILLICURIE","code_information":[{"code":"A9509","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":112.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":480,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":243.64,"standard_charge_algorithm": "Lesser of $243.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":375,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":337.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"}]}]},{"description":"HC IN-111 PENDETIDE","code_information":[{"code":"A9509","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":5985.85,"maximum":7459.29,"gross_charge":9209,"discounted_cash":2725.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7459.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7459.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7459.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5985.85,"methodology":"fee schedule"}]}]},{"description":"HC IN-111 PENDETIDE","code_information":[{"code":"A9509","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":243.64,"maximum":7459.29,"gross_charge":9209,"discounted_cash":2725.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7459.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7459.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7459.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5893.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":243.64,"standard_charge_algorithm": "Lesser of $243.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4604.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4144.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1749.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1841.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1381.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1841.8,"methodology":"fee schedule"}]}]},{"description":"HC TC99M NUCLIDETC99M NUCLIDE","code_information":[{"code":"A9512","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":35.1,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"}]}]},{"description":"HC TC99M NUCLIDETC99M NUCLIDE","code_information":[{"code":"A9512","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1.84,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":34.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"}]}]},{"description":"HC I-123 THYROID NUCLIDE-100 UCI","code_information":[{"code":"A9516","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":93.6,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.6,"methodology":"fee schedule"}]}]},{"description":"HC I-123 THYROID NUCLIDE-100 UCI","code_information":[{"code":"A9516","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":21.6,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":92.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":96.52,"standard_charge_algorithm": "Lesser of $96.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"}]}]},{"description":"HC R I-131 CAPTXPER MCI","code_information":[{"code":"A9517","type":"HCPCS"},{"code":"0344","type":"RC"}],"standard_charges":[{"minimum":52,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"}]}]},{"description":"HC R I-131 CAPTXPER MCI","code_information":[{"code":"A9517","type":"HCPCS"},{"code":"0344","type":"RC"}],"standard_charges":[{"minimum":12,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.34,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.84,"standard_charge_algorithm": "Lesser of $55.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.84,"standard_charge_algorithm": "Lesser of $55.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":21.92,"methodology":"case rate"}]}]},{"description":"LYMPHOSEEK NDC 65857-450-05","code_information":[{"code":"A9520","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1103.05,"maximum":1374.57,"gross_charge":1697,"discounted_cash":502.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1103.05,"methodology":"fee schedule"}]}]},{"description":"LYMPHOSEEK NDC 65857-450-05","code_information":[{"code":"A9520","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":254.55,"maximum":1374.57,"gross_charge":1697,"discounted_cash":502.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1086.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":541.5,"standard_charge_algorithm": "Lesser of $541.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":848.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":763.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"}]}]},{"description":"HC R TC-99M EXAMETAZINE","code_information":[{"code":"A9521","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":2408.25,"maximum":3001.05,"gross_charge":3705,"discounted_cash":1096.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3001.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3001.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3001.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2408.25,"methodology":"fee schedule"}]}]},{"description":"HC R TC-99M EXAMETAZINE","code_information":[{"code":"A9521","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":555.75,"maximum":3001.05,"gross_charge":3705,"discounted_cash":1096.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3001.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3001.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3001.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2371.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":802.34,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":802.34,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1226.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1762.05,"standard_charge_algorithm": "Lesser of $1762.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1852.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1667.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":741,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":741,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":717.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":767.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":738.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":753.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":789.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":760.36,"methodology":"case rate"}]}]},{"description":"HC I-131 THYROID METS NUCLIDE","code_information":[{"code":"A9528","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":142.35,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":142.35,"methodology":"fee schedule"}]}]},{"description":"HC I-131 THYROID METS NUCLIDE","code_information":[{"code":"A9528","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":32.85,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":140.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":97.06,"standard_charge_algorithm": "Lesser of $97.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":109.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":98.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"}]}]},{"description":"HC HEPATOBILIARY NUCLIDE","code_information":[{"code":"A9537","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":51.35,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.35,"methodology":"fee schedule"}]}]},{"description":"HC HEPATOBILIARY NUCLIDE","code_information":[{"code":"A9537","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":11.85,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63.75,"standard_charge_algorithm": "Lesser of $63.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"}]}]},{"description":"HC LUNG PERFUSION DOSE","code_information":[{"code":"A9540","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":212.55,"maximum":264.87,"gross_charge":327,"discounted_cash":96.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":212.55,"methodology":"fee schedule"}]}]},{"description":"HC LUNG PERFUSION DOSE","code_information":[{"code":"A9540","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":34.58,"maximum":264.87,"gross_charge":327,"discounted_cash":96.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":209.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.58,"standard_charge_algorithm": "Lesser of $34.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":163.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":147.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.4,"methodology":"fee schedule"}]}]},{"description":"HC TC99M SULFUR COLLOID NULICDE","code_information":[{"code":"A9541","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":365.3,"maximum":455.22,"gross_charge":562,"discounted_cash":166.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":365.3,"methodology":"fee schedule"}]}]},{"description":"HC TC99M SULFUR COLLOID NULICDE","code_information":[{"code":"A9541","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":84.3,"maximum":455.22,"gross_charge":562,"discounted_cash":166.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":455.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":359.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":308.16,"standard_charge_algorithm": "Lesser of $308.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":281,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":252.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.4,"methodology":"fee schedule"}]}]},{"description":"REGULAR SULFUR COLLOID","code_information":[{"code":"A9541","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":208,"maximum":259.2,"gross_charge":320,"discounted_cash":94.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":208,"methodology":"fee schedule"}]}]},{"description":"REGULAR SULFUR COLLOID","code_information":[{"code":"A9541","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":48,"maximum":308.16,"gross_charge":320,"discounted_cash":94.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":259.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":204.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":308.16,"standard_charge_algorithm": "Lesser of $308.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":160,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":144,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"}]}]},{"description":"HC INDIUM-111 DTPA PER 0.5 MCI","code_information":[{"code":"A9548","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":4092.4,"maximum":5099.76,"gross_charge":6296,"discounted_cash":1863.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5099.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5099.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5099.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4092.4,"methodology":"fee schedule"}]}]},{"description":"HC INDIUM-111 DTPA PER 0.5 MCI","code_information":[{"code":"A9548","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":476.25,"maximum":5099.76,"gross_charge":6296,"discounted_cash":1863.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5099.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5099.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5099.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4029.44,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":715.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":715.29,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1093.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":476.25,"standard_charge_algorithm": "Lesser of $476.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3148,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2833.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1196.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":944.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1259.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":639.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":684.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":658.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":671.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":703.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":677.87,"methodology":"case rate"}]}]},{"description":"DMSA RENAL NDC 17156-525-01","code_information":[{"code":"A9551","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":2281.5,"maximum":2843.1,"gross_charge":3510,"discounted_cash":1038.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2843.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2843.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2843.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2281.5,"methodology":"fee schedule"}]}]},{"description":"DMSA RENAL NDC 17156-525-01","code_information":[{"code":"A9551","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":526.5,"maximum":2843.1,"gross_charge":3510,"discounted_cash":1038.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2843.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2843.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2843.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2246.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":690.89,"standard_charge_algorithm": "Lesser of $690.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1755,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1579.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":702,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":702,"methodology":"fee schedule"}]}]},{"description":"HC FDG(F-18) PER DOSE","code_information":[{"code":"A9552","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":235.3,"maximum":293.22,"gross_charge":362,"discounted_cash":107.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":235.3,"methodology":"fee schedule"}]}]},{"description":"HC FDG(F-18) PER DOSE","code_information":[{"code":"A9552","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":54.3,"maximum":362,"gross_charge":362,"discounted_cash":107.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":231.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":362,"standard_charge_algorithm": "Lesser of $363.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":181,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":162.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.4,"methodology":"fee schedule"}]}]},{"description":"HC RUBIDIUM RB-82 UP TO 60 MCI","code_information":[{"code":"A9555","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":390,"maximum":486,"gross_charge":600,"discounted_cash":177.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":390,"methodology":"fee schedule"}]}]},{"description":"HC RUBIDIUM RB-82 UP TO 60 MCI","code_information":[{"code":"A9555","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":90,"maximum":486,"gross_charge":600,"discounted_cash":177.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":384,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":464.69,"standard_charge_algorithm": "Lesser of $464.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":300,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"}]}]},{"description":"HC GALLIUM NUCLIDE","code_information":[{"code":"A9556","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":81.9,"maximum":102.06,"gross_charge":126,"discounted_cash":37.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"}]}]},{"description":"HC GALLIUM NUCLIDE","code_information":[{"code":"A9556","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":18.9,"maximum":126,"gross_charge":126,"discounted_cash":37.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":126,"standard_charge_algorithm": "Lesser of $155.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"}]}]},{"description":"HC GI BLEED DOSE","code_information":[{"code":"A9560","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":251.55,"maximum":313.47,"gross_charge":387,"discounted_cash":114.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":251.55,"methodology":"fee schedule"}]}]},{"description":"HC GI BLEED DOSE","code_information":[{"code":"A9560","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":58.05,"maximum":313.47,"gross_charge":387,"discounted_cash":114.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":313.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":247.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.66,"standard_charge_algorithm": "Lesser of $107.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":193.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"}]}]},{"description":"HC MUGA NUCLIDE","code_information":[{"code":"A9560","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":105.95,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.95,"methodology":"fee schedule"}]}]},{"description":"HC MUGA NUCLIDE","code_information":[{"code":"A9560","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":24.45,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.66,"standard_charge_algorithm": "Lesser of $107.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"}]}]},{"description":"HC RBC TAGGED NUCLIDE","code_information":[{"code":"A9560","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":269.1,"maximum":335.34,"gross_charge":414,"discounted_cash":122.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":269.1,"methodology":"fee schedule"}]}]},{"description":"HC RBC TAGGED NUCLIDE","code_information":[{"code":"A9560","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":62.1,"maximum":335.34,"gross_charge":414,"discounted_cash":122.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":264.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.66,"standard_charge_algorithm": "Lesser of $107.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":207,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.8,"methodology":"fee schedule"}]}]},{"description":"HC BONE NUCLIDE DOSE","code_information":[{"code":"A9561","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":67.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"}]}]},{"description":"HC BONE NUCLIDE DOSE","code_information":[{"code":"A9561","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":15.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.71,"standard_charge_algorithm": "Lesser of $50.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"}]}]},{"description":"HC RENAL MAG3 DOSE","code_information":[{"code":"A9562","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":479.05,"maximum":596.97,"gross_charge":737,"discounted_cash":218.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":479.05,"methodology":"fee schedule"}]}]},{"description":"HC RENAL MAG3 DOSE","code_information":[{"code":"A9562","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":110.55,"maximum":596.97,"gross_charge":737,"discounted_cash":218.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":471.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":368.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":368.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":331.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.4,"methodology":"fee schedule"}]}]},{"description":"HC LUNG AEROSOL PER 25 MCI","code_information":[{"code":"A9567","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":143.65,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":143.65,"methodology":"fee schedule"}]}]},{"description":"HC LUNG AEROSOL PER 25 MCI","code_information":[{"code":"A9567","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":20.94,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":141.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.94,"standard_charge_algorithm": "Lesser of $20.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":99.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC CERETEC WBC NUCLIDE","code_information":[{"code":"A9569","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":4854.85,"maximum":6049.89,"gross_charge":7469,"discounted_cash":2210.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6049.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6049.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6049.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4854.85,"methodology":"fee schedule"}]}]},{"description":"HC CERETEC WBC NUCLIDE","code_information":[{"code":"A9569","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":930.09,"maximum":6049.89,"gross_charge":7469,"discounted_cash":2210.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6049.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6049.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6049.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4780.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1040.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1040.32,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1590.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1762.05,"standard_charge_algorithm": "Lesser of $1762.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3734.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3361.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1419.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1493.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1120.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1493.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":930.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":995.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":957.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":976.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1023.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":985.9,"methodology":"case rate"}]}]},{"description":"HC INDIUM WBC NUCLIDE PER DOSE","code_information":[{"code":"A9570","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":5367.7,"maximum":6688.98,"gross_charge":8258,"discounted_cash":2444.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6688.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6688.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6688.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5367.7,"methodology":"fee schedule"}]}]},{"description":"HC INDIUM WBC NUCLIDE PER DOSE","code_information":[{"code":"A9570","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":922.1,"maximum":6688.98,"gross_charge":8258,"discounted_cash":2444.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6688.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6688.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6688.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5285.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1031.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1031.39,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1576.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4121.99,"standard_charge_algorithm": "Lesser of $4121.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4129,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3716.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1569.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1238.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1651.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":922.1,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":986.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":949.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":968.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1014.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":977.43,"methodology":"case rate"}]}]},{"description":"HC OCTREOTIDE PER MCI","code_information":[{"code":"A9572","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":6923.8,"maximum":8628.12,"gross_charge":10652,"discounted_cash":3153,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8628.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8628.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8628.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6923.8,"methodology":"fee schedule"}]}]},{"description":"HC OCTREOTIDE PER MCI","code_information":[{"code":"A9572","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1597.8,"maximum":8628.12,"gross_charge":10652,"discounted_cash":3153,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8628.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8628.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8628.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6817.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1914.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1914.61,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2927.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5326,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5326,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4793.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2023.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2130.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1597.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2130.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1711.74,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1831.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1763.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1797.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1882.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1814.44,"methodology":"case rate"}]}]},{"description":"INJ VUEWAY 10X10 ML 0270-7015-42","code_information":[{"code":"A9573","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":60.12,"maximum":81.17,"gross_charge":100.2,"discounted_cash":29.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"}]}]},{"description":"INJ VUEWAY 10X10 ML 0270-7015-42","code_information":[{"code":"A9573","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.03,"maximum":81.17,"gross_charge":100.2,"discounted_cash":29.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"}]}]},{"description":"INJ VUEWAY 10X3 ML 0270-7015-38","code_information":[{"code":"A9573","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":18.36,"maximum":24.79,"gross_charge":30.6,"discounted_cash":9.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"}]}]},{"description":"INJ VUEWAY 10X3 ML 0270-7015-38","code_information":[{"code":"A9573","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.59,"maximum":24.79,"gross_charge":30.6,"discounted_cash":9.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"}]}]},{"description":"INJ VUEWAY 10X7.5 ML 0270-7015-40","code_information":[{"code":"A9573","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.2,"maximum":61.02,"gross_charge":75.33,"discounted_cash":22.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.2,"methodology":"fee schedule"}]}]},{"description":"INJ VUEWAY 10X7.5 ML 0270-7015-40","code_information":[{"code":"A9573","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.3,"maximum":61.02,"gross_charge":75.33,"discounted_cash":22.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"}]}]},{"description":"HC I-123 MIBG UP TO 10 MCI","code_information":[{"code":"A9582","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":7011.55,"maximum":8737.47,"gross_charge":10787,"discounted_cash":3192.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8737.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8737.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8737.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7011.55,"methodology":"fee schedule"}]}]},{"description":"HC I-123 MIBG UP TO 10 MCI","code_information":[{"code":"A9582","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1618.05,"maximum":8737.47,"gross_charge":10787,"discounted_cash":3192.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8737.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8737.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8737.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6903.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2074.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2074.81,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3171.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6805.15,"standard_charge_algorithm": "Lesser of $6805.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5393.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4854.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2049.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2157.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1618.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2157.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1854.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1984.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1910.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1947.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2040.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1966.26,"methodology":"case rate"}]}]},{"description":"GALLIUM 68 DOTATE PER 0.1 MILLICURIE DX","code_information":[{"code":"A9587","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":144.95,"maximum":180.63,"gross_charge":223,"discounted_cash":66.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":144.95,"methodology":"fee schedule"}]}]},{"description":"GALLIUM 68 DOTATE PER 0.1 MILLICURIE DX","code_information":[{"code":"A9587","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":33.45,"maximum":180.63,"gross_charge":223,"discounted_cash":66.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":142.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.09,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":78.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.04,"standard_charge_algorithm": "Lesser of $64.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":111.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":45.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":48.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":47.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":50.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":48.42,"methodology":"case rate"}]}]},{"description":"HEXAMINOLEVULINATE 100 MG INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"A9589","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10511-3001-02","type":"NDC"}],"standard_charges":[{"minimum":5284.94,"maximum":7134.67,"gross_charge":8808.23,"discounted_cash":2607.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7134.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7134.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7134.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5725.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6165.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5284.94,"methodology":"fee schedule"}]}]},{"description":"HEXAMINOLEVULINATE 100 MG INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"A9589","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10511-3001-02","type":"NDC"}],"standard_charges":[{"minimum":1321.24,"maximum":7134.67,"gross_charge":8808.23,"discounted_cash":2607.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7134.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7134.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7134.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5637.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1385.61,"standard_charge_algorithm": "Lesser of $1385.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1385.61,"standard_charge_algorithm": "Lesser of $1385.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3963.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6165.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5284.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1321.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1761.65,"methodology":"fee schedule"}]}]},{"description":"COPPER 64 DOTATATE 6995-064-01","code_information":[{"code":"A9592","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":6499.35,"maximum":8099.19,"gross_charge":9999,"discounted_cash":2959.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8099.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8099.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8099.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6499.35,"methodology":"fee schedule"}]}]},{"description":"COPPER 64 DOTATATE 6995-064-01","code_information":[{"code":"A9592","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1499.85,"maximum":8099.19,"gross_charge":9999,"discounted_cash":2959.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8099.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8099.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8099.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6399.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4999.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4999.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4499.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1899.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1999.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1999.8,"methodology":"fee schedule"}]}]},{"description":"F-18 PYLARIFY 71258-0022-00","code_information":[{"code":"A9595","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1248,"maximum":1555.2,"gross_charge":1920,"discounted_cash":568.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1248,"methodology":"fee schedule"}]}]},{"description":"F-18 PYLARIFY 71258-0022-00","code_information":[{"code":"A9595","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":288,"maximum":1555.2,"gross_charge":1920,"discounted_cash":568.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1228.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":960,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":960,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":864,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":384,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":288,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":384,"methodology":"fee schedule"}]}]},{"description":"ILLUC GALL 68 NDC 74725-100-25","code_information":[{"code":"A9596","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":1748.5,"maximum":2178.9,"gross_charge":2690,"discounted_cash":796.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1748.5,"methodology":"fee schedule"}]}]},{"description":"ILLUC GALL 68 NDC 74725-100-25","code_information":[{"code":"A9596","type":"HCPCS"},{"code":"0343","type":"RC"}],"standard_charges":[{"minimum":403.5,"maximum":2178.9,"gross_charge":2690,"discounted_cash":796.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2178.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1721.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1345,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1345,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1210.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":511.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":538,"methodology":"fee schedule"}]}]},{"description":"HC RADIUM223 DICHLORIDE XOFIGO","code_information":[{"code":"A9606","type":"HCPCS"},{"code":"0344","type":"RC"}],"standard_charges":[{"minimum":150.15,"maximum":187.11,"gross_charge":231,"discounted_cash":68.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":150.15,"methodology":"fee schedule"}]}]},{"description":"HC RADIUM223 DICHLORIDE XOFIGO","code_information":[{"code":"A9606","type":"HCPCS"},{"code":"0344","type":"RC"}],"standard_charges":[{"minimum":34.65,"maximum":258.45,"gross_charge":231,"discounted_cash":68.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":147.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":168.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":161.16,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":258.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":173.05,"standard_charge_algorithm": "Lesser of $173.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":173.05,"standard_charge_algorithm": "Lesser of $173.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":151.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":161.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":155.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":158.7,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":166.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":160.21,"methodology":"case rate"}]}]},{"description":"HC PLATE KYPHO *920705110000","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":7642.2,"maximum":10316.97,"gross_charge":12737,"discounted_cash":3770.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10316.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10316.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10316.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8279.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8915.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7642.2,"methodology":"fee schedule"}]}]},{"description":"HC PLATE KYPHO *920705110000","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1910.55,"maximum":10316.97,"gross_charge":12737,"discounted_cash":3770.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10316.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10316.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10316.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8151.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4457.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5094.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5731.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8915.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7642.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2420.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2547.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1910.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2547.4,"methodology":"fee schedule"}]}]},{"description":"KYPHO CEMNT/MIXER 0607-687-000","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":465,"maximum":627.75,"gross_charge":775,"discounted_cash":229.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":503.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465,"methodology":"fee schedule"}]}]},{"description":"KYPHO CEMNT/MIXER 0607-687-000","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":116.25,"maximum":627.75,"gross_charge":775,"discounted_cash":229.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":627.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":496,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":271.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":310,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":348.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":542.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":465,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BRACHY SEED","code_information":[{"code":"C1715","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.01,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BRACHY SEED","code_information":[{"code":"C1715","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"HC BRACHYTX SOURCE HDR IR-192","code_information":[{"code":"C1717","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":600,"maximum":810,"gross_charge":1000,"discounted_cash":296,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":650,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":700,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"}]}]},{"description":"HC BRACHYTX SOURCE HDR IR-192","code_information":[{"code":"C1717","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":150,"maximum":810,"gross_charge":1000,"discounted_cash":296,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":640,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":749.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":749.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":531.33,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":523.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":350,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":400,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":450,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":700,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":306.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":327.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":315.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":321.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":336.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":324.48,"methodology":"case rate"}]}]},{"description":"HC WARRANTY ADJUST - EP - ICD DR","code_information":[{"code":"C1721","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY ADJUST - EP - ICD DR","code_information":[{"code":"C1721","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC BALLN EVER AB35W08060080","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":170.91,"maximum":170.91,"gross_charge":211,"discounted_cash":62.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.91,"methodology":"fee schedule"}]}]},{"description":"HC BALLN EVER AB35W08060080","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.65,"maximum":170.91,"gross_charge":211,"discounted_cash":62.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON 10MM","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1858.95,"maximum":1858.95,"gross_charge":2295,"discounted_cash":679.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1858.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1858.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1858.95,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON 10MM","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":344.25,"maximum":1858.95,"gross_charge":2295,"discounted_cash":679.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1858.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1858.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1858.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":436.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":459,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":344.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":459,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON 8GA 0705815000","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2126.25,"maximum":2126.25,"gross_charge":2625,"discounted_cash":777,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2126.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2126.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2126.25,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON 8GA 0705815000","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":393.75,"maximum":2126.25,"gross_charge":2625,"discounted_cash":777,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2126.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2126.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2126.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":525,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":525,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON XXL 12X4 14-511","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":790.56,"maximum":790.56,"gross_charge":976,"discounted_cash":288.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":790.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":790.56,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON XXL 12X4 14-511","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":146.4,"maximum":790.56,"gross_charge":976,"discounted_cash":288.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":790.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":790.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":790.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH BALLN VAGINAL ALA-45","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":831.06,"maximum":831.06,"gross_charge":1026,"discounted_cash":303.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.06,"methodology":"fee schedule"}]}]},{"description":"HC CATH BALLN VAGINAL ALA-45","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":153.9,"maximum":831.06,"gross_charge":1026,"discounted_cash":303.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH BALLOON DIL 6714","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC CATH BALLOON DIL 6714","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH BILI COPE LOOP G09205","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC CATH BILI COPE LOOP G09205","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN ADM100040080","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":443.07,"maximum":443.07,"gross_charge":547,"discounted_cash":161.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.07,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN ADM100040080","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":82.05,"maximum":443.07,"gross_charge":547,"discounted_cash":161.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN COR SNS BVCS6180","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN COR SNS BVCS6180","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.25,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN NPHROM 210-162","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":646.38,"maximum":646.38,"gross_charge":798,"discounted_cash":236.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":646.38,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN NPHROM 210-162","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":119.7,"maximum":646.38,"gross_charge":798,"discounted_cash":236.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN NPHROMX 210-142","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":593.73,"maximum":593.73,"gross_charge":733,"discounted_cash":216.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":593.73,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN NPHROMX 210-142","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":109.95,"maximum":593.73,"gross_charge":733,"discounted_cash":216.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":593.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN NPHROMX 210160","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":602.64,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN NPHROMX 210160","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":111.6,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN PTA AB35W03020080","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":352.35,"maximum":352.35,"gross_charge":435,"discounted_cash":128.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.35,"methodology":"fee schedule"}]}]},{"description":"HC CATH BLLN PTA AB35W03020080","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":65.25,"maximum":352.35,"gross_charge":435,"discounted_cash":128.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROGREAT MCPB2413Y","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":704.7,"maximum":704.7,"gross_charge":870,"discounted_cash":257.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":704.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":704.7,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROGREAT MCPB2413Y","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":130.5,"maximum":704.7,"gross_charge":870,"discounted_cash":257.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":704.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":704.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174,"methodology":"fee schedule"}]}]},{"description":"HC PAK KYPHO EX W/BLLN KPE1001","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC PAK KYPHO EX W/BLLN KPE1001","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"HC PAK KYPHO EXPR KPE1002","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":89.91,"maximum":89.91,"gross_charge":111,"discounted_cash":32.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.91,"methodology":"fee schedule"}]}]},{"description":"HC PAK KYPHO EXPR KPE1002","code_information":[{"code":"C1726","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.65,"maximum":89.91,"gross_charge":111,"discounted_cash":32.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH 4.7FR 150CM AL13114000","code_information":[{"code":"C1728","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":162.6,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":176.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":189.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH 4.7FR 150CM AL13114000","code_information":[{"code":"C1728","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":40.65,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":173.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":108.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":189.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"}]}]},{"description":"CATH BACTISEAL EVD 82-1745","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":963.09,"maximum":963.09,"gross_charge":1189,"discounted_cash":351.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.09,"methodology":"fee schedule"}]}]},{"description":"CATH BACTISEAL EVD 82-1745","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":178.35,"maximum":963.09,"gross_charge":1189,"discounted_cash":351.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.8,"methodology":"fee schedule"}]}]},{"description":"CATH CEREBR EVD 10FR 37.550.501","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1594.08,"maximum":1594.08,"gross_charge":1968,"discounted_cash":582.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1594.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1594.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1594.08,"methodology":"fee schedule"}]}]},{"description":"CATH CEREBR EVD 10FR 37.550.501","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":295.2,"maximum":1594.08,"gross_charge":1968,"discounted_cash":582.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1594.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1594.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1594.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.6,"methodology":"fee schedule"}]}]},{"description":"CATH DRNG 16FRX25CM G07254","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":226.8,"maximum":226.8,"gross_charge":280,"discounted_cash":82.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":226.8,"methodology":"fee schedule"}]}]},{"description":"CATH DRNG 16FRX25CM G07254","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":42,"maximum":226.8,"gross_charge":280,"discounted_cash":82.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":226.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"}]}]},{"description":"CATH LUMEN EVD BACTISL 821750","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":984.15,"maximum":984.15,"gross_charge":1215,"discounted_cash":359.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.15,"methodology":"fee schedule"}]}]},{"description":"CATH LUMEN EVD BACTISL 821750","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":182.25,"maximum":984.15,"gross_charge":1215,"discounted_cash":359.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243,"methodology":"fee schedule"}]}]},{"description":"CRANIAL DRL LIDO RETRT 82-6614","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":710.37,"maximum":710.37,"gross_charge":877,"discounted_cash":259.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":710.37,"methodology":"fee schedule"}]}]},{"description":"CRANIAL DRL LIDO RETRT 82-6614","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":131.55,"maximum":710.37,"gross_charge":877,"discounted_cash":259.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":710.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH ABS BIL 10F 14000902","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":203.31,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"}]}]},{"description":"HC CATH ABS BIL 10F 14000902","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.65,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH ABSC 14000804","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":886.95,"maximum":886.95,"gross_charge":1095,"discounted_cash":324.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":886.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":886.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":886.95,"methodology":"fee schedule"}]}]},{"description":"HC CATH ABSC 14000804","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":164.25,"maximum":886.95,"gross_charge":1095,"discounted_cash":324.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":886.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":886.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":886.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":219,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":219,"methodology":"fee schedule"}]}]},{"description":"HC CATH BIL DRAIN G09326","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":234.9,"maximum":234.9,"gross_charge":290,"discounted_cash":85.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.9,"methodology":"fee schedule"}]}]},{"description":"HC CATH BIL DRAIN G09326","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":43.5,"maximum":234.9,"gross_charge":290,"discounted_cash":85.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"}]}]},{"description":"HC CATH BIL MAC G09500","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":179.82,"maximum":179.82,"gross_charge":222,"discounted_cash":65.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.82,"methodology":"fee schedule"}]}]},{"description":"HC CATH BIL MAC G09500","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.3,"maximum":179.82,"gross_charge":222,"discounted_cash":65.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH BILI MAC-LOC G09499","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC CATH BILI MAC-LOC G09499","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.1,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRAINAGE 6FX20 756506020","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":224.37,"maximum":224.37,"gross_charge":277,"discounted_cash":82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":224.37,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRAINAGE 6FX20 756506020","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":41.55,"maximum":224.37,"gross_charge":277,"discounted_cash":82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":224.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRAINGE 756516025","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":155.52,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRAINGE 756516025","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.8,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRNG 12.0FX25 G09503","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":174.96,"maximum":174.96,"gross_charge":216,"discounted_cash":63.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.96,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRNG 12.0FX25 G09503","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":174.96,"gross_charge":216,"discounted_cash":63.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRNG MP G09766","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC CATH DRNG MP G09766","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.3,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTR MIC-KEY 0100-20","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTR MIC-KEY 0100-20","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.75,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTSTMY 0100-14LV","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":204.93,"maximum":204.93,"gross_charge":253,"discounted_cash":74.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.93,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTSTMY 0100-14LV","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.95,"maximum":204.93,"gross_charge":253,"discounted_cash":74.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTSTMY 0120-20-2.5","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":216.27,"maximum":216.27,"gross_charge":267,"discounted_cash":79.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":216.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":216.27,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTSTMY 0120-20-2.5","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.05,"maximum":216.27,"gross_charge":267,"discounted_cash":79.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":216.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":216.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":216.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTSTMY MIC 010030","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTSTMY MIC 010030","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.45,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTY MIC-KEY 10026","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC CATH GASTY MIC-KEY 10026","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH LCK DRN RLC-14-038","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":677.97,"maximum":677.97,"gross_charge":837,"discounted_cash":247.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":677.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":677.97,"methodology":"fee schedule"}]}]},{"description":"HC CATH LCK DRN RLC-14-038","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":125.55,"maximum":677.97,"gross_charge":837,"discounted_cash":247.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":677.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":677.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":677.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTI 10.2FRX25 G-95902","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":162,"maximum":162,"gross_charge":200,"discounted_cash":59.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTI 10.2FRX25 G-95902","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30,"maximum":162,"gross_charge":200,"discounted_cash":59.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTP 12F 50CM G11975","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":120.69,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTP 12F 50CM G11975","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.35,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHROST 14FRX25 G09504","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":190.35,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHROST 14FRX25 G09504","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":35.25,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHSTMY 755610035","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":486,"maximum":486,"gross_charge":600,"discounted_cash":177.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHSTMY 755610035","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":90,"maximum":486,"gross_charge":600,"discounted_cash":177.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHSTMY 755610035","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":511.92,"maximum":511.92,"gross_charge":632,"discounted_cash":187.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":511.92,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHSTMY 755610035","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":94.8,"maximum":511.92,"gross_charge":632,"discounted_cash":187.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":511.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHSTMY 755612035","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1239.3,"maximum":1239.3,"gross_charge":1530,"discounted_cash":452.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1239.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1239.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1239.3,"methodology":"fee schedule"}]}]},{"description":"HC CATH NEPHSTMY 755612035","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":229.5,"maximum":1239.3,"gross_charge":1530,"discounted_cash":452.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1239.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1239.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1239.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"}]}]},{"description":"HC CATH PLEURAL 50-7000B","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1163.16,"maximum":1163.16,"gross_charge":1436,"discounted_cash":425.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1163.16,"methodology":"fee schedule"}]}]},{"description":"HC CATH PLEURAL 50-7000B","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":215.4,"maximum":1163.16,"gross_charge":1436,"discounted_cash":425.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1163.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":272.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.2,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 5 FR OSC-5F-10","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 5 FR OSC-5F-10","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.1,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABSC DRAIN 14000305","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":182.25,"maximum":182.25,"gross_charge":225,"discounted_cash":66.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABSC DRAIN 14000305","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.75,"maximum":182.25,"gross_charge":225,"discounted_cash":66.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABSC DRAIN 14000803","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":159.57,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABSC DRAIN 14000803","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.55,"maximum":159.57,"gross_charge":197,"discounted_cash":58.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABSC DRAIN 14000804","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":293.22,"maximum":293.22,"gross_charge":362,"discounted_cash":107.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.22,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABSC DRAIN 14000804","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":54.3,"maximum":293.22,"gross_charge":362,"discounted_cash":107.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.4,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER BILIARY G09829","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":243,"maximum":243,"gross_charge":300,"discounted_cash":88.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":243,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER BILIARY G09829","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":45,"maximum":243,"gross_charge":300,"discounted_cash":88.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER DRN MULTI G09501","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER DRN MULTI G09501","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":45.75,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER KUMPE 4F 11714014","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":104.49,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER KUMPE 4F 11714014","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.35,"maximum":104.49,"gross_charge":129,"discounted_cash":38.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER NEPH G09503","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.67,"maximum":5.67,"gross_charge":7,"discounted_cash":2.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.67,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER NEPH G09503","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1.05,"maximum":5.67,"gross_charge":7,"discounted_cash":2.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER NEPHRO ULT10 G09502","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER NEPHRO ULT10 G09502","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER OSC-5FR-15CM","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":656.1,"maximum":656.1,"gross_charge":810,"discounted_cash":239.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":656.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":656.1,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER OSC-5FR-15CM","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":121.5,"maximum":656.1,"gross_charge":810,"discounted_cash":239.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":656.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":656.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":162,"methodology":"fee schedule"}]}]},{"description":"NDL DRNGE 5FRX15CM 19G G09489","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"NDL DRNGE 5FRX15CM 19G G09489","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"}]}]},{"description":"NDL DRNGE 5FRX15CM 19G G09492","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":42.93,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"}]}]},{"description":"NDL DRNGE 5FRX15CM 19G G09492","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.95,"maximum":42.93,"gross_charge":53,"discounted_cash":15.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH DECAN 7FR R7D282CT","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2206.44,"maximum":2206.44,"gross_charge":2724,"discounted_cash":806.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2206.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2206.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2206.44,"methodology":"fee schedule"}]}]},{"description":"HC CATH DECAN 7FR R7D282CT","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":408.6,"maximum":2206.44,"gross_charge":2724,"discounted_cash":806.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2206.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2206.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2206.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIAG EP POLAR M004700300","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIAG EP POLAR M004700300","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH HEMOSPLIT *5733730","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":14436,"maximum":19488.6,"gross_charge":24060,"discounted_cash":7121.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19488.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19488.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19488.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15639,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16842,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14436,"methodology":"fee schedule"}]}]},{"description":"HC CATH HEMOSPLIT *5733730","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3609,"maximum":19488.6,"gross_charge":24060,"discounted_cash":7121.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19488.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19488.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19488.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15398.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8421,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9624,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10827,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16842,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14436,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4571.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4812,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3609,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4812,"methodology":"fee schedule"}]}]},{"description":"HC CATH HEMOSPLIT 5733270","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":147,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":159.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":171.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147,"methodology":"fee schedule"}]}]},{"description":"HC CATH HEMOSPLIT 5733270","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":85.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":110.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":171.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC CATH PERMA SPL II ASPC32-3","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":618,"maximum":834.3,"gross_charge":1030,"discounted_cash":304.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":669.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":721,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"}]}]},{"description":"HC CATH PERMA SPL II ASPC32-3","code_information":[{"code":"C1750","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":154.5,"maximum":834.3,"gross_charge":1030,"discounted_cash":304.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":834.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":360.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":412,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":463.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":721,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":206,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":206,"methodology":"fee schedule"}]}]},{"description":"CATH MID PWRGL 10CM ST018101D","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":345.06,"maximum":345.06,"gross_charge":426,"discounted_cash":126.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":345.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.06,"methodology":"fee schedule"}]}]},{"description":"CATH MID PWRGL 10CM ST018101D","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":63.9,"maximum":345.06,"gross_charge":426,"discounted_cash":126.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":345.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH CV GROSH 8FR 7711804","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":422.82,"maximum":422.82,"gross_charge":522,"discounted_cash":154.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.82,"methodology":"fee schedule"}]}]},{"description":"HC CATH CV GROSH 8FR 7711804","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":78.3,"maximum":422.82,"gross_charge":522,"discounted_cash":154.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH CV SURCUF 600650","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":381.51,"maximum":381.51,"gross_charge":471,"discounted_cash":139.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.51,"methodology":"fee schedule"}]}]},{"description":"HC CATH CV SURCUF 600650","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":70.65,"maximum":381.51,"gross_charge":471,"discounted_cash":139.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":381.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH LYSUS INFUS 500-52118","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1180.98,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"}]}]},{"description":"HC CATH LYSUS INFUS 500-52118","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":218.7,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH PICC 4FR SOLO 1194108D","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":554.85,"maximum":554.85,"gross_charge":685,"discounted_cash":202.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":554.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.85,"methodology":"fee schedule"}]}]},{"description":"HC CATH PICC 4FR SOLO 1194108D","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":102.75,"maximum":554.85,"gross_charge":685,"discounted_cash":202.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":554.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":137,"methodology":"fee schedule"}]}]},{"description":"HC CATH PICC 5FR SOLO 1295108D","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":578.34,"maximum":578.34,"gross_charge":714,"discounted_cash":211.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.34,"methodology":"fee schedule"}]}]},{"description":"HC CATH PICC 5FR SOLO 1295108D","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":107.1,"maximum":578.34,"gross_charge":714,"discounted_cash":211.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH POWERPICC 5FR 1395108QD","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":630.18,"maximum":630.18,"gross_charge":778,"discounted_cash":230.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":630.18,"methodology":"fee schedule"}]}]},{"description":"HC CATH POWERPICC 5FR 1395108QD","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":116.7,"maximum":630.18,"gross_charge":778,"discounted_cash":230.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":630.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH RENEGADE 150/20 18-253","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":891.81,"maximum":891.81,"gross_charge":1101,"discounted_cash":325.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891.81,"methodology":"fee schedule"}]}]},{"description":"HC CATH RENEGADE 150/20 18-253","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":165.15,"maximum":891.81,"gross_charge":1101,"discounted_cash":325.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.2,"methodology":"fee schedule"}]}]},{"description":"POWERLINE CV CATH 0720515","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":542.4,"maximum":732.24,"gross_charge":904,"discounted_cash":267.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":732.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":732.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":732.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":587.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":632.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":542.4,"methodology":"fee schedule"}]}]},{"description":"POWERLINE CV CATH 0720515","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":135.6,"maximum":732.24,"gross_charge":904,"discounted_cash":267.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":732.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":732.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":732.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":578.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":316.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":361.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":406.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":632.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":542.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIALYSIS MC061423","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":219.6,"maximum":296.46,"gross_charge":366,"discounted_cash":108.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":237.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":256.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIALYSIS MC061423","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":54.9,"maximum":296.46,"gross_charge":366,"discounted_cash":108.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":234.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":164.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":256.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.2,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER DIALYSIS MC061422","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":270,"maximum":364.5,"gross_charge":450,"discounted_cash":133.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":292.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":315,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":270,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER DIALYSIS MC061422","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":67.5,"maximum":364.5,"gross_charge":450,"discounted_cash":133.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":288,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":157.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":180,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":315,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER DIALYSIS MC061423","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":170.4,"maximum":230.04,"gross_charge":284,"discounted_cash":84.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":184.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":198.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.4,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER DIALYSIS MC061423","code_information":[{"code":"C1752","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":42.6,"maximum":230.04,"gross_charge":284,"discounted_cash":84.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":181.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":113.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":127.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":198.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH PACING RT C315HIS","code_information":[{"code":"C1756","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC CATH PACING RT C315HIS","code_information":[{"code":"C1756","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON EMBOL 12TLW805F35","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":219.51,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"}]}]},{"description":"HC BALLOON EMBOL 12TLW805F35","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.65,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"}]}]},{"description":"HC BEAD LC MICRON VE420GS","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2990.4,"maximum":4037.04,"gross_charge":4984,"discounted_cash":1475.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3239.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3488.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2990.4,"methodology":"fee schedule"}]}]},{"description":"HC BEAD LC MICRON VE420GS","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":747.6,"maximum":4037.04,"gross_charge":4984,"discounted_cash":1475.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3189.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1744.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1993.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2242.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3488.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2990.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH ASPIR CAT8XTORQ115","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6145.47,"maximum":6145.47,"gross_charge":7587,"discounted_cash":2245.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6145.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6145.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6145.47,"methodology":"fee schedule"}]}]},{"description":"HC CATH ASPIR CAT8XTORQ115","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1138.05,"maximum":6145.47,"gross_charge":7587,"discounted_cash":2245.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6145.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6145.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6145.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1441.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1517.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1138.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1517.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH EMBOLECTOMY 120803F","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC CATH EMBOLECTOMY 120803F","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.3,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH EMBOLECTOMY 120805F","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"}]}]},{"description":"HC CATH EMBOLECTOMY 120805F","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.75,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"}]}]},{"description":"HC CATH PROWLER 606-151MX","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1359.18,"maximum":1359.18,"gross_charge":1678,"discounted_cash":496.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1359.18,"methodology":"fee schedule"}]}]},{"description":"HC CATH PROWLER 606-151MX","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":251.7,"maximum":1359.18,"gross_charge":1678,"discounted_cash":496.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1359.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":318.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.6,"methodology":"fee schedule"}]}]},{"description":"INARI TRIEVER20 21-101","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":93.15,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"}]}]},{"description":"INARI TRIEVER20 21-101","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.25,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"}]}]},{"description":"SYS FLWTRVR RETRVL ASP FT-PPP","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21870,"maximum":21870,"gross_charge":27000,"discounted_cash":7992,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21870,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21870,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21870,"methodology":"fee schedule"}]}]},{"description":"SYS FLWTRVR RETRVL ASP FT-PPP","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4050,"maximum":21870,"gross_charge":27000,"discounted_cash":7992,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21870,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21870,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21870,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5130,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5400,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4050,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5400,"methodology":"fee schedule"}]}]},{"description":"DEVICE CLSR ANGIO SEAL 6F 610130","code_information":[{"code":"C1760","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":333,"maximum":449.55,"gross_charge":555,"discounted_cash":164.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":449.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":449.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":449.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":360.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":388.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"}]}]},{"description":"DEVICE CLSR ANGIO SEAL 6F 610130","code_information":[{"code":"C1760","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":83.25,"maximum":449.55,"gross_charge":555,"discounted_cash":164.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":449.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":449.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":449.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":355.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":194.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":222,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":249.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":388.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH BIDIREC D140010","code_information":[{"code":"C1766","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1649.16,"maximum":1649.16,"gross_charge":2036,"discounted_cash":602.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1649.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1649.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1649.16,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH BIDIREC D140010","code_information":[{"code":"C1766","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":305.4,"maximum":1649.16,"gross_charge":2036,"discounted_cash":602.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1649.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1649.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1649.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.2,"methodology":"fee schedule"}]}]},{"description":"HC GRAFT AORT ENDOPRO PTB104275","code_information":[{"code":"C1768","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6974.4,"maximum":9415.44,"gross_charge":11624,"discounted_cash":3440.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9415.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9415.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9415.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7555.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8136.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6974.4,"methodology":"fee schedule"}]}]},{"description":"HC GRAFT AORT ENDOPRO PTB104275","code_information":[{"code":"C1768","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1743.6,"maximum":9415.44,"gross_charge":11624,"discounted_cash":3440.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9415.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9415.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9415.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7439.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4068.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4649.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5230.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8136.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6974.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2208.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2324.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1743.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2324.8,"methodology":"fee schedule"}]}]},{"description":"HC GRAFT AORT THOR PTBB104275","code_information":[{"code":"C1768","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":7510.2,"maximum":10138.77,"gross_charge":12517,"discounted_cash":3705.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10138.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10138.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10138.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8136.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8761.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7510.2,"methodology":"fee schedule"}]}]},{"description":"HC GRAFT AORT THOR PTBB104275","code_information":[{"code":"C1768","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1877.55,"maximum":10138.77,"gross_charge":12517,"discounted_cash":3705.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10138.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10138.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10138.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8010.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4380.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5006.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5632.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8761.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7510.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2378.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2503.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1877.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2503.4,"methodology":"fee schedule"}]}]},{"description":"GLIDEWIRE ADVAN 260CM GA3502","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":400.95,"maximum":400.95,"gross_charge":495,"discounted_cash":146.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.95,"methodology":"fee schedule"}]}]},{"description":"GLIDEWIRE ADVAN 260CM GA3502","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":74.25,"maximum":400.95,"gross_charge":495,"discounted_cash":146.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":99,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE AMPLATZ 46-523","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE AMPLATZ 46-523","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE BEN 49-145","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE BEN 49-145","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.75,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE BEN G00693","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE BEN G00693","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE CATHETER 46-604","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":225.18,"maximum":225.18,"gross_charge":278,"discounted_cash":82.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.18,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE CATHETER 46-604","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":41.7,"maximum":225.18,"gross_charge":278,"discounted_cash":82.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":225.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.6,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE CPS COURIER DS2G002","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30.78,"maximum":30.78,"gross_charge":38,"discounted_cash":11.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.78,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE CPS COURIER DS2G002","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.7,"maximum":30.78,"gross_charge":38,"discounted_cash":11.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE DEFL G07672","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":125.55,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE DEFL G07672","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":23.25,"maximum":125.55,"gross_charge":155,"discounted_cash":45.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE JFX CORE 49-121","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE JFX CORE 49-121","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":23.4,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.2,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE RUNTHROUGH 25-1011","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE RUNTHROUGH 25-1011","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.1,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE VERRATA 10185P","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1312.2,"maximum":1312.2,"gross_charge":1620,"discounted_cash":479.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1312.2,"methodology":"fee schedule"}]}]},{"description":"HC GUIDEWIRE VERRATA 10185P","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":243,"maximum":1312.2,"gross_charge":1620,"discounted_cash":479.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1312.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":324,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE 0.014INX180CM G08777","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":558.09,"maximum":558.09,"gross_charge":689,"discounted_cash":203.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":558.09,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE 0.014INX180CM G08777","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":103.35,"maximum":558.09,"gross_charge":689,"discounted_cash":203.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":558.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.8,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ANG GR3506","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":99.63,"maximum":99.63,"gross_charge":123,"discounted_cash":36.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.63,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ANG GR3506","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.45,"maximum":99.63,"gross_charge":123,"discounted_cash":36.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ANG RDRUN G08801","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ANG RDRUN G08801","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.75,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE AQUAL 60000301","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE AQUAL 60000301","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ATTAIN GWR419578","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ATTAIN GWR419578","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE CATHETER 451-504F5","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":49.41,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE CATHETER 451-504F5","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.15,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE DEFL REUT G26958","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.44,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE DEFL REUT G26958","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ENDO AXC G50660","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":565.38,"maximum":565.38,"gross_charge":698,"discounted_cash":206.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.38,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE ENDO AXC G50660","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":104.7,"maximum":565.38,"gross_charge":698,"discounted_cash":206.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.6,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE FIX EMERALD 502-521","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE FIX EMERALD 502-521","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.35,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.8,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE FIX J EMERALD 502-524","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.68,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE FIX J EMERALD 502-524","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE FIX TAPR 49-101","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":103.68,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE FIX TAPR 49-101","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.2,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE GLIDE GR1805","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":174.15,"maximum":174.15,"gross_charge":215,"discounted_cash":63.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE GLIDE GR1805","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":32.25,"maximum":174.15,"gross_charge":215,"discounted_cash":63.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE NITREX N183002","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":238.95,"maximum":238.95,"gross_charge":295,"discounted_cash":87.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.95,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE NITREX N183002","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":44.25,"maximum":238.95,"gross_charge":295,"discounted_cash":87.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE PROSTREM 41274-01","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":196.83,"maximum":196.83,"gross_charge":243,"discounted_cash":71.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.83,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE PROSTREM 41274-01","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":196.83,"gross_charge":243,"discounted_cash":71.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE RDRUN 180CM G07516","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE RDRUN 180CM G07516","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE STIFF GS3508","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":41.31,"maximum":41.31,"gross_charge":51,"discounted_cash":15.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE STIFF GS3508","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.65,"maximum":41.31,"gross_charge":51,"discounted_cash":15.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE TANSCEND 46-811","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":454.41,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE TANSCEND 46-811","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":84.15,"maximum":454.41,"gross_charge":561,"discounted_cash":166.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE TRANSEND EX 46-806","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":628.56,"maximum":628.56,"gross_charge":776,"discounted_cash":229.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":628.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":628.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":628.56,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE TRANSEND EX 46-806","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":116.4,"maximum":628.56,"gross_charge":776,"discounted_cash":229.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":628.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":628.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":628.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.2,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE XSUPP H7491211901J1","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":157.95,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"}]}]},{"description":"HC GWIRE XSUPP H7491211901J1","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.25,"maximum":157.95,"gross_charge":195,"discounted_cash":57.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"}]}]},{"description":"HC WIRE AMPLATZ 260CM 46-526","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":132.84,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"}]}]},{"description":"HC WIRE AMPLATZ 260CM 46-526","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.6,"maximum":132.84,"gross_charge":164,"discounted_cash":48.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"}]}]},{"description":"HC WIRE BENTSON IQ35F80B","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC WIRE BENTSON IQ35F80B","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"HC WIRE CHOICE SUPPORT 12155-01J","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":218.7,"maximum":218.7,"gross_charge":270,"discounted_cash":79.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":218.7,"methodology":"fee schedule"}]}]},{"description":"HC WIRE CHOICE SUPPORT 12155-01J","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":218.7,"gross_charge":270,"discounted_cash":79.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"}]}]},{"description":"HC WIRE COPE MANDRL GUDE G05183","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":110.16,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"}]}]},{"description":"HC WIRE COPE MANDRL GUDE G05183","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.4,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"}]}]},{"description":"HC WIRE DOUBLE ANGLE RG*GW1818SA","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"}]}]},{"description":"HC WIRE DOUBLE ANGLE RG*GW1818SA","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.75,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GLIDE 46-231","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":433.35,"maximum":433.35,"gross_charge":535,"discounted_cash":158.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":433.35,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GLIDE 46-231","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":80.25,"maximum":433.35,"gross_charge":535,"discounted_cash":158.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":433.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE BENTSON 49-145","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":168.48,"maximum":168.48,"gross_charge":208,"discounted_cash":61.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.48,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE BENTSON 49-145","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.2,"maximum":168.48,"gross_charge":208,"discounted_cash":61.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE BENTSON G04194","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":97.2,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE BENTSON G04194","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE G00617","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE G00617","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.4,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE STIFF G31453","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.97,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"}]}]},{"description":"HC WIRE GUIDE STIFF G31453","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.55,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"}]}]},{"description":"HC WIRE MEIER 185CM SCH-30600","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":167.67,"maximum":167.67,"gross_charge":207,"discounted_cash":61.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.67,"methodology":"fee schedule"}]}]},{"description":"HC WIRE MEIER 185CM SCH-30600","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.05,"maximum":167.67,"gross_charge":207,"discounted_cash":61.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"}]}]},{"description":"HC WIRE ROADRUNNER G06866","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.59,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"}]}]},{"description":"HC WIRE ROADRUNNER G06866","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.85,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"}]}]},{"description":"HC WIRE ROSEN 260CM 49-157","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":47.79,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"}]}]},{"description":"HC WIRE ROSEN 260CM 49-157","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.85,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"}]}]},{"description":"HC WIRE ROSEN 49-156","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":586.44,"maximum":586.44,"gross_charge":724,"discounted_cash":214.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":586.44,"methodology":"fee schedule"}]}]},{"description":"HC WIRE ROSEN 49-156","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":108.6,"maximum":586.44,"gross_charge":724,"discounted_cash":214.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":586.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.8,"methodology":"fee schedule"}]}]},{"description":"HC WIRE SPORT 22235MJ","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":394.47,"maximum":394.47,"gross_charge":487,"discounted_cash":144.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.47,"methodology":"fee schedule"}]}]},{"description":"HC WIRE SPORT 22235MJ","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":73.05,"maximum":394.47,"gross_charge":487,"discounted_cash":144.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.4,"methodology":"fee schedule"}]}]},{"description":"HC WIRE WHOLEY 035-150J 405050","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":101.25,"maximum":101.25,"gross_charge":125,"discounted_cash":37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"}]}]},{"description":"HC WIRE WHOLEY 035-150J 405050","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.75,"maximum":101.25,"gross_charge":125,"discounted_cash":37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25,"methodology":"fee schedule"}]}]},{"description":"MICROWIRE SYNC 2611.014 200 CM","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":93.15,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"}]}]},{"description":"MICROWIRE SYNC 2611.014 200 CM","code_information":[{"code":"C1769","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.25,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"}]}]},{"description":"HC FILTER CO-AX RETRIEVAL G13287","code_information":[{"code":"C1773","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":742.77,"maximum":742.77,"gross_charge":917,"discounted_cash":271.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":742.77,"methodology":"fee schedule"}]}]},{"description":"HC FILTER CO-AX RETRIEVAL G13287","code_information":[{"code":"C1773","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":137.55,"maximum":742.77,"gross_charge":917,"discounted_cash":271.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":742.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.4,"methodology":"fee schedule"}]}]},{"description":"HC FILTER RETRIEVAL 466-C220F","code_information":[{"code":"C1773","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":347.49,"maximum":347.49,"gross_charge":429,"discounted_cash":126.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.49,"methodology":"fee schedule"}]}]},{"description":"HC FILTER RETRIEVAL 466-C220F","code_information":[{"code":"C1773","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":64.35,"maximum":347.49,"gross_charge":429,"discounted_cash":126.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.8,"methodology":"fee schedule"}]}]},{"description":"HC SNARE SYS 391003004","code_information":[{"code":"C1773","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1462.05,"maximum":1462.05,"gross_charge":1805,"discounted_cash":534.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1462.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1462.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1462.05,"methodology":"fee schedule"}]}]},{"description":"HC SNARE SYS 391003004","code_information":[{"code":"C1773","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":270.75,"maximum":1462.05,"gross_charge":1805,"discounted_cash":534.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1462.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1462.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1462.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":361,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":270.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":361,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY ADJUSTMENT - PACEMKR","code_information":[{"code":"C1785","type":"HCPCS"},{"code":"0275","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY ADJUSTMENT - PACEMKR","code_information":[{"code":"C1785","type":"HCPCS"},{"code":"0275","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC PORT PWR MRI 6FR 1716001","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":452.4,"maximum":610.74,"gross_charge":754,"discounted_cash":223.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":490.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":527.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.4,"methodology":"fee schedule"}]}]},{"description":"HC PORT PWR MRI 6FR 1716001","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":113.1,"maximum":610.74,"gross_charge":754,"discounted_cash":223.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":482.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":263.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":301.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":339.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":527.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.8,"methodology":"fee schedule"}]}]},{"description":"HC SMART PORT 6.6FR CT66LTPD-VI","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":582.6,"maximum":786.51,"gross_charge":971,"discounted_cash":287.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":786.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":786.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":786.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":631.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":679.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":582.6,"methodology":"fee schedule"}]}]},{"description":"HC SMART PORT 6.6FR CT66LTPD-VI","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":145.65,"maximum":786.51,"gross_charge":971,"discounted_cash":287.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":786.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":786.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":786.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":621.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":339.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":388.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":436.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":679.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":582.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.2,"methodology":"fee schedule"}]}]},{"description":"PORT PWR LUMEN 9.6F H965451830","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":548.4,"maximum":740.34,"gross_charge":914,"discounted_cash":270.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":740.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":740.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":740.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":594.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":639.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":548.4,"methodology":"fee schedule"}]}]},{"description":"PORT PWR LUMEN 9.6F H965451830","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":137.1,"maximum":740.34,"gross_charge":914,"discounted_cash":270.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":740.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":740.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":740.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":584.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":319.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":365.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":411.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":639.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":548.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.8,"methodology":"fee schedule"}]}]},{"description":"VACCESS CT LOW PROFILE PORT 6F","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":329.4,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":356.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":384.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.4,"methodology":"fee schedule"}]}]},{"description":"VACCESS CT LOW PROFILE PORT 6F","code_information":[{"code":"C1788","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":82.35,"maximum":444.69,"gross_charge":549,"discounted_cash":162.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":351.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":192.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":219.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":384.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.8,"methodology":"fee schedule"}]}]},{"description":"HC WIRE LOCALIZATION BLN 2010","code_information":[{"code":"C1819","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":348.6,"maximum":470.61,"gross_charge":581,"discounted_cash":171.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":470.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":470.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":377.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":406.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":348.6,"methodology":"fee schedule"}]}]},{"description":"HC WIRE LOCALIZATION BLN 2010","code_information":[{"code":"C1819","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":87.15,"maximum":2204,"gross_charge":581,"discounted_cash":171.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":470.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":470.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":470.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":371.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":203.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":232.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":261.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":348.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.2,"methodology":"fee schedule"}]}]},{"description":"HC BIPSY SYS TRAY 9463-VC-006","code_information":[{"code":"C1830","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":925.02,"maximum":925.02,"gross_charge":1142,"discounted_cash":338.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":925.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":925.02,"methodology":"fee schedule"}]}]},{"description":"HC BIPSY SYS TRAY 9463-VC-006","code_information":[{"code":"C1830","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":171.3,"maximum":925.02,"gross_charge":1142,"discounted_cash":338.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":925.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":925.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":925.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.4,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOPSY 9407-C-006","code_information":[{"code":"C1830","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":285.93,"maximum":285.93,"gross_charge":353,"discounted_cash":104.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.93,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOPSY 9407-C-006","code_information":[{"code":"C1830","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":52.95,"maximum":285.93,"gross_charge":353,"discounted_cash":104.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"}]}]},{"description":"GORE VIABIL STENT VH1006040","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4631.4,"maximum":6252.39,"gross_charge":7719,"discounted_cash":2284.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6252.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6252.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6252.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5017.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5403.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4631.4,"methodology":"fee schedule"}]}]},{"description":"GORE VIABIL STENT VH1006040","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1157.85,"maximum":6252.39,"gross_charge":7719,"discounted_cash":2284.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6252.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6252.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6252.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4940.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2701.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3087.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3473.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5403.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4631.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1466.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1543.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1157.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1543.8,"methodology":"fee schedule"}]}]},{"description":"GORE VIABIL STENT VH1008040","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4864.8,"maximum":6567.48,"gross_charge":8108,"discounted_cash":2399.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6567.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6567.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6567.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5270.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5675.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4864.8,"methodology":"fee schedule"}]}]},{"description":"GORE VIABIL STENT VH1008040","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1216.2,"maximum":6567.48,"gross_charge":8108,"discounted_cash":2399.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6567.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6567.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6567.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5189.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2837.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3243.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3648.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5675.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4864.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1540.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1621.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1216.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1621.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT ATRIUM ICAST 85418","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4212,"maximum":5686.2,"gross_charge":7020,"discounted_cash":2077.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5686.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5686.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5686.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4563,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4914,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4212,"methodology":"fee schedule"}]}]},{"description":"HC STENT ATRIUM ICAST 85418","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1053,"maximum":5686.2,"gross_charge":7020,"discounted_cash":2077.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5686.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5686.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5686.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4492.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2457,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2808,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3159,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4914,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4212,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1333.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404,"methodology":"fee schedule"}]}]},{"description":"HC STENT ATRIUM ICAST 85440","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3954.6,"maximum":5338.71,"gross_charge":6591,"discounted_cash":1950.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5338.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5338.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5338.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4284.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4613.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3954.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT ATRIUM ICAST 85440","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":988.65,"maximum":5338.71,"gross_charge":6591,"discounted_cash":1950.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5338.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5338.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5338.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4218.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2306.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2636.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4613.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3954.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1318.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1318.2,"methodology":"fee schedule"}]}]},{"description":"HC STENT ATRIUM ICAST 85441","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":4040.4,"maximum":5454.54,"gross_charge":6734,"discounted_cash":1993.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4377.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4713.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4040.4,"methodology":"fee schedule"}]}]},{"description":"HC STENT ATRIUM ICAST 85441","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1010.1,"maximum":5454.54,"gross_charge":6734,"discounted_cash":1993.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5454.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4309.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2356.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2693.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3030.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4713.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4040.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1279.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1010.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1346.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT ICAST 7X16 120CM 85454","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3534.6,"maximum":4771.71,"gross_charge":5891,"discounted_cash":1743.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4771.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4771.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4771.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3829.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4123.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3534.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT ICAST 7X16 120CM 85454","code_information":[{"code":"C1874","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":883.65,"maximum":4771.71,"gross_charge":5891,"discounted_cash":1743.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4771.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4771.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4771.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3770.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2061.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2356.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2650.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4123.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3534.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1119.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":883.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.2,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL PRO PRB3506040080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2256,"maximum":3045.6,"gross_charge":3760,"discounted_cash":1112.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2444,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2632,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2256,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL PRO PRB3506040080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":564,"maximum":3045.6,"gross_charge":3760,"discounted_cash":1112.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2406.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1316,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1504,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1692,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2632,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2256,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":752,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":564,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":752,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL PRO PRB3508040080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1417.8,"maximum":1914.03,"gross_charge":2363,"discounted_cash":699.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1914.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1914.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1914.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1535.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1654.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1417.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL PRO PRB3508040080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":354.45,"maximum":1914.03,"gross_charge":2363,"discounted_cash":699.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1914.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1914.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1914.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1512.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":827.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":945.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1063.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1654.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1417.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":354.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL PXB35-09-37-080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1215,"maximum":1640.25,"gross_charge":2025,"discounted_cash":599.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1417.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1215,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL PXB35-09-37-080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":303.75,"maximum":1640.25,"gross_charge":2025,"discounted_cash":599.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":708.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":911.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1417.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1215,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":405,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL SERB65-09-40-120","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1336.8,"maximum":1804.68,"gross_charge":2228,"discounted_cash":659.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1804.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1804.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1804.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1448.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1559.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT BIL SERB65-09-40-120","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":334.2,"maximum":1804.68,"gross_charge":2228,"discounted_cash":659.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1804.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1804.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1804.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1425.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":779.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":891.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1002.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1559.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT BILI PRO SERB65-10-20-8","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1498.8,"maximum":2023.38,"gross_charge":2498,"discounted_cash":739.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2023.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2023.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2023.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1623.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1748.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1498.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT BILI PRO SERB65-10-20-8","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":374.7,"maximum":2023.38,"gross_charge":2498,"discounted_cash":739.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2023.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2023.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2023.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1598.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":874.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":999.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1124.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1748.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1498.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":474.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":499.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT COR REBEL 39274-0840","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":696,"maximum":939.6,"gross_charge":1160,"discounted_cash":343.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":939.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":939.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":939.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":754,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":812,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":696,"methodology":"fee schedule"}]}]},{"description":"HC STENT COR REBEL 39274-0840","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":174,"maximum":939.6,"gross_charge":1160,"discounted_cash":343.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":939.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":939.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":939.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":742.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":406,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":464,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":522,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":812,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":696,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":232,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":174,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":232,"methodology":"fee schedule"}]}]},{"description":"HC STENT PROT G PRB3508020080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2148.6,"maximum":2900.61,"gross_charge":3581,"discounted_cash":1059.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2327.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2506.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2148.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT PROT G PRB3508020080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":537.15,"maximum":2900.61,"gross_charge":3581,"discounted_cash":1059.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2900.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2291.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1253.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1432.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1611.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2506.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2148.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.2,"methodology":"fee schedule"}]}]},{"description":"HC STENT PROT G SERB650720080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2149.8,"maximum":2902.23,"gross_charge":3583,"discounted_cash":1060.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2902.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2902.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2902.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2328.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2508.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2149.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT PROT G SERB650720080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":537.45,"maximum":2902.23,"gross_charge":3583,"discounted_cash":1060.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2902.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2902.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2902.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2293.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1254.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1433.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1612.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2508.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2149.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":680.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT VISI PXB350827080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1648.8,"maximum":2225.88,"gross_charge":2748,"discounted_cash":813.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2225.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2225.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2225.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1786.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1648.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT VISI PXB350827080","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":412.2,"maximum":2225.88,"gross_charge":2748,"discounted_cash":813.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2225.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2225.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2225.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1758.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":961.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1099.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1236.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1923.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1648.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.6,"methodology":"fee schedule"}]}]},{"description":"HC TRIAL STENT","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"HC TRIAL STENT","code_information":[{"code":"C1876","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"FILTER VNA FEMORAL DENALI","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2227.8,"maximum":3007.53,"gross_charge":3713,"discounted_cash":1099.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3007.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3007.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3007.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2413.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2599.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2227.8,"methodology":"fee schedule"}]}]},{"description":"FILTER VNA FEMORAL DENALI","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":556.95,"maximum":3007.53,"gross_charge":3713,"discounted_cash":1099.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3007.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3007.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3007.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2376.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1299.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1485.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1670.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2599.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2227.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":705.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":742.6,"methodology":"fee schedule"}]}]},{"description":"HC FILTER IVC FEML G33016","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1822.2,"maximum":2459.97,"gross_charge":3037,"discounted_cash":898.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2459.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2459.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2459.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1974.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2125.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1822.2,"methodology":"fee schedule"}]}]},{"description":"HC FILTER IVC FEML G33016","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":455.55,"maximum":2459.97,"gross_charge":3037,"discounted_cash":898.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2459.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2459.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2459.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1943.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1062.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1214.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2125.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1822.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":455.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.4,"methodology":"fee schedule"}]}]},{"description":"HC FILTER IVC SELECT G48373","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2343,"maximum":3163.05,"gross_charge":3905,"discounted_cash":1155.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3163.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3163.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3163.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2538.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2733.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2343,"methodology":"fee schedule"}]}]},{"description":"HC FILTER IVC SELECT G48373","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":585.75,"maximum":3163.05,"gross_charge":3905,"discounted_cash":1155.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3163.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3163.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3163.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2499.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1366.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1562,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1757.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2733.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2343,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":781,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":585.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":781,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VEAN CAVA G34505","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1782,"maximum":2405.7,"gross_charge":2970,"discounted_cash":879.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2405.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2405.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2405.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1930.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2079,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1782,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VEAN CAVA G34505","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":445.5,"maximum":2405.7,"gross_charge":2970,"discounted_cash":879.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2405.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2405.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2405.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1900.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1039.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1188,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1336.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2079,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1782,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":594,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":594,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA 352506070","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1701,"maximum":2296.35,"gross_charge":2835,"discounted_cash":839.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2296.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2296.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2296.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1842.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1701,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA 352506070","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":425.25,"maximum":2296.35,"gross_charge":2835,"discounted_cash":839.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2296.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2296.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2296.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1814.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":992.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1134,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1275.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1701,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":538.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":425.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA 352506070E","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1563.6,"maximum":2110.86,"gross_charge":2606,"discounted_cash":771.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2110.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1693.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1824.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1563.6,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA 352506070E","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":390.9,"maximum":2110.86,"gross_charge":2606,"discounted_cash":771.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2110.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1667.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":912.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1042.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1172.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1824.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1563.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":495.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":390.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.2,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA 466-F220A","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2464.8,"maximum":3327.48,"gross_charge":4108,"discounted_cash":1215.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3327.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3327.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3327.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2670.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2875.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2464.8,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA 466-F220A","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":616.2,"maximum":3327.48,"gross_charge":4108,"discounted_cash":1215.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3327.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3327.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3327.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2629.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1437.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1643.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1848.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2875.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2464.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.6,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA G48378","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2256,"maximum":3045.6,"gross_charge":3760,"discounted_cash":1112.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2444,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2632,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2256,"methodology":"fee schedule"}]}]},{"description":"HC FILTER VENA CAVA G48378","code_information":[{"code":"C1880","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":564,"maximum":3045.6,"gross_charge":3760,"discounted_cash":1112.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3045.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2406.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1316,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1504,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1692,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2632,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2256,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":752,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":564,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":752,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY ADJUST - EP - ICD","code_information":[{"code":"C1882","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY ADJUST - EP - ICD","code_information":[{"code":"C1882","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC LEAD ADAPTER KIT 5866-40M","code_information":[{"code":"C1883","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"HC LEAD ADAPTER KIT 5866-40M","code_information":[{"code":"C1883","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL 400 10MMX35CM RBY2C1035","code_information":[{"code":"C1884","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2073.6,"maximum":2799.36,"gross_charge":3456,"discounted_cash":1022.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2246.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2073.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL 400 10MMX35CM RBY2C1035","code_information":[{"code":"C1884","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":518.4,"maximum":2799.36,"gross_charge":3456,"discounted_cash":1022.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2211.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1209.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1382.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"}]}]},{"description":"CATH VENGR BLLN ATTAIN 6215-80","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":93.15,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"}]}]},{"description":"CATH VENGR BLLN ATTAIN 6215-80","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.25,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"}]}]},{"description":"HC CATH ANGIO G09371","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC CATH ANGIO G09371","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH CON 5F RBL 3.5 39228-735","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC CATH CON 5F RBL 3.5 39228-735","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIREXION HI-FLO 19-527","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1374.57,"maximum":1374.57,"gross_charge":1697,"discounted_cash":502.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.57,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIREXION HI-FLO 19-527","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":254.55,"maximum":1374.57,"gross_charge":1697,"discounted_cash":502.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1374.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIRXN TRNSND 19-584","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1782,"maximum":1782,"gross_charge":2200,"discounted_cash":651.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1782,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1782,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1782,"methodology":"fee schedule"}]}]},{"description":"HC CATH DIRXN TRNSND 19-584","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":330,"maximum":1782,"gross_charge":2200,"discounted_cash":651.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1782,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1782,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1782,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":418,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":440,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":330,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":440,"methodology":"fee schedule"}]}]},{"description":"HC CATH GLDECATH CG414","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC CATH GLDECATH CG414","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.9,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH INFUS 500-55106","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5120.01,"maximum":5120.01,"gross_charge":6321,"discounted_cash":1871.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5120.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5120.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5120.01,"methodology":"fee schedule"}]}]},{"description":"HC CATH INFUS 500-55106","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":948.15,"maximum":5120.01,"gross_charge":6321,"discounted_cash":1871.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5120.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5120.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5120.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1200.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1264.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH INNER CPS QRT DS2N027-59","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":396.09,"maximum":396.09,"gross_charge":489,"discounted_cash":144.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.09,"methodology":"fee schedule"}]}]},{"description":"HC CATH INNER CPS QRT DS2N027-59","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":73.35,"maximum":396.09,"gross_charge":489,"discounted_cash":144.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":396.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROG MC*PV2815Y","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":728.19,"maximum":728.19,"gross_charge":899,"discounted_cash":266.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":728.19,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROG MC*PV2815Y","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":134.85,"maximum":728.19,"gross_charge":899,"discounted_cash":266.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROGR MC*PE28151YV","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":155.52,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROGR MC*PE28151YV","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.8,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH MICRO RENHF 18-457","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1475.82,"maximum":1475.82,"gross_charge":1822,"discounted_cash":539.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1475.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1475.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1475.82,"methodology":"fee schedule"}]}]},{"description":"HC CATH MICRO RENHF 18-457","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":273.3,"maximum":1475.82,"gross_charge":1822,"discounted_cash":539.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1475.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1475.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1475.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":346.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":273.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":364.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH RNGD HIFLO 18-299","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1132.38,"maximum":1132.38,"gross_charge":1398,"discounted_cash":413.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1132.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1132.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1132.38,"methodology":"fee schedule"}]}]},{"description":"HC CATH RNGD HIFLO 18-299","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":209.7,"maximum":1132.38,"gross_charge":1398,"discounted_cash":413.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1132.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1132.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1132.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH RNGD HIFLO 18-303","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1133.19,"maximum":1133.19,"gross_charge":1399,"discounted_cash":414.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1133.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1133.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1133.19,"methodology":"fee schedule"}]}]},{"description":"HC CATH RNGD HIFLO 18-303","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":209.85,"maximum":1133.19,"gross_charge":1399,"discounted_cash":414.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1133.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1133.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1133.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH SWIFT NINJA MIV-20500","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5248.8,"maximum":5248.8,"gross_charge":6480,"discounted_cash":1918.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5248.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5248.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5248.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH SWIFT NINJA MIV-20500","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":972,"maximum":5248.8,"gross_charge":6480,"discounted_cash":1918.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5248.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5248.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5248.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1231.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":972,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER GLIDE SIM CG401","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":145.8,"maximum":145.8,"gross_charge":180,"discounted_cash":53.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER GLIDE SIM CG401","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27,"maximum":145.8,"gross_charge":180,"discounted_cash":53.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER GUIDE 4F 65CM CG412","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1180.98,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER GUIDE 4F 65CM CG412","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":218.7,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER PROGR MC*PE28111YB","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1258.74,"maximum":1258.74,"gross_charge":1554,"discounted_cash":459.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1258.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1258.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1258.74,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER PROGR MC*PE28111YB","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":233.1,"maximum":1258.74,"gross_charge":1554,"discounted_cash":459.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1258.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1258.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1258.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":310.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER SOS 2 4F 10711402","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.26,"maximum":37.26,"gross_charge":46,"discounted_cash":13.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER SOS 2 4F 10711402","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.9,"maximum":37.26,"gross_charge":46,"discounted_cash":13.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"}]}]},{"description":"HC GLIDE CATHETER CG508","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":156.33,"maximum":156.33,"gross_charge":193,"discounted_cash":57.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.33,"methodology":"fee schedule"}]}]},{"description":"HC GLIDE CATHETER CG508","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.95,"maximum":156.33,"gross_charge":193,"discounted_cash":57.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"}]}]},{"description":"HC GLIDECATH 4F ANGLED CG417","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":136.08,"maximum":136.08,"gross_charge":168,"discounted_cash":49.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.08,"methodology":"fee schedule"}]}]},{"description":"HC GLIDECATH 4F ANGLED CG417","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":25.2,"maximum":136.08,"gross_charge":168,"discounted_cash":49.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.6,"methodology":"fee schedule"}]}]},{"description":"HC GLIDECATH CG510","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":120.69,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"}]}]},{"description":"HC GLIDECATH CG510","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.35,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"}]}]},{"description":"HC GLIDECATH SIDEWINDER CG402","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":174.96,"maximum":174.96,"gross_charge":216,"discounted_cash":63.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.96,"methodology":"fee schedule"}]}]},{"description":"HC GLIDECATH SIDEWINDER CG402","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":174.96,"gross_charge":216,"discounted_cash":63.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"}]}]},{"description":"HC KT SPINEJACK 0909000058","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":15181.2,"maximum":20494.62,"gross_charge":25302,"discounted_cash":7489.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20494.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20494.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20494.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16446.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17711.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15181.2,"methodology":"fee schedule"}]}]},{"description":"HC KT SPINEJACK 0909000058","code_information":[{"code":"C1889","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":3795.3,"maximum":20494.62,"gross_charge":25302,"discounted_cash":7489.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20494.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20494.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20494.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16193.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8855.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10120.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11385.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17711.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15181.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4807.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5060.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3795.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5060.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELWY 9FR 6609","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.39,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELWY 9FR 6609","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELWY G08321","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.44,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELWY G08321","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CSG CSG/WORLEY-1-09","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CSG CSG/WORLEY-1-09","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH INTR PEELW 26F G066447","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":110.16,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH INTR PEELW 26F G066447","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.4,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEEL AWAY G08322","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":139.32,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEEL AWAY G08322","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":25.8,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEEL AWAY G09067","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEEL AWAY G09067","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":36.75,"maximum":198.45,"gross_charge":245,"discounted_cash":72.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEELAWAY G06446","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":107.73,"maximum":107.73,"gross_charge":133,"discounted_cash":39.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.73,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEELAWAY G06446","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.95,"maximum":107.73,"gross_charge":133,"discounted_cash":39.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEELAWAY INT-105-33","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.59,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEELAWAY INT-105-33","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.85,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEELAWAY INT-105-37","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":46.98,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PEELAWAY INT-105-37","code_information":[{"code":"C1892","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.7,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH CPS DIRECT DS2C003","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":923.4,"maximum":923.4,"gross_charge":1140,"discounted_cash":337.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":923.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":923.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":923.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH CPS DIRECT DS2C003","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":171,"maximum":923.4,"gross_charge":1140,"discounted_cash":337.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":923.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":923.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":923.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":228,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228,"methodology":"fee schedule"}]}]},{"description":"HC KIT LIVER ROSCH G06929","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":83.43,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"}]}]},{"description":"HC KIT LIVER ROSCH G06929","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.45,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH INTRO 914ES","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH INTRO 914ES","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PREL PLS-1009.5","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PREL PLS-1009.5","code_information":[{"code":"C1893","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"}]}]},{"description":"GORE DRY SEAL SHEATH DSF2433","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":298.08,"maximum":298.08,"gross_charge":368,"discounted_cash":108.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.08,"methodology":"fee schedule"}]}]},{"description":"GORE DRY SEAL SHEATH DSF2433","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":55.2,"maximum":298.08,"gross_charge":368,"discounted_cash":108.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.6,"methodology":"fee schedule"}]}]},{"description":"GORE SHTH DRYSL DSF1633","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":673.92,"maximum":673.92,"gross_charge":832,"discounted_cash":246.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":673.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":673.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":673.92,"methodology":"fee schedule"}]}]},{"description":"GORE SHTH DRYSL DSF1633","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":124.8,"maximum":673.92,"gross_charge":832,"discounted_cash":246.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":673.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":673.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":673.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.4,"methodology":"fee schedule"}]}]},{"description":"GORE SHTH DRYSL DSF1833","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":899.91,"maximum":899.91,"gross_charge":1111,"discounted_cash":328.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":899.91,"methodology":"fee schedule"}]}]},{"description":"GORE SHTH DRYSL DSF1833","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":166.65,"maximum":899.91,"gross_charge":1111,"discounted_cash":328.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRO FLX CKFLO G13033","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":177.39,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"}]}]},{"description":"HC INTRO FLX CKFLO G13033","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":32.85,"maximum":177.39,"gross_charge":219,"discounted_cash":64.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRO FLX SHUTTLE G31138","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":292.41,"maximum":292.41,"gross_charge":361,"discounted_cash":106.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.41,"methodology":"fee schedule"}]}]},{"description":"HC INTRO FLX SHUTTLE G31138","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":54.15,"maximum":292.41,"gross_charge":361,"discounted_cash":106.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRO KT CKFLO G13081","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.44,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"}]}]},{"description":"HC INTRO KT CKFLO G13081","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRO MICROPUN 5FR G56202","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":208.17,"maximum":208.17,"gross_charge":257,"discounted_cash":76.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.17,"methodology":"fee schedule"}]}]},{"description":"HC INTRO MICROPUN 5FR G56202","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":38.55,"maximum":208.17,"gross_charge":257,"discounted_cash":76.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELAWAY 12FR AP12045P","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":63.18,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELAWAY 12FR AP12045P","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.7,"maximum":63.18,"gross_charge":78,"discounted_cash":23.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELAWAY G08315","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":164.43,"maximum":164.43,"gross_charge":203,"discounted_cash":60.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.43,"methodology":"fee schedule"}]}]},{"description":"HC INTRO PEELAWAY G08315","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30.45,"maximum":164.43,"gross_charge":203,"discounted_cash":60.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SHEATH 504-608T","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.63,"maximum":18.63,"gross_charge":23,"discounted_cash":6.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SHEATH 504-608T","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.45,"maximum":18.63,"gross_charge":23,"discounted_cash":6.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SHEATH PLWY G06491","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":123.93,"maximum":123.93,"gross_charge":153,"discounted_cash":45.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.93,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SHEATH PLWY G06491","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.95,"maximum":123.93,"gross_charge":153,"discounted_cash":45.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SHEATH RSS403","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.68,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SHEATH RSS403","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":22.68,"gross_charge":28,"discounted_cash":8.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SUPR ARROW CL-07865","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":213.03,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SUPR ARROW CL-07865","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":39.45,"maximum":213.03,"gross_charge":263,"discounted_cash":77.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SYS OSTEO T34A","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1747.17,"maximum":1747.17,"gross_charge":2157,"discounted_cash":638.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1747.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1747.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1747.17,"methodology":"fee schedule"}]}]},{"description":"HC INTRO SYS OSTEO T34A","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":323.55,"maximum":1747.17,"gross_charge":2157,"discounted_cash":638.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1747.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1747.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1747.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":323.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER COOK G11240","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":201.69,"maximum":201.69,"gross_charge":249,"discounted_cash":73.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.69,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER COOK G11240","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.35,"maximum":201.69,"gross_charge":249,"discounted_cash":73.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER ET 9-0212-70","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.39,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER ET 9-0212-70","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER GWIRE RSS503","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":896.67,"maximum":896.67,"gross_charge":1107,"discounted_cash":327.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":896.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":896.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":896.67,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER GWIRE RSS503","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":166.05,"maximum":896.67,"gross_charge":1107,"discounted_cash":327.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":896.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":896.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":896.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER ILS 0914-20","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5584.95,"maximum":5584.95,"gross_charge":6895,"discounted_cash":2040.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5584.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5584.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5584.95,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER ILS 0914-20","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1034.25,"maximum":5584.95,"gross_charge":6895,"discounted_cash":2040.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5584.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5584.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5584.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1310.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1379,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1034.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1379,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER MIC 98436","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":482.76,"maximum":482.76,"gross_charge":596,"discounted_cash":176.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":482.76,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER MIC 98436","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":89.4,"maximum":482.76,"gross_charge":596,"discounted_cash":176.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":482.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER MICRO 6F 0678960","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER MICRO 6F 0678960","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.95,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER OSTEO EXPRESS T24A","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2353.86,"maximum":2353.86,"gross_charge":2906,"discounted_cash":860.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2353.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2353.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2353.86,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER OSTEO EXPRESS T24A","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":435.9,"maximum":2353.86,"gross_charge":2906,"discounted_cash":860.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2353.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2353.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2353.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":435.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER OSTEO T05J","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":131.22,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER OSTEO T05J","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.3,"maximum":131.22,"gross_charge":162,"discounted_cash":47.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER SHEATH 5FR 406359","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":4.86,"gross_charge":6,"discounted_cash":1.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.86,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER SHEATH 5FR 406359","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.9,"maximum":4.86,"gross_charge":6,"discounted_cash":1.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER SKATER 651506300","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":124.74,"maximum":124.74,"gross_charge":154,"discounted_cash":45.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.74,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER SKATER 651506300","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":23.1,"maximum":124.74,"gross_charge":154,"discounted_cash":45.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"}]}]},{"description":"HC SET INTRO MICROPUN G43870","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":100.44,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"}]}]},{"description":"HC SET INTRO MICROPUN G43870","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.6,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"}]}]},{"description":"HC SET TRANSJUG LIVER SET G06541","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC SET TRANSJUG LIVER SET G06541","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.95,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 12 FR G08956","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":168.48,"maximum":168.48,"gross_charge":208,"discounted_cash":61.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.48,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 12 FR G08956","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.2,"maximum":168.48,"gross_charge":208,"discounted_cash":61.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 14F 30CM RB G08957","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":122.31,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 14F 30CM RB G08957","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.65,"maximum":122.31,"gross_charge":151,"discounted_cash":44.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.2,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 1OF LG VAL 13C G13031","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":183.87,"maximum":183.87,"gross_charge":227,"discounted_cash":67.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.87,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 1OF LG VAL 13C G13031","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":34.05,"maximum":183.87,"gross_charge":227,"discounted_cash":67.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 5F FLEXOR 55CM G13009","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":147.42,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 5F FLEXOR 55CM G13009","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.3,"maximum":147.42,"gross_charge":182,"discounted_cash":53.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 6FR FLEXOR G29983","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH 6FR FLEXOR G29983","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH AVANTI W/O GW 15-720","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH AVANTI W/O GW 15-720","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH BRITE TIP 401-635M","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":71.28,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH BRITE TIP 401-635M","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.2,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH BRITE TIP 7FR 401-790M","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":171.72,"maximum":171.72,"gross_charge":212,"discounted_cash":62.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":171.72,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH BRITE TIP 7FR 401-790M","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":171.72,"gross_charge":212,"discounted_cash":62.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CARDIO RAIN 4F 506410H","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CARDIO RAIN 4F 506410H","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.85,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CARDIO RAIN 5F 506510S","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":95.58,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CARDIO RAIN 5F 506510S","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.7,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CROSS CUT 54-84501","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":182.25,"maximum":182.25,"gross_charge":225,"discounted_cash":66.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH CROSS CUT 54-84501","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.75,"maximum":182.25,"gross_charge":225,"discounted_cash":66.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEX 90CM G12266","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEX 90CM G12266","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.25,"maximum":44.55,"gross_charge":55,"discounted_cash":16.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEXMO 55CM G11633","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":155.52,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEXMO 55CM G11633","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.8,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEXOR 6F 55CM G29799","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEXOR 6F 55CM G29799","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.45,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEXOR 7F 55CM G13132","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":84.24,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH FLEXOR 7F 55CM G13132","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.6,"maximum":84.24,"gross_charge":104,"discounted_cash":30.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH GUID RENAL RSR13","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":187.92,"maximum":187.92,"gross_charge":232,"discounted_cash":68.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.92,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH GUID RENAL RSR13","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":187.92,"gross_charge":232,"discounted_cash":68.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.4,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH INTRO PSS-6F-4-038MT","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH INTRO PSS-6F-4-038MT","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH LG VAL 30C G07465","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH LG VAL 30C G07465","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PINNACLE 6CM RSB601","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":67.23,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH PINNACLE 6CM RSB601","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.45,"maximum":67.23,"gross_charge":83,"discounted_cash":24.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH STEERABLE SGC0301","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"HC SHEATH STEERABLE SGC0301","code_information":[{"code":"C1894","type":"HCPCS"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY CREDIT","code_information":[{"code":"C1895","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"HC WARRANTY CREDIT","code_information":[{"code":"C1895","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"LEAD SOLIA S 53 377177","code_information":[{"code":"C1898","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"LEAD SOLIA S 53 377177","code_information":[{"code":"C1898","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"LEAD SENTUS PROMIRI OTW 408718","code_information":[{"code":"C1900","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"LEAD SENTUS PROMIRI OTW 408718","code_information":[{"code":"C1900","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HC YTTRIUM 90 MICROSPHERES","code_information":[{"code":"C2616","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":26460,"maximum":35721,"gross_charge":44100,"discounted_cash":13053.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35721,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35721,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35721,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28665,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30870,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26460,"methodology":"fee schedule"}]}]},{"description":"HC YTTRIUM 90 MICROSPHERES","code_information":[{"code":"C2616","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6615,"maximum":38280.59,"gross_charge":44100,"discounted_cash":13053.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35721,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35721,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35721,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28224,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38280.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":38280.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26303.54,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26731.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15435,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17640,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19845,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30870,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26460,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8379,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8820,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6615,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8820,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15632.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16726.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16101.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16414,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17195.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16570.32,"methodology":"case rate"}]}]},{"description":"HC STENT DBL J 6F 22CM 24-573","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":284.4,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":308.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":331.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.4,"methodology":"fee schedule"}]}]},{"description":"HC STENT DBL J 6F 22CM 24-573","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":71.1,"maximum":383.94,"gross_charge":474,"discounted_cash":140.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":303.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":165.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":189.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":213.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":331.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT DOUBLE J 24-563","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":483,"maximum":652.05,"gross_charge":805,"discounted_cash":238.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":523.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":563.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":483,"methodology":"fee schedule"}]}]},{"description":"HC STENT DOUBLE J 24-563","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":120.75,"maximum":652.05,"gross_charge":805,"discounted_cash":238.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":652.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":515.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":281.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":322,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":563.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":483,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":161,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":161,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPH 22-139","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":177,"maximum":238.95,"gross_charge":295,"discounted_cash":87.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":191.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":206.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPH 22-139","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":44.25,"maximum":238.95,"gross_charge":295,"discounted_cash":87.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":188.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":103.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":118,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":132.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":206.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPH 22-140","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":213.6,"maximum":288.36,"gross_charge":356,"discounted_cash":105.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":231.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":249.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":213.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPH 22-140","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":53.4,"maximum":288.36,"gross_charge":356,"discounted_cash":105.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":227.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":124.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":142.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":160.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":249.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":213.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.2,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPH 22-141","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":190.8,"maximum":257.58,"gross_charge":318,"discounted_cash":94.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":206.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":222.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPH 22-141","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":47.7,"maximum":257.58,"gross_charge":318,"discounted_cash":94.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":203.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":111.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":127.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":143.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":222.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPHURET PGTL 10FRX28CM","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":141,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":152.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"}]}]},{"description":"HC STENT NEPHURET PGTL 10FRX28CM","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":35.25,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":150.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":82.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"}]}]},{"description":"HC STENT URET DBL 24-564","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":457.2,"maximum":617.22,"gross_charge":762,"discounted_cash":225.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":495.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":533.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":457.2,"methodology":"fee schedule"}]}]},{"description":"HC STENT URET DBL 24-564","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":114.3,"maximum":617.22,"gross_charge":762,"discounted_cash":225.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":617.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":487.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":266.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":342.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":533.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":457.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.4,"methodology":"fee schedule"}]}]},{"description":"HC STENT URET FADER 175-261","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":182.4,"maximum":246.24,"gross_charge":304,"discounted_cash":89.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":197.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":212.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":182.4,"methodology":"fee schedule"}]}]},{"description":"HC STENT URET FADER 175-261","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":45.6,"maximum":246.24,"gross_charge":304,"discounted_cash":89.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":194.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":106.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":121.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":136.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":212.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT URET FIRM 89007","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":145.8,"maximum":196.83,"gross_charge":243,"discounted_cash":71.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":157.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT URET FIRM 89007","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":196.83,"gross_charge":243,"discounted_cash":71.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":109.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"HC STNT DRN NEPH URET 10F 24CM","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":141.23,"maximum":190.66,"gross_charge":235.38,"discounted_cash":69.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":153,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":164.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.23,"methodology":"fee schedule"}]}]},{"description":"HC STNT DRN NEPH URET 10F 24CM","code_information":[{"code":"C2617","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":35.31,"maximum":190.66,"gross_charge":235.38,"discounted_cash":69.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":150.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":94.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":164.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.08,"methodology":"fee schedule"}]}]},{"description":"HC STENT NONCOR TEMP G48168","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":260.4,"maximum":351.54,"gross_charge":434,"discounted_cash":128.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":282.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":303.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":260.4,"methodology":"fee schedule"}]}]},{"description":"HC STENT NONCOR TEMP G48168","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":65.1,"maximum":351.54,"gross_charge":434,"discounted_cash":128.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":277.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":151.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":173.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":195.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":303.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":260.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.8,"methodology":"fee schedule"}]}]},{"description":"HC STENT NON-COR TEMP G48168","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":183.6,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":198.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"}]}]},{"description":"HC STENT NON-COR TEMP G48168","code_information":[{"code":"C2625","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":45.9,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":195.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":107.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":122.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"}]}]},{"description":"BARD SNARE RETRIEVAL KT SRK30","code_information":[{"code":"C2629","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":565.8,"maximum":763.83,"gross_charge":943,"discounted_cash":279.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":763.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":763.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":763.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":612.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":660.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":565.8,"methodology":"fee schedule"}]}]},{"description":"BARD SNARE RETRIEVAL KT SRK30","code_information":[{"code":"C2629","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":141.45,"maximum":763.83,"gross_charge":943,"discounted_cash":279.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":763.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":763.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":763.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":603.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":330.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":377.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":424.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":660.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":565.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.6,"methodology":"fee schedule"}]}]},{"description":"BRACHYTHERAPY SOURCE I 125","code_information":[{"code":"C2638","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":39.6,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"}]}]},{"description":"BRACHYTHERAPY SOURCE I 125","code_information":[{"code":"C2638","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":9.9,"maximum":81.09,"gross_charge":66,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":81.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.97,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":56.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":33.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":35.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":34.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":34.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":36.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":35.11,"methodology":"case rate"}]}]},{"description":"BRACHYTHERAPY NON-STRAND I 125","code_information":[{"code":"C2639","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":27,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27,"methodology":"fee schedule"}]}]},{"description":"BRACHYTHERAPY NON-STRAND I 125","code_information":[{"code":"C2639","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":6.75,"maximum":76.88,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":76.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.52,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":53.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":33.27,"methodology":"case rate"}]}]},{"description":"BRACHYTHRPY SRC STRANDED P103","code_information":[{"code":"C2640","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":82.8,"maximum":111.78,"gross_charge":138,"discounted_cash":40.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.8,"methodology":"fee schedule"}]}]},{"description":"BRACHYTHRPY SRC STRANDED P103","code_information":[{"code":"C2640","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":20.7,"maximum":152.58,"gross_charge":138,"discounted_cash":40.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":152.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":116.67,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":106.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":62.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":66.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":64.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":65.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":68.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":66.05,"methodology":"case rate"}]}]},{"description":"BRACHYTHRPY SRCNON-STRND P103","code_information":[{"code":"C2641","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":70.2,"maximum":94.77,"gross_charge":117,"discounted_cash":34.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"}]}]},{"description":"BRACHYTHRPY SRCNON-STRND P103","code_information":[{"code":"C2641","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":17.55,"maximum":174.64,"gross_charge":117,"discounted_cash":34.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":174.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":113.1,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":121.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":71.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":76.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":73.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":74.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":78.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":75.6,"methodology":"case rate"}]}]},{"description":"LOW CST SKIN SUB LG 1ST 25SQCM","code_information":[{"code":"C5271","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1660.5,"maximum":1660.5,"gross_charge":2050,"discounted_cash":606.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB LG 1ST 25SQCM","code_information":[{"code":"C5271","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2050,"discounted_cash":606.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"HC SKIN SUBST/A/L ADD 25SQCM LC","code_information":[{"code":"C5272","type":"HCPCS"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":1271.7,"maximum":1271.7,"gross_charge":1570,"discounted_cash":464.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1271.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1271.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1271.7,"methodology":"fee schedule"}]}]},{"description":"HC SKIN SUBST/A/L ADD 25SQCM LC","code_information":[{"code":"C5272","type":"HCPCS"},{"code":"0761","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":2204,"gross_charge":1570,"discounted_cash":464.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1271.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1271.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1271.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":298.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":314,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":314,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB LG ADD 25SQCM","code_information":[{"code":"C5272","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":857.79,"maximum":857.79,"gross_charge":1059,"discounted_cash":313.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.79,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB LG ADD 25SQCM","code_information":[{"code":"C5272","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":158.85,"maximum":5079,"gross_charge":1059,"discounted_cash":313.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB LG EA 100SQCM","code_information":[{"code":"C5273","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5422.95,"maximum":5422.95,"gross_charge":6695,"discounted_cash":1981.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5422.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5422.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5422.95,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB LG EA 100SQCM","code_information":[{"code":"C5273","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":6410,"gross_charge":6695,"discounted_cash":1981.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5422.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5422.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5422.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4004.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2660.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2796.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6410,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5237.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1272.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1339,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1635.4,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1749.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1684.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1717.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1798.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1733.52,"methodology":"case rate"}]}]},{"description":"LOW CST SKIN SUB LG AD 100SQCM","code_information":[{"code":"C5274","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2797.74,"maximum":2797.74,"gross_charge":3454,"discounted_cash":1022.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2797.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2797.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2797.74,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB LG AD 100SQCM","code_information":[{"code":"C5274","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":5079,"gross_charge":3454,"discounted_cash":1022.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2797.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2797.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2797.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.8,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB FT 1ST 25SQCM","code_information":[{"code":"C5275","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1660.5,"maximum":1660.5,"gross_charge":2050,"discounted_cash":606.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB FT 1ST 25SQCM","code_information":[{"code":"C5275","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2050,"discounted_cash":606.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"LOW CST SKIN SUB FT ADD 25SQCM","code_information":[{"code":"C5276","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":857.79,"maximum":857.79,"gross_charge":1059,"discounted_cash":313.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.79,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB FT ADD 25SQCM","code_information":[{"code":"C5276","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":158.85,"maximum":5079,"gross_charge":1059,"discounted_cash":313.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB FT EA 100SQCM","code_information":[{"code":"C5277","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1660.5,"maximum":1660.5,"gross_charge":2050,"discounted_cash":606.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB FT EA 100SQCM","code_information":[{"code":"C5277","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2204,"gross_charge":2050,"discounted_cash":606.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1660.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1340.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":916.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":935.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":410,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":547.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":585.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":563.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":574.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":580.11,"methodology":"case rate"}]}]},{"description":"LOW CST SKIN SUB FT AD 100SQCM","code_information":[{"code":"C5278","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":857.79,"maximum":857.79,"gross_charge":1059,"discounted_cash":313.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.79,"methodology":"fee schedule"}]}]},{"description":"LOW CST SKIN SUB FT AD 100SQCM","code_information":[{"code":"C5278","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":158.85,"maximum":5079,"gross_charge":1059,"discounted_cash":313.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":857.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.8,"methodology":"fee schedule"}]}]},{"description":"HC MRA ABD W CONTR","code_information":[{"code":"C8900","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4428.27,"maximum":4428.27,"gross_charge":5467,"discounted_cash":1618.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4428.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4428.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4428.27,"methodology":"fee schedule"}]}]},{"description":"HC MRA ABD W CONTR","code_information":[{"code":"C8900","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4428.27,"gross_charge":5467,"discounted_cash":1618.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4428.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4428.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4428.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1147.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":908.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3280.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1038.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":820.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA ABD WO CONTR","code_information":[{"code":"C8901","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":3468.42,"maximum":3468.42,"gross_charge":4282,"discounted_cash":1267.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3468.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3468.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3468.42,"methodology":"fee schedule"}]}]},{"description":"HC MRA ABD WO CONTR","code_information":[{"code":"C8901","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":3468.42,"gross_charge":4282,"discounted_cash":1267.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3468.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3468.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3468.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":792.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":627.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2569.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRA ABD WOW CONTR","code_information":[{"code":"C8902","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":5335.47,"maximum":5335.47,"gross_charge":6587,"discounted_cash":1949.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5335.47,"methodology":"fee schedule"}]}]},{"description":"HC MRA ABD WOW CONTR","code_information":[{"code":"C8902","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":5335.47,"gross_charge":6587,"discounted_cash":1949.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5335.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1325.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1049.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3952.2,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1251.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1317.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRI BREAST BIL WOW CONTR","code_information":[{"code":"C8908","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":4908.6,"maximum":4908.6,"gross_charge":6060,"discounted_cash":1793.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4908.6,"methodology":"fee schedule"}]}]},{"description":"HC MRI BREAST BIL WOW CONTR","code_information":[{"code":"C8908","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":4908.6,"gross_charge":6060,"discounted_cash":1793.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1325.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1049.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3636,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1151.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":909,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA CHEST W CONTR","code_information":[{"code":"C8909","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2553.93,"maximum":2553.93,"gross_charge":3153,"discounted_cash":933.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2553.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2553.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2553.93,"methodology":"fee schedule"}]}]},{"description":"HC MRA CHEST W CONTR","code_information":[{"code":"C8909","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2553.93,"gross_charge":3153,"discounted_cash":933.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2553.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2553.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2553.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1147.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":908.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1891.8,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":472.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA CHEST WO CONTR","code_information":[{"code":"C8910","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1700.19,"maximum":1700.19,"gross_charge":2099,"discounted_cash":621.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1700.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1700.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1700.19,"methodology":"fee schedule"}]}]},{"description":"HC MRA CHEST WO CONTR","code_information":[{"code":"C8910","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2459,"gross_charge":2099,"discounted_cash":621.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1700.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1700.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1700.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":792.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":627.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1259.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRA CHEST WOW CONTR","code_information":[{"code":"C8911","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2890.89,"maximum":2890.89,"gross_charge":3569,"discounted_cash":1056.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2890.89,"methodology":"fee schedule"}]}]},{"description":"HC MRA CHEST WOW CONTR","code_information":[{"code":"C8911","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":2890.89,"gross_charge":3569,"discounted_cash":1056.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1325.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1049.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2141.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":535.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA LWR EXTREM WOW CONTR","code_information":[{"code":"C8914","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":6199.74,"maximum":6199.74,"gross_charge":7654,"discounted_cash":2265.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6199.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6199.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6199.74,"methodology":"fee schedule"}]}]},{"description":"HC MRA LWR EXTREM WOW CONTR","code_information":[{"code":"C8914","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":319.29,"maximum":6199.74,"gross_charge":7654,"discounted_cash":2265.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6199.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6199.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6199.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1325.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1049.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":561,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4592.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1454.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1530.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1530.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA PELVIS W CONTR","code_information":[{"code":"C8918","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1117.8,"maximum":1117.8,"gross_charge":1380,"discounted_cash":408.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1117.8,"methodology":"fee schedule"}]}]},{"description":"HC MRA PELVIS W CONTR","code_information":[{"code":"C8918","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":207,"maximum":2459,"gross_charge":1380,"discounted_cash":408.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1380,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1147.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":908.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":828,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":276,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":207,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":276,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC MRA PELVIS WO CONTR","code_information":[{"code":"C8919","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":2890.89,"maximum":2890.89,"gross_charge":3569,"discounted_cash":1056.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2890.89,"methodology":"fee schedule"}]}]},{"description":"HC MRA PELVIS WO CONTR","code_information":[{"code":"C8919","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":216.11,"maximum":2890.89,"gross_charge":3569,"discounted_cash":1056.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2890.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":529.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":357.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":792.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":627.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":369.55,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2141.4,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":678.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":535.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":222.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":226.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":237.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.08,"methodology":"case rate"}]}]},{"description":"HC MRA PELVIS WOW CONTR","code_information":[{"code":"C8920","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":1117.8,"maximum":1117.8,"gross_charge":1380,"discounted_cash":408.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1117.8,"methodology":"fee schedule"}]}]},{"description":"HC MRA PELVIS WOW CONTR","code_information":[{"code":"C8920","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":207,"maximum":2459,"gross_charge":1380,"discounted_cash":408.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1117.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1380,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1325.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1049.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":828,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":262.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":276,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":207,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":276,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC TTE WITH CONTRAST NO DOPLR","code_information":[{"code":"C8923","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2204.01,"maximum":2204.01,"gross_charge":2721,"discounted_cash":805.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2204.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2204.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2204.01,"methodology":"fee schedule"}]}]},{"description":"HC TTE WITH CONTRAST NO DOPLR","code_information":[{"code":"C8923","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2960.69,"gross_charge":2721,"discounted_cash":805.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2204.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2204.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2204.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2960.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2311.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC LIMITED OR FU TTE W/CONTRAST","code_information":[{"code":"C8924","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2220.21,"maximum":2220.21,"gross_charge":2741,"discounted_cash":811.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2220.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2220.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2220.21,"methodology":"fee schedule"}]}]},{"description":"HC LIMITED OR FU TTE W/CONTRAST","code_information":[{"code":"C8924","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2220.21,"gross_charge":2741,"discounted_cash":811.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2220.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2220.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2220.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":781.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":561.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1651.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1547.09,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":545.99,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":411.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":319.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":341.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":328.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":335.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":351.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":338.45,"methodology":"case rate"}]}]},{"description":"HC TEE WITH CONTRAST","code_information":[{"code":"C8925","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":3551.04,"maximum":3551.04,"gross_charge":4384,"discounted_cash":1297.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3551.04,"methodology":"fee schedule"}]}]},{"description":"HC TEE WITH CONTRAST","code_information":[{"code":"C8925","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3551.04,"gross_charge":4384,"discounted_cash":1297.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3551.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2960.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2311.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":832.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC STRESS ECHO W/CONT","code_information":[{"code":"C8928","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":2715.12,"maximum":2715.12,"gross_charge":3352,"discounted_cash":992.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2715.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2715.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2715.12,"methodology":"fee schedule"}]}]},{"description":"HC STRESS ECHO W/CONT","code_information":[{"code":"C8928","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":2960.69,"gross_charge":3352,"discounted_cash":992.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2715.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2715.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2715.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2960.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2311.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":670.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC TTE WITH CONTRAST WITH DOPL","code_information":[{"code":"C8929","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":3257.82,"maximum":3257.82,"gross_charge":4022,"discounted_cash":1190.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3257.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3257.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3257.82,"methodology":"fee schedule"}]}]},{"description":"HC TTE WITH CONTRAST WITH DOPL","code_information":[{"code":"C8929","type":"HCPCS"},{"code":"0483","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3257.82,"gross_charge":4022,"discounted_cash":1190.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3257.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3257.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3257.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1729.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1168.21,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2960.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2311.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1207.86,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":706.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":755.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":727.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":741.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":776.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":748.73,"methodology":"case rate"}]}]},{"description":"HC CAD BREAST MRI","code_information":[{"code":"C8937","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":190.35,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"}]}]},{"description":"HC CAD BREAST MRI","code_information":[{"code":"C8937","type":"HCPCS"},{"code":"0610","type":"RC"}],"standard_charges":[{"minimum":35.25,"maximum":2459,"gross_charge":235,"discounted_cash":69.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":235,"standard_charge_algorithm": "Lesser of $1787.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":710.7,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2459,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2422,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1181,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64950-0362-04","type":"NDC"}],"standard_charges":[{"minimum":144.91,"maximum":195.63,"gross_charge":241.51,"discounted_cash":71.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":156.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":169.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.91,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64950-0362-04","type":"NDC"}],"standard_charges":[{"minimum":1.58,"maximum":195.63,"gross_charge":241.51,"discounted_cash":71.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":154.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":108.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":169.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.31,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70839-0362-04","type":"NDC"}],"standard_charges":[{"minimum":151.09,"maximum":203.97,"gross_charge":251.81,"discounted_cash":74.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":176.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.09,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70839-0362-04","type":"NDC"}],"standard_charges":[{"minimum":1.58,"maximum":203.97,"gross_charge":251.81,"discounted_cash":74.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":161.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":113.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":176.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.37,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81665-0301-02","type":"NDC"}],"standard_charges":[{"minimum":49.37,"maximum":66.64,"gross_charge":82.27,"discounted_cash":24.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81665-0301-02","type":"NDC"}],"standard_charges":[{"minimum":1.58,"maximum":66.64,"gross_charge":82.27,"discounted_cash":24.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":113.63,"maximum":153.4,"gross_charge":189.38,"discounted_cash":56.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.63,"methodology":"fee schedule"}]}]},{"description":"COCAINE 4 % NASAL SOLUTION","code_information":[{"code":"C9046","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":153.4,"gross_charge":189.38,"discounted_cash":56.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":121.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.58,"standard_charge_algorithm": "Lesser of $1.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"}]}]},{"description":"CAPLACIZUMAB-YHDP 11 MG SOLUTION FOR INJECTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58468-0225-01","type":"NDC"}],"standard_charges":[{"minimum":28705.91,"maximum":38752.97,"gross_charge":47843.17,"discounted_cash":14161.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38752.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38752.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38752.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31098.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33490.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28705.91,"methodology":"fee schedule"}]}]},{"description":"CAPLACIZUMAB-YHDP 11 MG SOLUTION FOR INJECTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58468-0225-01","type":"NDC"}],"standard_charges":[{"minimum":743.35,"maximum":38752.97,"gross_charge":47843.17,"discounted_cash":14161.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38752.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38752.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38752.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30619.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":743.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":782.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":757.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":795.51,"standard_charge_algorithm": "Lesser of $795.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":795.51,"standard_charge_algorithm": "Lesser of $795.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21529.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33490.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28705.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9090.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9568.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7176.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9568.64,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0791-20","type":"NDC"}],"standard_charges":[{"minimum":69.06,"maximum":93.24,"gross_charge":115.1,"discounted_cash":34.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.06,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0791-20","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":93.24,"gross_charge":115.1,"discounted_cash":34.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.02,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0087-11","type":"NDC"}],"standard_charges":[{"minimum":34.52,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0087-11","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0242-01","type":"NDC"}],"standard_charges":[{"minimum":87.45,"maximum":118.05,"gross_charge":145.74,"discounted_cash":43.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":94.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0242-01","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":118.05,"gross_charge":145.74,"discounted_cash":43.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0140-01","type":"NDC"}],"standard_charges":[{"minimum":91.64,"maximum":123.72,"gross_charge":152.73,"discounted_cash":45.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.64,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0140-01","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":123.72,"gross_charge":152.73,"discounted_cash":45.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":97.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":68.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":106.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.55,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0140-02","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0140-02","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":189.2,"maximum":255.41,"gross_charge":315.32,"discounted_cash":93.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":204.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":220.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.2,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION","code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.37,"maximum":255.41,"gross_charge":315.32,"discounted_cash":93.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":201.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":141.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":220.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE INJECTION 10 MG/ML FOR IV PUSH","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"31722-0203-31","type":"NDC"}],"standard_charges":[{"minimum":69.26,"maximum":93.5,"gross_charge":115.43,"discounted_cash":34.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE INJECTION 10 MG/ML FOR IV PUSH","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"31722-0203-31","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":93.5,"gross_charge":115.43,"discounted_cash":34.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.09,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE INJECTION 10 MG/ML FOR IV PUSH","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70710-1359-01","type":"NDC"}],"standard_charges":[{"minimum":184.19,"maximum":248.66,"gross_charge":306.98,"discounted_cash":90.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":199.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":184.19,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE INJECTION 10 MG/ML FOR IV PUSH","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70710-1359-01","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":248.66,"gross_charge":306.98,"discounted_cash":90.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":196.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":138.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":184.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.4,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE INJECTION 10 MG/ML FOR IV PUSH","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72205-0220-01","type":"NDC"}],"standard_charges":[{"minimum":133.83,"maximum":180.67,"gross_charge":223.04,"discounted_cash":66.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":144.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":156.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.83,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE INJECTION 10 MG/ML FOR IV PUSH","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72205-0220-01","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":180.67,"gross_charge":223.04,"discounted_cash":66.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":142.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"standard_charge_algorithm": "Lesser of $0.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":100.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":156.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.61,"methodology":"fee schedule"}]}]},{"description":"GLUCARPIDASE 1000 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9293","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0210-11","type":"NDC"}],"standard_charges":[{"minimum":178146.14,"maximum":240497.29,"gross_charge":296910.23,"discounted_cash":87885.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240497.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240497.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240497.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":192991.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":207837.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178146.14,"methodology":"fee schedule"}]}]},{"description":"GLUCARPIDASE 1000 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9293","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0210-11","type":"NDC"}],"standard_charges":[{"minimum":422.41,"maximum":240497.29,"gross_charge":296910.23,"discounted_cash":87885.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240497.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240497.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240497.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":190022.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":422.41,"standard_charge_algorithm": "Lesser of $422.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":422.41,"standard_charge_algorithm": "Lesser of $422.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":133609.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":207837.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178146.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56412.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59382.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44536.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59382.05,"methodology":"fee schedule"}]}]},{"description":"ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68547-0501-02","type":"NDC"}],"standard_charges":[{"minimum":7212.12,"maximum":9736.37,"gross_charge":12020.2,"discounted_cash":3557.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9736.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9736.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9736.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7813.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8414.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7212.12,"methodology":"fee schedule"}]}]},{"description":"ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68547-0501-02","type":"NDC"}],"standard_charges":[{"minimum":1803.03,"maximum":9736.37,"gross_charge":12020.2,"discounted_cash":3557.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9736.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9736.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9736.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7692.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6010.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6010.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5409.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8414.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7212.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2283.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2404.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1803.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2404.04,"methodology":"fee schedule"}]}]},{"description":"CANGRELOR 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9460","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10122-0620-01","type":"NDC"}],"standard_charges":[{"minimum":2234.07,"maximum":3016,"gross_charge":3723.45,"discounted_cash":1102.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3016,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3016,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3016,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2420.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2606.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2234.07,"methodology":"fee schedule"}]}]},{"description":"CANGRELOR 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"C9460","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10122-0620-01","type":"NDC"}],"standard_charges":[{"minimum":16.73,"maximum":3016,"gross_charge":3723.45,"discounted_cash":1102.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3016,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3016,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3016,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2383.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":28.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.22,"standard_charge_algorithm": "Lesser of $19.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.22,"standard_charge_algorithm": "Lesser of $19.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2606.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2234.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":744.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16.73,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":17.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":18.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17.73,"methodology":"case rate"}]}]},{"description":"COVID 19 CONVALESCENT PLASMA","code_information":[{"code":"C9507","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2502.9,"maximum":2502.9,"gross_charge":3090,"discounted_cash":914.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2502.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2502.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2502.9,"methodology":"fee schedule"}]}]},{"description":"COVID 19 CONVALESCENT PLASMA","code_information":[{"code":"C9507","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":2502.9,"gross_charge":3090,"discounted_cash":914.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2502.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2502.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2502.9,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"}]}]},{"description":"HC PRQ DE COR STNT SNGL","code_information":[{"code":"C9600","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ DE COR STNT SNGL","code_information":[{"code":"C9600","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7126,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC PRQ DE COR STNT ADD BRAN","code_information":[{"code":"C9601","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11241.99,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"}]}]},{"description":"HC PRQ DE COR STNT ADD BRAN","code_information":[{"code":"C9601","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2637.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2081.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"}]}]},{"description":"HC PRQ DE COR STN/ATH/ANGIO","code_information":[{"code":"C9602","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":30174.93,"maximum":30174.93,"gross_charge":37253,"discounted_cash":11026.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"}]}]},{"description":"HC PRQ DE COR STN/ATH/ANGIO","code_information":[{"code":"C9602","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":39313.11,"gross_charge":37253,"discounted_cash":11026.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5587.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"ATHR/DES COR/ANGIO ADDL BRCH","code_information":[{"code":"C9603","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29879.28,"maximum":29879.28,"gross_charge":36888,"discounted_cash":10918.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29879.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29879.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29879.28,"methodology":"fee schedule"}]}]},{"description":"ATHR/DES COR/ANGIO ADDL BRCH","code_information":[{"code":"C9603","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29879.28,"gross_charge":36888,"discounted_cash":10918.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29879.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29879.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29879.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7008.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7377.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5533.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7377.6,"methodology":"fee schedule"}]}]},{"description":"HC PRQ REVSC BYP GRFT&DES 1VSL","code_information":[{"code":"C9604","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":29583.63,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"}]}]},{"description":"HC PRQ REVSC BYP GRFT&DES 1VSL","code_information":[{"code":"C9604","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":29583.63,"gross_charge":36523,"discounted_cash":10810.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29583.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6939.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5478.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7304.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC PRQ REVSC BYP GRFT&DES ADDL","code_information":[{"code":"C9605","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":11241.99,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"}]}]},{"description":"HC PRQ REVSC BYP GRFT&DES ADDL","code_information":[{"code":"C9605","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":11241.99,"gross_charge":13879,"discounted_cash":4108.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11241.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2637.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2081.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2775.8,"methodology":"fee schedule"}]}]},{"description":"HC PRQ COR REVSC MI&DES 1 VSL","code_information":[{"code":"C9606","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":30174.93,"maximum":30174.93,"gross_charge":37253,"discounted_cash":11026.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"}]}]},{"description":"HC PRQ COR REVSC MI&DES 1 VSL","code_information":[{"code":"C9606","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":30174.93,"gross_charge":37253,"discounted_cash":11026.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1627,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5587.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"}]}]},{"description":"HC PRQ COR DE REVSC CHRNC 1VSL","code_information":[{"code":"C9607","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":30174.93,"maximum":30174.93,"gross_charge":37253,"discounted_cash":11026.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"}]}]},{"description":"HC PRQ COR DE REVSC CHRNC 1VSL","code_information":[{"code":"C9607","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":39313.11,"gross_charge":37253,"discounted_cash":11026.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30174.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7078.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5587.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7450.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC PRQ COR DE REVSC CHRNC ADDL","code_information":[{"code":"C9608","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":15087.87,"maximum":15087.87,"gross_charge":18627,"discounted_cash":5513.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15087.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15087.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15087.87,"methodology":"fee schedule"}]}]},{"description":"HC PRQ COR DE REVSC CHRNC ADDL","code_information":[{"code":"C9608","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":15087.87,"gross_charge":18627,"discounted_cash":5513.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15087.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15087.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15087.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6535,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5549,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10650,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5583,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":479,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3539.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3725.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2794.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3725.4,"methodology":"fee schedule"}]}]},{"description":"HC REVAS ART W/LITH & PTA","code_information":[{"code":"C9764","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":31234.41,"maximum":31234.41,"gross_charge":38561,"discounted_cash":11414.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31234.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31234.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31234.41,"methodology":"fee schedule"}]}]},{"description":"HC REVAS ART W/LITH & PTA","code_information":[{"code":"C9764","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":31234.41,"gross_charge":38561,"discounted_cash":11414.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31234.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31234.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31234.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7326.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7712.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5784.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7712.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"REVAS LITHOTRIPSY INCL PTA","code_information":[{"code":"C9764","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":15774.75,"maximum":15774.75,"gross_charge":19475,"discounted_cash":5764.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15774.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15774.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15774.75,"methodology":"fee schedule"}]}]},{"description":"REVAS LITHOTRIPSY INCL PTA","code_information":[{"code":"C9764","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":24828.2,"gross_charge":19475,"discounted_cash":5764.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15774.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15774.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15774.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":5355,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3700.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3895,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2921.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3895,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"REVAS IVL/STENT","code_information":[{"code":"C9765","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":31549.5,"maximum":31549.5,"gross_charge":38950,"discounted_cash":11529.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31549.5,"methodology":"fee schedule"}]}]},{"description":"REVAS IVL/STENT","code_information":[{"code":"C9765","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":38950,"discounted_cash":11529.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7400.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5842.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"REVAS IVL/ARTHERECTOMY","code_information":[{"code":"C9766","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":31549.5,"maximum":31549.5,"gross_charge":38950,"discounted_cash":11529.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31549.5,"methodology":"fee schedule"}]}]},{"description":"REVAS IVL/ARTHERECTOMY","code_information":[{"code":"C9766","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":39313.11,"gross_charge":38950,"discounted_cash":11529.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31549.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7400.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5842.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7790,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"REVAS IVL/PTRA/STENT","code_information":[{"code":"C9767","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":50795.1,"maximum":50795.1,"gross_charge":62710,"discounted_cash":18562.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50795.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50795.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50795.1,"methodology":"fee schedule"}]}]},{"description":"REVAS IVL/PTRA/STENT","code_information":[{"code":"C9767","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":50795.1,"gross_charge":62710,"discounted_cash":18562.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50795.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50795.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50795.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39313.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25584.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":27452.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11914.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12542,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9406.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12542,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":16054.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":17177.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":16535.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16856.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":17659.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":17017.27,"methodology":"case rate"}]}]},{"description":"HC REVAS TIB IVL/PTA","code_information":[{"code":"C9772","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":30869.1,"maximum":30869.1,"gross_charge":38110,"discounted_cash":11280.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30869.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30869.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30869.1,"methodology":"fee schedule"}]}]},{"description":"HC REVAS TIB IVL/PTA","code_information":[{"code":"C9772","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":30869.1,"gross_charge":38110,"discounted_cash":11280.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30869.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30869.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30869.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":24828.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16051.03,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":17337.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":10901,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7240.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7622,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5716.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7622,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":10138.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10848.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":10443.09,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10645.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":11152.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10747.26,"methodology":"case rate"}]}]},{"description":"HC PSA ANNUAL SCREENING-GA","code_information":[{"code":"G0103","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":73.71,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"}]}]},{"description":"HC PSA ANNUAL SCREENING-GA","code_information":[{"code":"G0103","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":19.31,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":33.02,"standard_charge_algorithm": "Lesser of $33.02 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":19.31,"standard_charge_algorithm": "Lesser of $19.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.66,"standard_charge_algorithm": "Lesser of $20.66 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.89,"standard_charge_algorithm": "Lesser of $19.89 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":20.28,"standard_charge_algorithm": "Lesser of $20.28 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":21.24,"standard_charge_algorithm": "Lesser of $21.24 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.47,"standard_charge_algorithm": "Lesser of $20.47 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC DSMT INDIV PER 30 MIN FU","code_information":[{"code":"G0108","type":"HCPCS"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":56.7,"maximum":56.7,"gross_charge":70,"discounted_cash":20.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"}]}]},{"description":"HC DSMT INDIV PER 30 MIN FU","code_information":[{"code":"G0108","type":"HCPCS"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":10.5,"maximum":228.25,"gross_charge":70,"discounted_cash":20.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":228.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":171.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":86.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":54.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":55.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":53.59,"methodology":"fee schedule"}]}]},{"description":"HC DSMT GRP PER 30 MIN","code_information":[{"code":"G0109","type":"HCPCS"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC DSMT GRP PER 30 MIN","code_information":[{"code":"G0109","type":"HCPCS"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":7.5,"maximum":142,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"HC PR INDIVIDUAL EDUCATION Q 15 MIN","code_information":[{"code":"G0237","type":"HCPCS"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC PR INDIVIDUAL EDUCATION Q 15 MIN","code_information":[{"code":"G0237","type":"HCPCS"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":189.52,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":30.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":37.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":21.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.21,"methodology":"case rate"}]}]},{"description":"HC RESTR LUNG DISEASE GRP EX 15MI","code_information":[{"code":"G0239","type":"HCPCS"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":96.39,"maximum":96.39,"gross_charge":119,"discounted_cash":35.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"}]}]},{"description":"HC RESTR LUNG DISEASE GRP EX 15MI","code_information":[{"code":"G0239","type":"HCPCS"},{"code":"0410","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":189.52,"gross_charge":119,"discounted_cash":35.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":85.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":58.52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":37.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":36.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":38.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.2,"methodology":"case rate"}]}]},{"description":"HC INJ SI JOINT BIL W/GUID","code_information":[{"code":"G0260","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1734.21,"maximum":1734.21,"gross_charge":2141,"discounted_cash":633.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1734.21,"methodology":"fee schedule"}]}]},{"description":"HC INJ SI JOINT BIL W/GUID","code_information":[{"code":"G0260","type":"HCPCS"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":2141,"discounted_cash":633.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC INJ SI JT(ANS/STRD)W/FLUORO","code_information":[{"code":"G0260","type":"HCPCS"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":1734.21,"maximum":1734.21,"gross_charge":2141,"discounted_cash":633.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1734.21,"methodology":"fee schedule"}]}]},{"description":"HC INJ SI JT(ANS/STRD)W/FLUORO","code_information":[{"code":"G0260","type":"HCPCS"},{"code":"0320","type":"RC"}],"standard_charges":[{"minimum":167,"maximum":1836.63,"gross_charge":2141,"discounted_cash":633.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1734.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1252,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1516.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1008.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":217,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":167,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1058.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1331,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1638,"methodology":"case rate"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.86,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":1753,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1643,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1836.63,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":955,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":321.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":619.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":662.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":637.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":650.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":681.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":656.29,"methodology":"case rate"}]}]},{"description":"HC HBO FBC PER 30 MIN","code_information":[{"code":"G0277","type":"HCPCS"},{"code":"0413","type":"RC"}],"standard_charges":[{"minimum":705.51,"maximum":705.51,"gross_charge":871,"discounted_cash":257.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":705.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":705.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":705.51,"methodology":"fee schedule"}]}]},{"description":"HC HBO FBC PER 30 MIN","code_information":[{"code":"G0277","type":"HCPCS"},{"code":"0413","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":1362,"gross_charge":871,"discounted_cash":257.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":705.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":705.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":705.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":301.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":202.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":429.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":142.75,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":210.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1172,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1362,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":641,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":123.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":131.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":126.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":129.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":135.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":130.69,"methodology":"case rate"}]}]},{"description":"HC ILIAC ANGIO CARDIAC CATH","code_information":[{"code":"G0278","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":3721.95,"maximum":3721.95,"gross_charge":4595,"discounted_cash":1360.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3721.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3721.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3721.95,"methodology":"fee schedule"}]}]},{"description":"HC ILIAC ANGIO CARDIAC CATH","code_information":[{"code":"G0278","type":"HCPCS"},{"code":"0481","type":"RC"}],"standard_charges":[{"minimum":21.19,"maximum":7669,"gross_charge":4595,"discounted_cash":1360.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3721.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3721.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3721.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5206,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6047,"methodology":"fee schedule"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":7669,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2204,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":873.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":919,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":689.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":919,"methodology":"fee schedule"}]}]},{"description":"HC BREAST DGTL TOMOSYNTHESIS UNI","code_information":[{"code":"G0279","type":"HCPCS"},{"code":"0401","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC BREAST DGTL TOMOSYNTHESIS UNI","code_information":[{"code":"G0279","type":"HCPCS"},{"code":"0401","type":"RC"}],"standard_charges":[{"minimum":13.8,"maximum":285,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":285,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"}]}]},{"description":"HC OT ELEC STIM OTHER THAN WOUND","code_information":[{"code":"G0283","type":"HCPCS"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC OT ELEC STIM OTHER THAN WOUND","code_information":[{"code":"G0283","type":"HCPCS"},{"code":"0430","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":189.52,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC PT ELEC STIM OTHER THAN WOUND","code_information":[{"code":"G0283","type":"HCPCS"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC PT ELEC STIM OTHER THAN WOUND","code_information":[{"code":"G0283","type":"HCPCS"},{"code":"0420","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":270,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.78,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":270,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC OBSERVATION","code_information":[{"code":"G0378","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC OBSERVATION","code_information":[{"code":"G0378","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":24.9,"maximum":3642,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2678,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2764,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3211,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3009,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":164,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1706,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1706,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"}]}]},{"description":"HC OBSERV DIRECT HOSP REFERAL","code_information":[{"code":"G0379","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC OBSERV DIRECT HOSP REFERAL","code_information":[{"code":"G0379","type":"HCPCS"},{"code":"0762","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3642,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1342.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1342.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":937.15,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":937.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2764,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3211,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3009,"methodology":"case rate"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":164,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3642,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1706,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1706,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280,"methodology":"case rate"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":548.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":586.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":564.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":575.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":602.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":581.03,"methodology":"case rate"}]}]},{"description":"HC LAB AMITRIPTYLINE","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":435.78,"maximum":435.78,"gross_charge":538,"discounted_cash":159.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB AMITRIPTYLINE","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":435.78,"gross_charge":538,"discounted_cash":159.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":140.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":195.68,"standard_charge_algorithm": "Lesser of $195.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":225.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":251.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"standard_charge_algorithm": "Lesser of $114.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":122.44,"standard_charge_algorithm": "Lesser of $122.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":117.86,"standard_charge_algorithm": "Lesser of $117.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":120.15,"standard_charge_algorithm": "Lesser of $120.15 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":125.87,"standard_charge_algorithm": "Lesser of $125.87 or 110 Percent of Billed Charges","median_amount":11.83,"10th_percentile":11.83,"90th_percentile":11.83,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":121.3,"standard_charge_algorithm": "Lesser of $121.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB SALICYATE LEVEL","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":435.78,"maximum":435.78,"gross_charge":538,"discounted_cash":159.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435.78,"methodology":"fee schedule"}]}]},{"description":"HC LAB SALICYATE LEVEL","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":435.78,"gross_charge":538,"discounted_cash":159.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":140.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":195.68,"standard_charge_algorithm": "Lesser of $195.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":225.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":251.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"standard_charge_algorithm": "Lesser of $114.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":122.44,"standard_charge_algorithm": "Lesser of $122.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":117.86,"standard_charge_algorithm": "Lesser of $117.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":120.15,"standard_charge_algorithm": "Lesser of $120.15 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":125.87,"standard_charge_algorithm": "Lesser of $125.87 or 110 Percent of Billed Charges","median_amount":11.83,"10th_percentile":11.83,"90th_percentile":11.83,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":121.3,"standard_charge_algorithm": "Lesser of $121.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"PHOSPHATIDYLETHANOL (PETH)","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":414.72,"maximum":414.72,"gross_charge":512,"discounted_cash":151.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":414.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":414.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":414.72,"methodology":"fee schedule"}]}]},{"description":"PHOSPHATIDYLETHANOL (PETH)","code_information":[{"code":"G0480","type":"HCPCS"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":105.3,"maximum":414.72,"gross_charge":512,"discounted_cash":151.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":414.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":414.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":414.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":177.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":140.69,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":195.68,"standard_charge_algorithm": "Lesser of $195.68 or 171 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":225.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":251.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":114.43,"standard_charge_algorithm": "Lesser of $114.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":122.44,"standard_charge_algorithm": "Lesser of $122.44 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":117.86,"standard_charge_algorithm": "Lesser of $117.86 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":120.15,"standard_charge_algorithm": "Lesser of $120.15 or 105 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":125.87,"standard_charge_algorithm": "Lesser of $125.87 or 110 Percent of Billed Charges","median_amount":11.83,"10th_percentile":11.83,"90th_percentile":11.83,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":121.3,"standard_charge_algorithm": "Lesser of $121.30 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC ROOM CHARGE SEMIPRIVATE","code_information":[{"code":"HC12000001","type":"CDM"},{"code":"0120","type":"RC"}],"standard_charges":[{"minimum":891,"maximum":891,"gross_charge":1100,"discounted_cash":325.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2729,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2977,"methodology":"per diem"}]}]},{"description":"HC MONITORED BED - OVERFLOW CDU","code_information":[{"code":"HC12000004","type":"CDM"},{"code":"0120","type":"RC"}],"standard_charges":[{"minimum":1373.76,"maximum":1373.76,"gross_charge":1696,"discounted_cash":502.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1373.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1373.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1373.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2729,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2977,"methodology":"per diem"}]}]},{"description":"HC DAILY CARE SEMI-PRI TELEM","code_information":[{"code":"HC12100000","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"minimum":891,"maximum":891,"gross_charge":1100,"discounted_cash":325.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":891,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1787,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":2729,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2977,"methodology":"per diem"}]}]},{"description":"HC DAILY CARE CVICU","code_information":[{"code":"HC20100000","type":"CDM"},{"code":"0201","type":"RC"}],"standard_charges":[{"minimum":3847.5,"maximum":3847.5,"gross_charge":4750,"discounted_cash":1406,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3847.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3847.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3847.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3301,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5649,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5282,"methodology":"per diem"}]}]},{"description":"HC DAILY CARE MIC","code_information":[{"code":"HC20200000","type":"CDM"},{"code":"0202","type":"RC"}],"standard_charges":[{"minimum":2825.28,"maximum":2825.28,"gross_charge":3488,"discounted_cash":1032.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2825.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2825.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2825.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3301,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5649,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5282,"methodology":"per diem"}]}]},{"description":"HC ROOM CHARGE PCU","code_information":[{"code":"HC20600003","type":"CDM"},{"code":"0206","type":"RC"}],"standard_charges":[{"minimum":2381.4,"maximum":2381.4,"gross_charge":2940,"discounted_cash":870.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2381.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2381.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2381.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3301,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5649,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2977,"methodology":"per diem"}]}]},{"description":"HC CORONARY CARE UNIT (ICU)","code_information":[{"code":"HC21000000","type":"CDM"},{"code":"0210","type":"RC"}],"standard_charges":[{"minimum":2771.82,"maximum":2771.82,"gross_charge":3422,"discounted_cash":1012.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2771.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3301,"methodology":"per diem"},{"payer_name":"Health One Alliance","plan_name":"Commercial|All Plans","standard_charge_dollar":5649,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5282,"methodology":"per diem"}]}]},{"description":"HC CARDIAC SHORT STAY","code_information":[{"code":"HC21400000","type":"CDM"},{"code":"0214","type":"RC"}],"standard_charges":[{"minimum":1489.59,"maximum":1489.59,"gross_charge":1839,"discounted_cash":544.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1489.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1489.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1489.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3301,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2977,"methodology":"per diem"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63323-0690-30","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":4.75,"gross_charge":5.86,"discounted_cash":1.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63323-0690-30","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":4.75,"gross_charge":5.86,"discounted_cash":1.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63323-0692-10","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":4.73,"gross_charge":5.83,"discounted_cash":1.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63323-0692-10","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":4.73,"gross_charge":5.83,"discounted_cash":1.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63323-0694-44","type":"NDC"}],"standard_charges":[{"minimum":3.18,"maximum":3.18,"gross_charge":3.92,"discounted_cash":1.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.18,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"63323-0694-44","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":3.18,"gross_charge":3.92,"discounted_cash":1.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":4.96,"maximum":4.96,"gross_charge":6.12,"discounted_cash":1.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.96,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":0.92,"maximum":4.96,"gross_charge":6.12,"discounted_cash":1.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":10.49,"maximum":10.49,"gross_charge":12.94,"discounted_cash":3.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.49,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":1.95,"maximum":10.49,"gross_charge":12.94,"discounted_cash":3.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"}]}]},{"description":"AMINOLEVULINIC ACID HCL 30 MG/ML ORAL SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"71469-0231-01","type":"NDC"}],"standard_charges":[{"minimum":18301.07,"maximum":18301.07,"gross_charge":22593.91,"discounted_cash":6687.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18301.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18301.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18301.07,"methodology":"fee schedule"}]}]},{"description":"AMINOLEVULINIC ACID HCL 30 MG/ML ORAL SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"71469-0231-01","type":"NDC"}],"standard_charges":[{"minimum":3389.09,"maximum":18301.07,"gross_charge":22593.91,"discounted_cash":6687.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18301.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18301.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18301.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10167.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4292.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4518.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3389.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4518.79,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"14789-0015-07","type":"NDC"}],"standard_charges":[{"minimum":1822.76,"maximum":1822.76,"gross_charge":2250.31,"discounted_cash":666.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1822.76,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"14789-0015-07","type":"NDC"}],"standard_charges":[{"minimum":337.55,"maximum":1822.76,"gross_charge":2250.31,"discounted_cash":666.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1012.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.07,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70121-1605-01","type":"NDC"}],"standard_charges":[{"minimum":1144.59,"maximum":1144.59,"gross_charge":1413.07,"discounted_cash":418.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1144.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1144.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1144.59,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70121-1605-01","type":"NDC"}],"standard_charges":[{"minimum":211.97,"maximum":1144.59,"gross_charge":1413.07,"discounted_cash":418.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1144.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1144.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1144.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":635.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.62,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":287.79,"maximum":287.79,"gross_charge":355.29,"discounted_cash":105.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":287.79,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":53.3,"maximum":287.79,"gross_charge":355.29,"discounted_cash":105.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":159.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.06,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":2290.78,"maximum":2290.78,"gross_charge":2828.12,"discounted_cash":837.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2290.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2290.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2290.78,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":424.22,"maximum":2290.78,"gross_charge":2828.12,"discounted_cash":837.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2290.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2290.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2290.78,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1272.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":537.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.63,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":3117.62,"maximum":3117.62,"gross_charge":3848.91,"discounted_cash":1139.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3117.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3117.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3117.62,"methodology":"fee schedule"}]}]},{"description":"ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":577.34,"maximum":3117.62,"gross_charge":3848.91,"discounted_cash":1139.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3117.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3117.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3117.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1732.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.79,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":19.14,"maximum":19.14,"gross_charge":23.62,"discounted_cash":7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.14,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":3.55,"maximum":19.14,"gross_charge":23.62,"discounted_cash":7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":189.03,"maximum":189.03,"gross_charge":233.37,"discounted_cash":69.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":189.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":189.03,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 20 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":35.01,"maximum":189.03,"gross_charge":233.37,"discounted_cash":69.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":189.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":189.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":105.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"25021-0677-10","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"25021-0677-10","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"43598-0666-25","type":"NDC"}],"standard_charges":[{"minimum":56.75,"maximum":56.75,"gross_charge":70.05,"discounted_cash":20.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"43598-0666-25","type":"NDC"}],"standard_charges":[{"minimum":10.51,"maximum":56.75,"gross_charge":70.05,"discounted_cash":20.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"54879-0037-10","type":"NDC"}],"standard_charges":[{"minimum":70.18,"maximum":70.18,"gross_charge":86.64,"discounted_cash":25.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.18,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"54879-0037-10","type":"NDC"}],"standard_charges":[{"minimum":13,"maximum":70.18,"gross_charge":86.64,"discounted_cash":25.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"54879-0037-50","type":"NDC"}],"standard_charges":[{"minimum":61.99,"maximum":61.99,"gross_charge":76.53,"discounted_cash":22.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"54879-0037-50","type":"NDC"}],"standard_charges":[{"minimum":11.48,"maximum":61.99,"gross_charge":76.53,"discounted_cash":22.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"69918-0700-01","type":"NDC"}],"standard_charges":[{"minimum":56.98,"maximum":56.98,"gross_charge":70.34,"discounted_cash":20.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.98,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"69918-0700-01","type":"NDC"}],"standard_charges":[{"minimum":10.56,"maximum":56.98,"gross_charge":70.34,"discounted_cash":20.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70069-0301-01","type":"NDC"}],"standard_charges":[{"minimum":58.45,"maximum":58.45,"gross_charge":72.15,"discounted_cash":21.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.45,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70069-0301-01","type":"NDC"}],"standard_charges":[{"minimum":10.83,"maximum":58.45,"gross_charge":72.15,"discounted_cash":21.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70069-0301-25","type":"NDC"}],"standard_charges":[{"minimum":56.71,"maximum":56.71,"gross_charge":70.01,"discounted_cash":20.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.71,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"70069-0301-25","type":"NDC"}],"standard_charges":[{"minimum":10.51,"maximum":56.71,"gross_charge":70.01,"discounted_cash":20.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"71288-0719-10","type":"NDC"}],"standard_charges":[{"minimum":49.76,"maximum":49.76,"gross_charge":61.42,"discounted_cash":18.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.76,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"71288-0719-10","type":"NDC"}],"standard_charges":[{"minimum":9.22,"maximum":49.76,"gross_charge":61.42,"discounted_cash":18.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"72572-0750-10","type":"NDC"}],"standard_charges":[{"minimum":88.15,"maximum":88.15,"gross_charge":108.82,"discounted_cash":32.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.15,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"},{"code":"72572-0750-10","type":"NDC"}],"standard_charges":[{"minimum":16.33,"maximum":88.15,"gross_charge":108.82,"discounted_cash":32.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.77,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":64.55,"maximum":64.55,"gross_charge":79.69,"discounted_cash":23.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.55,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":11.96,"maximum":64.55,"gross_charge":79.69,"discounted_cash":23.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.94,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":104.07,"maximum":104.07,"gross_charge":128.48,"discounted_cash":38.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.07,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC25000000","type":"CDM"},{"code":"0250","type":"RC"}],"standard_charges":[{"minimum":19.28,"maximum":104.07,"gross_charge":128.48,"discounted_cash":38.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"31722-0557-60","type":"NDC"}],"standard_charges":[{"minimum":121.63,"maximum":121.63,"gross_charge":150.16,"discounted_cash":44.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.63,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"31722-0557-60","type":"NDC"}],"standard_charges":[{"minimum":22.53,"maximum":121.63,"gross_charge":150.16,"discounted_cash":44.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"60505-3583-06","type":"NDC"}],"standard_charges":[{"minimum":111.33,"maximum":111.33,"gross_charge":137.44,"discounted_cash":40.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.33,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"60505-3583-06","type":"NDC"}],"standard_charges":[{"minimum":20.62,"maximum":111.33,"gross_charge":137.44,"discounted_cash":40.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.49,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"69097-0514-03","type":"NDC"}],"standard_charges":[{"minimum":74.24,"maximum":74.24,"gross_charge":91.65,"discounted_cash":27.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.24,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"69097-0514-03","type":"NDC"}],"standard_charges":[{"minimum":13.75,"maximum":74.24,"gross_charge":91.65,"discounted_cash":27.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":117.36,"maximum":117.36,"gross_charge":144.88,"discounted_cash":42.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.36,"methodology":"fee schedule"}]}]},{"description":"ABACAVIR 300 MG TABLET","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":21.74,"maximum":117.36,"gross_charge":144.88,"discounted_cash":42.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.98,"methodology":"fee schedule"}]}]},{"description":"CUSTODIOL BRETSCHEIDER HTK PERFUSION SOLUTION","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"25767-0735-45","type":"NDC"}],"standard_charges":[{"minimum":4671.65,"maximum":4671.65,"gross_charge":5767.46,"discounted_cash":1707.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4671.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4671.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4671.65,"methodology":"fee schedule"}]}]},{"description":"CUSTODIOL BRETSCHEIDER HTK PERFUSION SOLUTION","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"25767-0735-45","type":"NDC"}],"standard_charges":[{"minimum":865.12,"maximum":4671.65,"gross_charge":5767.46,"discounted_cash":1707.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4671.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4671.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4671.65,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2595.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1095.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":865.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1153.5,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":12.77,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":27.63,"maximum":27.63,"gross_charge":34.11,"discounted_cash":10.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.63,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":5.12,"maximum":27.63,"gross_charge":34.11,"discounted_cash":10.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":29.76,"maximum":29.76,"gross_charge":36.73,"discounted_cash":10.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.76,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 20 % IN WATER (D20W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":5.51,"maximum":29.76,"gross_charge":36.73,"discounted_cash":10.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":14.89,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":2.76,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":56.71,"maximum":56.71,"gross_charge":70.01,"discounted_cash":20.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.71,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":10.51,"maximum":56.71,"gross_charge":70.01,"discounted_cash":20.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":34,"maximum":34,"gross_charge":41.97,"discounted_cash":12.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":6.3,"maximum":34,"gross_charge":41.97,"discounted_cash":12.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":38.25,"maximum":38.25,"gross_charge":47.22,"discounted_cash":13.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.25,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":7.09,"maximum":38.25,"gross_charge":47.22,"discounted_cash":13.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":59.49,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":11.02,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":6.4,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":1.19,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":21.26,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":3.94,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV MBP/AV","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":8.1,"gross_charge":9.99,"discounted_cash":2.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV MBP/AV","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":1.5,"maximum":8.1,"gross_charge":9.99,"discounted_cash":2.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV MBP/AV","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":21.69,"maximum":21.69,"gross_charge":26.77,"discounted_cash":7.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.69,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV MBP/AV","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":4.02,"maximum":21.69,"gross_charge":26.77,"discounted_cash":7.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"63323-0178-26","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"63323-0178-26","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"63323-0178-76","type":"NDC"}],"standard_charges":[{"minimum":25.51,"maximum":25.51,"gross_charge":31.49,"discounted_cash":9.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.51,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","drug_information": {"unit": 1,"type": "ML"},"code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"},{"code":"63323-0178-76","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":25.51,"gross_charge":31.49,"discounted_cash":9.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":8.52,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":17.01,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"}]}]},{"description":"WATER FOR INJECTION STERILE INTRAVENOUS SOLUTION","code_information":[{"code":"HC25800001","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"2K NATURALYTE LIQUID ACID CONCENTRATE","code_information":[{"code":"HC25800175","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"2K NATURALYTE LIQUID ACID CONCENTRATE","code_information":[{"code":"HC25800175","type":"CDM"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":5.4,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"}]}]},{"description":"HC ACDA ANTICOAGULANT 777967000","code_information":[{"code":"HC27000010","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":25.92,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"}]}]},{"description":"HC ACDA ANTICOAGULANT 777967000","code_information":[{"code":"HC27000010","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":4.8,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"}]}]},{"description":"HC CIRCUIT BIPAP/CPAP","code_information":[{"code":"HC27000032","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":30.78,"maximum":30.78,"gross_charge":38,"discounted_cash":11.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.78,"methodology":"fee schedule"}]}]},{"description":"HC CIRCUIT BIPAP/CPAP","code_information":[{"code":"HC27000032","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":5.7,"maximum":30.78,"gross_charge":38,"discounted_cash":11.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"}]}]},{"description":"HC DEVICE CATH REVOLUTION CFG624","code_information":[{"code":"HC27000039","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":39.69,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"}]}]},{"description":"HC DEVICE CATH REVOLUTION CFG624","code_information":[{"code":"HC27000039","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"}]}]},{"description":"HC DIALYZER REVACLEAR 110633","code_information":[{"code":"HC27000040","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":24.3,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"}]}]},{"description":"HC DIALYZER REVACLEAR 110633","code_information":[{"code":"HC27000040","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":4.5,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"}]}]},{"description":"HC DRAIN PLUER-VAC MINI 16400","code_information":[{"code":"HC27000042","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":149.04,"maximum":149.04,"gross_charge":184,"discounted_cash":54.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.04,"methodology":"fee schedule"}]}]},{"description":"HC DRAIN PLUER-VAC MINI 16400","code_information":[{"code":"HC27000042","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":149.04,"gross_charge":184,"discounted_cash":54.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"}]}]},{"description":"HC DRAINAGE PLEUR-EV 4000-100N","code_information":[{"code":"HC27000043","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"HC DRAINAGE PLEUR-EV 4000-100N","code_information":[{"code":"HC27000043","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":24.45,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"}]}]},{"description":"HC GRID ACCUGRID SPECIMEN 302","code_information":[{"code":"HC27000056","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC GRID ACCUGRID SPECIMEN 302","code_information":[{"code":"HC27000056","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"}]}]},{"description":"HC MANUAL RESUSCITATOR","code_information":[{"code":"HC27000071","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"HC MANUAL RESUSCITATOR","code_information":[{"code":"HC27000071","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":5.25,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"}]}]},{"description":"HC METER PEAK FLOW","code_information":[{"code":"HC27000072","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":43.74,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"}]}]},{"description":"HC METER PEAK FLOW","code_information":[{"code":"HC27000072","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"}]}]},{"description":"HC NEBULIZER OR HUMIDIFIER","code_information":[{"code":"HC27000073","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":25.11,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"}]}]},{"description":"HC NEBULIZER OR HUMIDIFIER","code_information":[{"code":"HC27000073","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":4.65,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"}]}]},{"description":"HC PERTRACH D4550","code_information":[{"code":"HC27000082","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":272.97,"maximum":272.97,"gross_charge":337,"discounted_cash":99.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.97,"methodology":"fee schedule"}]}]},{"description":"HC PERTRACH D4550","code_information":[{"code":"HC27000082","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":50.55,"maximum":272.97,"gross_charge":337,"discounted_cash":99.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.4,"methodology":"fee schedule"}]}]},{"description":"HC SCALE SPRING DLYS 5K3582","code_information":[{"code":"HC27000097","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":45.36,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"}]}]},{"description":"HC SCALE SPRING DLYS 5K3582","code_information":[{"code":"HC27000097","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":8.4,"maximum":45.36,"gross_charge":56,"discounted_cash":16.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"}]}]},{"description":"HC SET MINICAP W/CLAMP 5C4482","code_information":[{"code":"HC27000101","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":127.17,"maximum":127.17,"gross_charge":157,"discounted_cash":46.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.17,"methodology":"fee schedule"}]}]},{"description":"HC SET MINICAP W/CLAMP 5C4482","code_information":[{"code":"HC27000101","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":23.55,"maximum":127.17,"gross_charge":157,"discounted_cash":46.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"}]}]},{"description":"HC SNARE EN 12-20 RETR 392006020","code_information":[{"code":"HC27000103","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":822.15,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"}]}]},{"description":"HC SNARE EN 12-20 RETR 392006020","code_information":[{"code":"HC27000103","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":152.25,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"}]}]},{"description":"HC SNARE GOOSE NECK AMP GN500","code_information":[{"code":"HC27000104","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":638.28,"maximum":638.28,"gross_charge":788,"discounted_cash":233.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":638.28,"methodology":"fee schedule"}]}]},{"description":"HC SNARE GOOSE NECK AMP GN500","code_information":[{"code":"HC27000104","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":118.2,"maximum":638.28,"gross_charge":788,"discounted_cash":233.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":638.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.6,"methodology":"fee schedule"}]}]},{"description":"HC SNARE GOSE NECK AMPLTZ GN3500","code_information":[{"code":"HC27000108","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":689.31,"maximum":689.31,"gross_charge":851,"discounted_cash":251.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":689.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":689.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":689.31,"methodology":"fee schedule"}]}]},{"description":"HC SNARE GOSE NECK AMPLTZ GN3500","code_information":[{"code":"HC27000108","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":127.65,"maximum":689.31,"gross_charge":851,"discounted_cash":251.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":689.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":689.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":689.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.2,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEED 0270-22-3.5-45","code_information":[{"code":"HC27000126","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":749.25,"maximum":749.25,"gross_charge":925,"discounted_cash":273.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":749.25,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEED 0270-22-3.5-45","code_information":[{"code":"HC27000126","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":138.75,"maximum":749.25,"gross_charge":925,"discounted_cash":273.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":749.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":185,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEEDING 0270-22-1.5-45","code_information":[{"code":"HC27000129","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":733.86,"maximum":733.86,"gross_charge":906,"discounted_cash":268.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":733.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":733.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":733.86,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEEDING 0270-22-1.5-45","code_information":[{"code":"HC27000129","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":135.9,"maximum":733.86,"gross_charge":906,"discounted_cash":268.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":733.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":733.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":733.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.2,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTOSTOMY 021018","code_information":[{"code":"HC27000131","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":366.12,"maximum":366.12,"gross_charge":452,"discounted_cash":133.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.12,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTOSTOMY 021018","code_information":[{"code":"HC27000131","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":67.8,"maximum":366.12,"gross_charge":452,"discounted_cash":133.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.4,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTROTOMY 24 FR 000724","code_information":[{"code":"HC27000133","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":49.41,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTROTOMY 24 FR 000724","code_information":[{"code":"HC27000133","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":9.15,"maximum":49.41,"gross_charge":61,"discounted_cash":18.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"HC TUBE HI-LO EVAC 7.0 100382030","code_information":[{"code":"HC27000134","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":29.97,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"}]}]},{"description":"HC TUBE HI-LO EVAC 7.0 100382030","code_information":[{"code":"HC27000134","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":5.55,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"}]}]},{"description":"HC TUBE INTRODUCER 1503014","code_information":[{"code":"HC27000135","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":208.98,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"}]}]},{"description":"HC TUBE INTRODUCER 1503014","code_information":[{"code":"HC27000135","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":38.7,"maximum":208.98,"gross_charge":258,"discounted_cash":76.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":208.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE JEJUNAL 14F 0200-14","code_information":[{"code":"HC27000136","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":289.98,"maximum":289.98,"gross_charge":358,"discounted_cash":105.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.98,"methodology":"fee schedule"}]}]},{"description":"HC TUBE JEJUNAL 14F 0200-14","code_information":[{"code":"HC27000136","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":53.7,"maximum":289.98,"gross_charge":358,"discounted_cash":105.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE JEJUNAL MIC 0250-22","code_information":[{"code":"HC27000137","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":498.96,"maximum":498.96,"gross_charge":616,"discounted_cash":182.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.96,"methodology":"fee schedule"}]}]},{"description":"HC TUBE JEJUNAL MIC 0250-22","code_information":[{"code":"HC27000137","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":92.4,"maximum":498.96,"gross_charge":616,"discounted_cash":182.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.2,"methodology":"fee schedule"}]}]},{"description":"HC TUBE JEJUNAL MIC 18FR 020018","code_information":[{"code":"HC27000138","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":357.21,"maximum":357.21,"gross_charge":441,"discounted_cash":130.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.21,"methodology":"fee schedule"}]}]},{"description":"HC TUBE JEJUNAL MIC 18FR 020018","code_information":[{"code":"HC27000138","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":66.15,"maximum":357.21,"gross_charge":441,"discounted_cash":130.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.2,"methodology":"fee schedule"}]}]},{"description":"HC TUBE TRACHEOTOMY","code_information":[{"code":"HC27000145","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":95.58,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"}]}]},{"description":"HC TUBE TRACHEOTOMY","code_information":[{"code":"HC27000145","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":17.7,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"}]}]},{"description":"HC VENT MRI CIRCUIT 620B0035-12","code_information":[{"code":"HC27000149","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC VENT MRI CIRCUIT 620B0035-12","code_information":[{"code":"HC27000149","type":"CDM"},{"code":"0270","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"BENZOIN TOPICAL TINCTURE","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"40565-0111-82","type":"NDC"}],"standard_charges":[{"minimum":101.48,"maximum":101.48,"gross_charge":125.28,"discounted_cash":37.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.48,"methodology":"fee schedule"}]}]},{"description":"BENZOIN TOPICAL TINCTURE","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"40565-0111-82","type":"NDC"}],"standard_charges":[{"minimum":18.8,"maximum":101.48,"gross_charge":125.28,"discounted_cash":37.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.06,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 2 X 4 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"63713-0019-62","type":"NDC"}],"standard_charges":[{"minimum":736.38,"maximum":736.38,"gross_charge":909.11,"discounted_cash":269.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":736.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":736.38,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 2 X 4 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"63713-0019-62","type":"NDC"}],"standard_charges":[{"minimum":136.37,"maximum":736.38,"gross_charge":909.11,"discounted_cash":269.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":736.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":736.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":736.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.83,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 3 X 4 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"77888-8013-63","type":"NDC"}],"standard_charges":[{"minimum":443.48,"maximum":443.48,"gross_charge":547.5,"discounted_cash":162.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.48,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 3 X 4 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"77888-8013-63","type":"NDC"}],"standard_charges":[{"minimum":82.13,"maximum":443.48,"gross_charge":547.5,"discounted_cash":162.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.5,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 4 X 8 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"63713-0019-52","type":"NDC"}],"standard_charges":[{"minimum":10805.85,"maximum":10805.85,"gross_charge":13340.55,"discounted_cash":3948.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10805.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10805.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10805.85,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 4 X 8 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"63713-0019-52","type":"NDC"}],"standard_charges":[{"minimum":2001.09,"maximum":10805.85,"gross_charge":13340.55,"discounted_cash":3948.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10805.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10805.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10805.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2534.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2668.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2001.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2668.11,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 4 X 8 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"81370-0195-27","type":"NDC"}],"standard_charges":[{"minimum":478.3,"maximum":478.3,"gross_charge":590.49,"discounted_cash":174.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":478.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":478.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":478.3,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED 4 X 8 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"81370-0195-27","type":"NDC"}],"standard_charges":[{"minimum":88.58,"maximum":478.3,"gross_charge":590.49,"discounted_cash":174.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":478.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":478.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":478.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.1,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED HEMOSTAT 4 X 4 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"63713-0020-30","type":"NDC"}],"standard_charges":[{"minimum":829.3,"maximum":829.3,"gross_charge":1023.82,"discounted_cash":303.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":829.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":829.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":829.3,"methodology":"fee schedule"}]}]},{"description":"CELLULOSE OXIDIZED HEMOSTAT 4 X 4 MISC","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"63713-0020-30","type":"NDC"}],"standard_charges":[{"minimum":153.58,"maximum":829.3,"gross_charge":1023.82,"discounted_cash":303.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":829.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":829.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":829.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":204.77,"methodology":"fee schedule"}]}]},{"description":"POVIDONE-IODINE 10 % TOPICAL SWAB","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"67618-0153-03","type":"NDC"}],"standard_charges":[{"minimum":0.38,"maximum":0.38,"gross_charge":0.46,"discounted_cash":0.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"POVIDONE-IODINE 10 % TOPICAL SWAB","drug_information": {"unit": 15.787,"type": "EA"},"code_information":[{"code":"HC27200672","type":"CDM"},{"code":"0272","type":"RC"},{"code":"67618-0153-03","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.38,"gross_charge":0.46,"discounted_cash":0.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"HC ADAPTER CATH G06002","code_information":[{"code":"HC27210601","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":36.45,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"HC ADAPTER CATH G06002","code_information":[{"code":"HC27210601","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.75,"maximum":36.45,"gross_charge":45,"discounted_cash":13.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"}]}]},{"description":"HC SUPPLY SHELL 272 NO HCPCS","code_information":[{"code":"HC27210602","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":521.64,"maximum":521.64,"gross_charge":644,"discounted_cash":190.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.64,"methodology":"fee schedule"}]}]},{"description":"HC SUPPLY SHELL 272 NO HCPCS","code_information":[{"code":"HC27210602","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":96.6,"maximum":521.64,"gross_charge":644,"discounted_cash":190.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.8,"methodology":"fee schedule"}]}]},{"description":"HC ANTENNA PERC 20CM CA50L1","code_information":[{"code":"HC27210607","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6987.87,"maximum":6987.87,"gross_charge":8627,"discounted_cash":2553.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6987.87,"methodology":"fee schedule"}]}]},{"description":"HC ANTENNA PERC 20CM CA50L1","code_information":[{"code":"HC27210607","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1294.05,"maximum":6987.87,"gross_charge":8627,"discounted_cash":2553.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6987.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1639.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1725.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1725.4,"methodology":"fee schedule"}]}]},{"description":"HC ANTENNA PERCUTAN 30CM CA30L2","code_information":[{"code":"HC27210610","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8503.38,"maximum":8503.38,"gross_charge":10498,"discounted_cash":3107.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8503.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8503.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8503.38,"methodology":"fee schedule"}]}]},{"description":"HC ANTENNA PERCUTAN 30CM CA30L2","code_information":[{"code":"HC27210610","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1574.7,"maximum":8503.38,"gross_charge":10498,"discounted_cash":3107.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8503.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8503.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8503.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1994.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1574.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2099.6,"methodology":"fee schedule"}]}]},{"description":"HC BASKET SEGURA 380-118","code_information":[{"code":"HC27210617","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":443.88,"maximum":443.88,"gross_charge":548,"discounted_cash":162.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.88,"methodology":"fee schedule"}]}]},{"description":"HC BASKET SEGURA 380-118","code_information":[{"code":"HC27210617","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":82.2,"maximum":443.88,"gross_charge":548,"discounted_cash":162.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.6,"methodology":"fee schedule"}]}]},{"description":"HC BASKET STONE M0063801180","code_information":[{"code":"HC27210618","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":486.81,"maximum":486.81,"gross_charge":601,"discounted_cash":177.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486.81,"methodology":"fee schedule"}]}]},{"description":"HC BASKET STONE M0063801180","code_information":[{"code":"HC27210618","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":90.15,"maximum":486.81,"gross_charge":601,"discounted_cash":177.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":486.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.2,"methodology":"fee schedule"}]}]},{"description":"HC BEAD LC MICRON VE220GS","code_information":[{"code":"HC27210619","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4037.04,"maximum":4037.04,"gross_charge":4984,"discounted_cash":1475.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4037.04,"methodology":"fee schedule"}]}]},{"description":"HC BEAD LC MICRON VE220GS","code_information":[{"code":"HC27210619","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":747.6,"maximum":4037.04,"gross_charge":4984,"discounted_cash":1475.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4037.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":946.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":996.8,"methodology":"fee schedule"}]}]},{"description":"HC BINDER BREAST 2XL 2XL/L","code_information":[{"code":"HC27210620","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":52.65,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"}]}]},{"description":"HC BINDER BREAST 2XL 2XL/L","code_information":[{"code":"HC27210620","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.75,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"}]}]},{"description":"HC BINDER BREAST LRG L-BBIND","code_information":[{"code":"HC27210622","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"HC BINDER BREAST LRG L-BBIND","code_information":[{"code":"HC27210622","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.22,"gross_charge":62,"discounted_cash":18.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"HC BINDER BREAST SM S-BBIND","code_information":[{"code":"HC27210624","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":43.74,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"}]}]},{"description":"HC BINDER BREAST SM S-BBIND","code_information":[{"code":"HC27210624","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"}]}]},{"description":"HC BIPAP CX HEATED 834311","code_information":[{"code":"HC27210627","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":61.56,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"}]}]},{"description":"HC BIPAP CX HEATED 834311","code_information":[{"code":"HC27210627","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.4,"maximum":61.56,"gross_charge":76,"discounted_cash":22.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"}]}]},{"description":"HC BONE BIOPSY EXPRESS F07A","code_information":[{"code":"HC27210628","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":190.35,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"}]}]},{"description":"HC BONE BIOPSY EXPRESS F07A","code_information":[{"code":"HC27210628","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":35.25,"maximum":190.35,"gross_charge":235,"discounted_cash":69.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":190.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"}]}]},{"description":"HC BTL CNT EVAC 500ML 01614-03","code_information":[{"code":"HC27210629","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":58.32,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"}]}]},{"description":"HC BTL CNT EVAC 500ML 01614-03","code_information":[{"code":"HC27210629","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.8,"maximum":58.32,"gross_charge":72,"discounted_cash":21.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"HC BTL EVAC 1000ML 01614-05","code_information":[{"code":"HC27210630","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":33.21,"maximum":33.21,"gross_charge":41,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"}]}]},{"description":"HC BTL EVAC 1000ML 01614-05","code_information":[{"code":"HC27210630","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.15,"maximum":33.21,"gross_charge":41,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"}]}]},{"description":"HC CAMISOLE HANNAH 28602XABWH","code_information":[{"code":"HC27210632","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":77.76,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"}]}]},{"description":"HC CAMISOLE HANNAH 28602XABWH","code_information":[{"code":"HC27210632","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":14.4,"maximum":77.76,"gross_charge":96,"discounted_cash":28.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"}]}]},{"description":"HC CANNISTER ASPIRATION IAPS2","code_information":[{"code":"HC27210651","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":787.32,"maximum":787.32,"gross_charge":972,"discounted_cash":287.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":787.32,"methodology":"fee schedule"}]}]},{"description":"HC CANNISTER ASPIRATION IAPS2","code_information":[{"code":"HC27210651","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":145.8,"maximum":787.32,"gross_charge":972,"discounted_cash":287.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":787.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"}]}]},{"description":"HC CANNULA STIFF 5FR G35551","code_information":[{"code":"HC27210653","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":47.79,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"}]}]},{"description":"HC CANNULA STIFF 5FR G35551","code_information":[{"code":"HC27210653","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.85,"maximum":47.79,"gross_charge":59,"discounted_cash":17.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"}]}]},{"description":"HC CANNULA VERTEP 0306-410-000","code_information":[{"code":"HC27210656","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":110.97,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"}]}]},{"description":"HC CANNULA VERTEP 0306-410-000","code_information":[{"code":"HC27210656","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.55,"maximum":110.97,"gross_charge":137,"discounted_cash":40.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.4,"methodology":"fee schedule"}]}]},{"description":"HC CAST TOT W/BOOT 4 TCCEZ104B","code_information":[{"code":"HC27210661","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":256.77,"maximum":256.77,"gross_charge":317,"discounted_cash":93.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":256.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.77,"methodology":"fee schedule"}]}]},{"description":"HC CAST TOT W/BOOT 4 TCCEZ104B","code_information":[{"code":"HC27210661","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":47.55,"maximum":256.77,"gross_charge":317,"discounted_cash":93.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":256.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH CENTESIS 10CM OSC-5F-10LT","code_information":[{"code":"HC27210663","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"HC CATH CENTESIS 10CM OSC-5F-10LT","code_information":[{"code":"HC27210663","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.5,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"}]}]},{"description":"HC CATH COBRA 2 5FRX80CM G08586","code_information":[{"code":"HC27210664","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC CATH COBRA 2 5FRX80CM G08586","code_information":[{"code":"HC27210664","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.8,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH TORC NB 5FX80 G11203","code_information":[{"code":"HC27210665","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"HC CATH TORC NB 5FX80 G11203","code_information":[{"code":"HC27210665","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":38.88,"gross_charge":48,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH ACCU-VU 13709705","code_information":[{"code":"HC27210666","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":280.26,"maximum":280.26,"gross_charge":346,"discounted_cash":102.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":280.26,"methodology":"fee schedule"}]}]},{"description":"HC CATH ACCU-VU 13709705","code_information":[{"code":"HC27210666","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":51.9,"maximum":280.26,"gross_charge":346,"discounted_cash":102.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":280.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH ALPHA CRVD 5735190","code_information":[{"code":"HC27210667","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":798.66,"maximum":798.66,"gross_charge":986,"discounted_cash":291.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":798.66,"methodology":"fee schedule"}]}]},{"description":"HC CATH ALPHA CRVD 5735190","code_information":[{"code":"HC27210667","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":147.9,"maximum":798.66,"gross_charge":986,"discounted_cash":291.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":798.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":187.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH FOL BARDX 0165L24","code_information":[{"code":"HC27210672","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.48,"maximum":6.48,"gross_charge":8,"discounted_cash":2.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.48,"methodology":"fee schedule"}]}]},{"description":"HC CATH FOL BARDX 0165L24","code_information":[{"code":"HC27210672","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":6.48,"gross_charge":8,"discounted_cash":2.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH FOLEY 16F 0196L16","code_information":[{"code":"HC27210676","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.3,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"}]}]},{"description":"HC CATH FOLEY 16F 0196L16","code_information":[{"code":"HC27210676","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.5,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTMY 0230-18-4.0","code_information":[{"code":"HC27210684","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":395.28,"maximum":395.28,"gross_charge":488,"discounted_cash":144.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.28,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTMY 0230-18-4.0","code_information":[{"code":"HC27210684","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":73.2,"maximum":395.28,"gross_charge":488,"discounted_cash":144.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTMY 0250-18","code_information":[{"code":"HC27210685","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":498.96,"maximum":498.96,"gross_charge":616,"discounted_cash":182.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.96,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTMY 0250-18","code_information":[{"code":"HC27210685","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":92.4,"maximum":498.96,"gross_charge":616,"discounted_cash":182.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTMY PEG G22639","code_information":[{"code":"HC27210686","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":238.14,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTMY PEG G22639","code_information":[{"code":"HC27210686","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":44.1,"maximum":238.14,"gross_charge":294,"discounted_cash":87.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTOMY 20020","code_information":[{"code":"HC27210687","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":296.46,"maximum":296.46,"gross_charge":366,"discounted_cash":108.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.46,"methodology":"fee schedule"}]}]},{"description":"HC CATH JEJUSTOMY 20020","code_information":[{"code":"HC27210687","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":54.9,"maximum":296.46,"gross_charge":366,"discounted_cash":108.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH KIT GASTSTMY 0120-18-2.5","code_information":[{"code":"HC27210688","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":204.93,"maximum":204.93,"gross_charge":253,"discounted_cash":74.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.93,"methodology":"fee schedule"}]}]},{"description":"HC CATH KIT GASTSTMY 0120-18-2.5","code_information":[{"code":"HC27210688","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.95,"maximum":204.93,"gross_charge":253,"discounted_cash":74.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH LCK 12F DR RLC-12-038","code_information":[{"code":"HC27210691","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":133.65,"maximum":133.65,"gross_charge":165,"discounted_cash":48.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.65,"methodology":"fee schedule"}]}]},{"description":"HC CATH LCK 12F DR RLC-12-038","code_information":[{"code":"HC27210691","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.75,"maximum":133.65,"gross_charge":165,"discounted_cash":48.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROGR MC*PE28131YB","code_information":[{"code":"HC27210697","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1180.98,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIC PROGR MC*PE28131YB","code_information":[{"code":"HC27210697","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":218.7,"maximum":1180.98,"gross_charge":1458,"discounted_cash":431.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1180.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.6,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIKAELSSON 10732101","code_information":[{"code":"HC27210698","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.59,"maximum":31.59,"gross_charge":39,"discounted_cash":11.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.59,"methodology":"fee schedule"}]}]},{"description":"HC CATH MIKAELSSON 10732101","code_information":[{"code":"HC27210698","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.85,"maximum":31.59,"gross_charge":39,"discounted_cash":11.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTILUMEN CDC-45703-1A","code_information":[{"code":"HC27210699","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":171.72,"maximum":171.72,"gross_charge":212,"discounted_cash":62.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":171.72,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTILUMEN CDC-45703-1A","code_information":[{"code":"HC27210699","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.8,"maximum":171.72,"gross_charge":212,"discounted_cash":62.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":171.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTP 14FRX25 G09504","code_information":[{"code":"HC27210700","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":155.52,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"}]}]},{"description":"HC CATH MULTP 14FRX25 G09504","code_information":[{"code":"HC27210700","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.8,"maximum":155.52,"gross_charge":192,"discounted_cash":56.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH RLG 5FR G06094","code_information":[{"code":"HC27210702","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":39.69,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"}]}]},{"description":"HC CATH RLG 5FR G06094","code_information":[{"code":"HC27210702","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":39.69,"gross_charge":49,"discounted_cash":14.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH SECUR CFG624","code_information":[{"code":"HC27210703","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"HC CATH SECUR CFG624","code_information":[{"code":"HC27210703","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.4,"maximum":29.16,"gross_charge":36,"discounted_cash":10.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH SFT-VU 5FR 10712008","code_information":[{"code":"HC27210704","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"HC CATH SFT-VU 5FR 10712008","code_information":[{"code":"HC27210704","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.6,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH SUCTION PRO72 Z115-14","code_information":[{"code":"HC27210706","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH SUCTION PRO72 Z115-14","code_information":[{"code":"HC27210706","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6,"maximum":32.4,"gross_charge":40,"discounted_cash":11.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 7FR SNG CAT878","code_information":[{"code":"HC27210708","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":241.38,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 7FR SNG CAT878","code_information":[{"code":"HC27210708","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":44.7,"maximum":241.38,"gross_charge":298,"discounted_cash":88.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":241.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.6,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABDN CAT875","code_information":[{"code":"HC27210709","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":79.38,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER ABDN CAT875","code_information":[{"code":"HC27210709","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":14.7,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER FOLEY 18FR 0102L18","code_information":[{"code":"HC27210718","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":19.44,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER FOLEY 18FR 0102L18","code_information":[{"code":"HC27210718","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.6,"maximum":19.44,"gross_charge":24,"discounted_cash":7.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER FOLEY 24FR 0167L24","code_information":[{"code":"HC27210724","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.01,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER FOLEY 24FR 0167L24","code_information":[{"code":"HC27210724","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER TAPER ANGLE CG415","code_information":[{"code":"HC27210734","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.87,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER TAPER ANGLE CG415","code_information":[{"code":"HC27210734","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":21.87,"gross_charge":27,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"HC CEMENT BONE AND MIXER C01B","code_information":[{"code":"HC27210742","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":268.11,"maximum":268.11,"gross_charge":331,"discounted_cash":97.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.11,"methodology":"fee schedule"}]}]},{"description":"HC CEMENT BONE AND MIXER C01B","code_information":[{"code":"HC27210742","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":49.65,"maximum":268.11,"gross_charge":331,"discounted_cash":97.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.2,"methodology":"fee schedule"}]}]},{"description":"HC CIRCUIT PARA 162-100/905/340","code_information":[{"code":"HC27210747","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":34.02,"maximum":34.02,"gross_charge":42,"discounted_cash":12.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.02,"methodology":"fee schedule"}]}]},{"description":"HC CIRCUIT PARA 162-100/905/340","code_information":[{"code":"HC27210747","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.3,"maximum":34.02,"gross_charge":42,"discounted_cash":12.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"}]}]},{"description":"HC CIRCUIT VAP PF-DPC-HIGHEA","code_information":[{"code":"HC27210748","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":219.51,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"}]}]},{"description":"HC CIRCUIT VAP PF-DPC-HIGHEA","code_information":[{"code":"HC27210748","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.65,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"}]}]},{"description":"HC CLIP GELMARK 11G GMUT11T","code_information":[{"code":"HC27210751","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":200.88,"maximum":200.88,"gross_charge":248,"discounted_cash":73.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.88,"methodology":"fee schedule"}]}]},{"description":"HC CLIP GELMARK 11G GMUT11T","code_information":[{"code":"HC27210751","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.2,"maximum":200.88,"gross_charge":248,"discounted_cash":73.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"}]}]},{"description":"HC CONTROLLER AZUR 45-4001","code_information":[{"code":"HC27210756","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"HC CONTROLLER AZUR 45-4001","code_information":[{"code":"HC27210756","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.5,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"}]}]},{"description":"HC CORE BIOP 1816MS","code_information":[{"code":"HC27210757","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":116.64,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"}]}]},{"description":"HC CORE BIOP 1816MS","code_information":[{"code":"HC27210757","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.6,"maximum":116.64,"gross_charge":144,"discounted_cash":42.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"}]}]},{"description":"HC CT CATH KT CENTESIS OSC-5F-7L","code_information":[{"code":"HC27210759","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"HC CT CATH KT CENTESIS OSC-5F-7L","code_information":[{"code":"HC27210759","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.25,"maximum":60.75,"gross_charge":75,"discounted_cash":22.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"}]}]},{"description":"HC CT TRAY PARACENT SPPT-100/C","code_information":[{"code":"HC27210763","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":55.89,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"}]}]},{"description":"HC CT TRAY PARACENT SPPT-100/C","code_information":[{"code":"HC27210763","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.35,"maximum":55.89,"gross_charge":69,"discounted_cash":20.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"}]}]},{"description":"HC DEVICE INFLT ENCORE 710-114","code_information":[{"code":"HC27210765","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":76.95,"maximum":76.95,"gross_charge":95,"discounted_cash":28.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.95,"methodology":"fee schedule"}]}]},{"description":"HC DEVICE INFLT ENCORE 710-114","code_information":[{"code":"HC27210765","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":14.25,"maximum":76.95,"gross_charge":95,"discounted_cash":28.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19,"methodology":"fee schedule"}]}]},{"description":"HC DEVICE VPEP OSCILLATING 510","code_information":[{"code":"HC27210767","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":68.04,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"HC DEVICE VPEP OSCILLATING 510","code_information":[{"code":"HC27210767","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":68.04,"gross_charge":84,"discounted_cash":24.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"}]}]},{"description":"HC DIALYER POLYFLUX REV 110634","code_information":[{"code":"HC27210768","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30.78,"maximum":30.78,"gross_charge":38,"discounted_cash":11.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.78,"methodology":"fee schedule"}]}]},{"description":"HC DIALYER POLYFLUX REV 110634","code_information":[{"code":"HC27210768","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.7,"maximum":30.78,"gross_charge":38,"discounted_cash":11.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"}]}]},{"description":"HC DIALYZER EXELTRA 170 5M2120","code_information":[{"code":"HC27210770","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":314.28,"maximum":314.28,"gross_charge":388,"discounted_cash":114.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":314.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":314.28,"methodology":"fee schedule"}]}]},{"description":"HC DIALYZER EXELTRA 170 5M2120","code_information":[{"code":"HC27210770","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":58.2,"maximum":314.28,"gross_charge":388,"discounted_cash":114.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":314.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":314.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.6,"methodology":"fee schedule"}]}]},{"description":"HC DILATOR VES 4FR G02366","code_information":[{"code":"HC27210774","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.35,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"}]}]},{"description":"HC DILATOR VES 4FR G02366","code_information":[{"code":"HC27210774","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.25,"maximum":28.35,"gross_charge":35,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"}]}]},{"description":"HC DRAINGE SYS THOR S-1100-08LF","code_information":[{"code":"HC27210778","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":703.08,"maximum":703.08,"gross_charge":868,"discounted_cash":256.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":703.08,"methodology":"fee schedule"}]}]},{"description":"HC DRAINGE SYS THOR S-1100-08LF","code_information":[{"code":"HC27210778","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":130.2,"maximum":703.08,"gross_charge":868,"discounted_cash":256.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":703.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.6,"methodology":"fee schedule"}]}]},{"description":"HC DRESSING AQUACEL *412012","code_information":[{"code":"HC27210784","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.39,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"HC DRESSING AQUACEL *412012","code_information":[{"code":"HC27210784","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2.85,"maximum":15.39,"gross_charge":19,"discounted_cash":5.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"}]}]},{"description":"HC DRILL HAND 10G 0306-810-000","code_information":[{"code":"HC27210813","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":115.83,"maximum":115.83,"gross_charge":143,"discounted_cash":42.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.83,"methodology":"fee schedule"}]}]},{"description":"HC DRILL HAND 10G 0306-810-000","code_information":[{"code":"HC27210813","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.45,"maximum":115.83,"gross_charge":143,"discounted_cash":42.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"HC DRNGE KT THOR ATS 4000-100N","code_information":[{"code":"HC27210814","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":132.03,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"}]}]},{"description":"HC DRNGE KT THOR ATS 4000-100N","code_information":[{"code":"HC27210814","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.45,"maximum":132.03,"gross_charge":163,"discounted_cash":48.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRD ECG MRI *81255628","code_information":[{"code":"HC27210815","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":25.92,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRD ECG MRI *81255628","code_information":[{"code":"HC27210815","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.8,"maximum":25.92,"gross_charge":32,"discounted_cash":9.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRD PADPRO CONM:2001M-C","code_information":[{"code":"HC27210817","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":38.07,"maximum":38.07,"gross_charge":47,"discounted_cash":13.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"}]}]},{"description":"HC ELECTRD PADPRO CONM:2001M-C","code_information":[{"code":"HC27210817","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.05,"maximum":38.07,"gross_charge":47,"discounted_cash":13.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"}]}]},{"description":"HC FEEDING TUBE J 0230-18-3.5","code_information":[{"code":"HC27210823","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":380.7,"maximum":380.7,"gross_charge":470,"discounted_cash":139.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.7,"methodology":"fee schedule"}]}]},{"description":"HC FEEDING TUBE J 0230-18-3.5","code_information":[{"code":"HC27210823","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":70.5,"maximum":380.7,"gross_charge":470,"discounted_cash":139.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94,"methodology":"fee schedule"}]}]},{"description":"HC FILTR OPTEAS 55CM 466-F230AF","code_information":[{"code":"HC27210826","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2417.04,"maximum":2417.04,"gross_charge":2984,"discounted_cash":883.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2417.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2417.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2417.04,"methodology":"fee schedule"}]}]},{"description":"HC FILTR OPTEAS 55CM 466-F230AF","code_information":[{"code":"HC27210826","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":447.6,"maximum":2417.04,"gross_charge":2984,"discounted_cash":883.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2417.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2417.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2417.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.8,"methodology":"fee schedule"}]}]},{"description":"HC FORCEP TRIPOD FG-600U","code_information":[{"code":"HC27210830","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":137.7,"maximum":137.7,"gross_charge":170,"discounted_cash":50.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.7,"methodology":"fee schedule"}]}]},{"description":"HC FORCEP TRIPOD FG-600U","code_information":[{"code":"HC27210830","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":25.5,"maximum":137.7,"gross_charge":170,"discounted_cash":50.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34,"methodology":"fee schedule"}]}]},{"description":"HC GUIDE SET NDL 900013B01","code_information":[{"code":"HC27210839","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.97,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"}]}]},{"description":"HC GUIDE SET NDL 900013B01","code_information":[{"code":"HC27210839","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.55,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"}]}]},{"description":"HC HANDLE HARNESS RH1","code_information":[{"code":"HC27210840","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":492.48,"maximum":492.48,"gross_charge":608,"discounted_cash":179.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":492.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":492.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":492.48,"methodology":"fee schedule"}]}]},{"description":"HC HANDLE HARNESS RH1","code_information":[{"code":"HC27210840","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":91.2,"maximum":492.48,"gross_charge":608,"discounted_cash":179.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":492.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":492.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":492.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.6,"methodology":"fee schedule"}]}]},{"description":"HC HANDPIECE ATEC9 GAUG 0912-20","code_information":[{"code":"HC27210842","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":498.15,"maximum":498.15,"gross_charge":615,"discounted_cash":182.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.15,"methodology":"fee schedule"}]}]},{"description":"HC HANDPIECE ATEC9 GAUG 0912-20","code_information":[{"code":"HC27210842","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":92.25,"maximum":498.15,"gross_charge":615,"discounted_cash":182.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":498.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123,"methodology":"fee schedule"}]}]},{"description":"HC HANDPIECE DEV ATEC0914-20MR","code_information":[{"code":"HC27210843","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":606.69,"maximum":606.69,"gross_charge":749,"discounted_cash":221.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":606.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":606.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":606.69,"methodology":"fee schedule"}]}]},{"description":"HC HANDPIECE DEV ATEC0914-20MR","code_information":[{"code":"HC27210843","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.35,"maximum":606.69,"gross_charge":749,"discounted_cash":221.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":606.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":606.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":606.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.8,"methodology":"fee schedule"}]}]},{"description":"HC HANDPIECE STX EVIVA 1913-12T","code_information":[{"code":"HC27210844","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":528.12,"maximum":528.12,"gross_charge":652,"discounted_cash":193,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":528.12,"methodology":"fee schedule"}]}]},{"description":"HC HANDPIECE STX EVIVA 1913-12T","code_information":[{"code":"HC27210844","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":97.8,"maximum":528.12,"gross_charge":652,"discounted_cash":193,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":528.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.4,"methodology":"fee schedule"}]}]},{"description":"HC HOLDER CATH PICC","code_information":[{"code":"HC27210847","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":25.11,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"}]}]},{"description":"HC HOLDER CATH PICC","code_information":[{"code":"HC27210847","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.65,"maximum":25.11,"gross_charge":31,"discounted_cash":9.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"}]}]},{"description":"HC INFLATOR BALLOON","code_information":[{"code":"HC27210854","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":174.96,"maximum":174.96,"gross_charge":216,"discounted_cash":63.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.96,"methodology":"fee schedule"}]}]},{"description":"HC INFLATOR BALLOON","code_information":[{"code":"HC27210854","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":32.4,"maximum":174.96,"gross_charge":216,"discounted_cash":63.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRO ACUSTK 20-702","code_information":[{"code":"HC27210858","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":221.13,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"}]}]},{"description":"HC INTRO ACUSTK 20-702","code_information":[{"code":"HC27210858","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":40.95,"maximum":221.13,"gross_charge":273,"discounted_cash":80.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"}]}]},{"description":"HC INTRO BRT TIP 0.035IN 401-623","code_information":[{"code":"HC27210859","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":53.46,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"}]}]},{"description":"HC INTRO BRT TIP 0.035IN 401-623","code_information":[{"code":"HC27210859","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.9,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"}]}]},{"description":"HC INTRO KIT18FR MIC 98438","code_information":[{"code":"HC27210860","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":464.13,"maximum":464.13,"gross_charge":573,"discounted_cash":169.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":464.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.13,"methodology":"fee schedule"}]}]},{"description":"HC INTRO KIT18FR MIC 98438","code_information":[{"code":"HC27210860","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":85.95,"maximum":464.13,"gross_charge":573,"discounted_cash":169.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":464.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":464.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":464.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.6,"methodology":"fee schedule"}]}]},{"description":"HC IVAS SYS 2-10MM 0705-110-000","code_information":[{"code":"HC27210861","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2225.07,"maximum":2225.07,"gross_charge":2747,"discounted_cash":813.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2225.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2225.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2225.07,"methodology":"fee schedule"}]}]},{"description":"HC IVAS SYS 2-10MM 0705-110-000","code_information":[{"code":"HC27210861","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":412.05,"maximum":2225.07,"gross_charge":2747,"discounted_cash":813.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2225.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2225.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2225.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":521.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.4,"methodology":"fee schedule"}]}]},{"description":"HC KIT ACCESS 5FR MAK501N-E","code_information":[{"code":"HC27210862","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":55.08,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"}]}]},{"description":"HC KIT ACCESS 5FR MAK501N-E","code_information":[{"code":"HC27210862","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.2,"maximum":55.08,"gross_charge":68,"discounted_cash":20.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"}]}]},{"description":"HC KIT AMPLATZ GOOSE NECK SK700","code_information":[{"code":"HC27210863","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1342.98,"maximum":1342.98,"gross_charge":1658,"discounted_cash":490.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1342.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1342.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1342.98,"methodology":"fee schedule"}]}]},{"description":"HC KIT AMPLATZ GOOSE NECK SK700","code_information":[{"code":"HC27210863","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":248.7,"maximum":1342.98,"gross_charge":1658,"discounted_cash":490.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1342.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1342.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1342.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.6,"methodology":"fee schedule"}]}]},{"description":"HC KIT BIOPSY LIVER 19G TL-19","code_information":[{"code":"HC27210865","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1126.71,"maximum":1126.71,"gross_charge":1391,"discounted_cash":411.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1126.71,"methodology":"fee schedule"}]}]},{"description":"HC KIT BIOPSY LIVER 19G TL-19","code_information":[{"code":"HC27210865","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":208.65,"maximum":1126.71,"gross_charge":1391,"discounted_cash":411.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.2,"methodology":"fee schedule"}]}]},{"description":"HC KIT BONE BIO 10G 0306-104-000","code_information":[{"code":"HC27210867","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":170.1,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"}]}]},{"description":"HC KIT BONE BIO 10G 0306-104-000","code_information":[{"code":"HC27210867","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":31.5,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"}]}]},{"description":"HC KIT BRONCH BRC-BAL-INT-SL","code_information":[{"code":"HC27210868","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":164.43,"maximum":164.43,"gross_charge":203,"discounted_cash":60.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.43,"methodology":"fee schedule"}]}]},{"description":"HC KIT BRONCH BRC-BAL-INT-SL","code_information":[{"code":"HC27210868","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30.45,"maximum":164.43,"gross_charge":203,"discounted_cash":60.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"}]}]},{"description":"HC KIT MAX BARRIER 3884445","code_information":[{"code":"HC27210874","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":59.94,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"}]}]},{"description":"HC KIT MAX BARRIER 3884445","code_information":[{"code":"HC27210874","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.1,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"}]}]},{"description":"HC KIT TISSEEL FIBRIN 1504514","code_information":[{"code":"HC27210879","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":247.86,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"}]}]},{"description":"HC KIT TISSEEL FIBRIN 1504514","code_information":[{"code":"HC27210879","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":45.9,"maximum":247.86,"gross_charge":306,"discounted_cash":90.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BIOPSY SMARK 2S-13","code_information":[{"code":"HC27210884","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":163.62,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BIOPSY SMARK 2S-13","code_information":[{"code":"HC27210884","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30.3,"maximum":163.62,"gross_charge":202,"discounted_cash":59.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BX TRIMARK-EVIVA-2S-13","code_information":[{"code":"HC27210886","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BX TRIMARK-EVIVA-2S-13","code_information":[{"code":"HC27210886","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.75,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"}]}]},{"description":"HC MASK BIPAP LG 1061720","code_information":[{"code":"HC27210888","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":63.99,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"}]}]},{"description":"HC MASK BIPAP LG 1061720","code_information":[{"code":"HC27210888","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.85,"maximum":63.99,"gross_charge":79,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"}]}]},{"description":"HC MASK BIPAP XLG 1080424","code_information":[{"code":"HC27210891","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":128.79,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"}]}]},{"description":"HC MASK BIPAP XLG 1080424","code_information":[{"code":"HC27210891","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":23.85,"maximum":128.79,"gross_charge":159,"discounted_cash":47.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"}]}]},{"description":"HC MICROCOIL TORNADO G08259","code_information":[{"code":"HC27210894","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":233.28,"maximum":233.28,"gross_charge":288,"discounted_cash":85.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.28,"methodology":"fee schedule"}]}]},{"description":"HC MICROCOIL TORNADO G08259","code_information":[{"code":"HC27210894","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":43.2,"maximum":233.28,"gross_charge":288,"discounted_cash":85.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":233.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"}]}]},{"description":"HC NDL BX GRID GUIDELINE BX 217","code_information":[{"code":"HC27210897","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":57.51,"maximum":57.51,"gross_charge":71,"discounted_cash":21.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"}]}]},{"description":"HC NDL BX GRID GUIDELINE BX 217","code_information":[{"code":"HC27210897","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.65,"maximum":57.51,"gross_charge":71,"discounted_cash":21.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.2,"methodology":"fee schedule"}]}]},{"description":"HC NEEDL BX SFT 141302","code_information":[{"code":"HC27210903","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":88.29,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"}]}]},{"description":"HC NEEDL BX SFT 141302","code_information":[{"code":"HC27210903","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.35,"maximum":88.29,"gross_charge":109,"discounted_cash":32.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE ACC 10G","code_information":[{"code":"HC27210906","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":121.5,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE ACC 10G","code_information":[{"code":"HC27210906","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":22.5,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIO SFT 16GX1 121616","code_information":[{"code":"HC27210908","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":89.1,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIO SFT 16GX1 121616","code_information":[{"code":"HC27210908","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.5,"maximum":89.1,"gross_charge":110,"discounted_cash":32.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOPSY PRB F14105US","code_information":[{"code":"HC27210913","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":607.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOPSY PRB F14105US","code_information":[{"code":"HC27210913","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.5,"maximum":607.5,"gross_charge":750,"discounted_cash":222,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOPSY SFT TISS G27018","code_information":[{"code":"HC27210914","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":110.16,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOPSY SFT TISS G27018","code_information":[{"code":"HC27210914","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.4,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BRST LOC 360-1580-01","code_information":[{"code":"HC27210915","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":91.53,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BRST LOC 360-1580-01","code_information":[{"code":"HC27210915","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.95,"maximum":91.53,"gross_charge":113,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BRST LOC 370-1580-01","code_information":[{"code":"HC27210916","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":85.05,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BRST LOC 370-1580-01","code_information":[{"code":"HC27210916","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.75,"maximum":85.05,"gross_charge":105,"discounted_cash":31.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE INTROD ISN1920","code_information":[{"code":"HC27210918","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE INTROD ISN1920","code_information":[{"code":"HC27210918","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.8,"maximum":74.52,"gross_charge":92,"discounted_cash":27.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE PERC VASC 78050","code_information":[{"code":"HC27210919","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":230.85,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE PERC VASC 78050","code_information":[{"code":"HC27210919","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":42.75,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE SIDEKICK 890304","code_information":[{"code":"HC27210920","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE SIDEKICK 890304","code_information":[{"code":"HC27210920","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"}]}]},{"description":"HC PAD COOLING MED 317-07-02","code_information":[{"code":"HC27210926","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1995.84,"maximum":1995.84,"gross_charge":2464,"discounted_cash":729.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1995.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1995.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1995.84,"methodology":"fee schedule"}]}]},{"description":"HC PAD COOLING MED 317-07-02","code_information":[{"code":"HC27210926","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":369.6,"maximum":1995.84,"gross_charge":2464,"discounted_cash":729.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1995.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1995.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1995.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.8,"methodology":"fee schedule"}]}]},{"description":"HC PAD COOLING UNIVER 317-00-04","code_information":[{"code":"HC27210927","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":822.15,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"}]}]},{"description":"HC PAD COOLING UNIVER 317-00-04","code_information":[{"code":"HC27210927","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":152.25,"maximum":822.15,"gross_charge":1015,"discounted_cash":300.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203,"methodology":"fee schedule"}]}]},{"description":"HC PAK VERTEBROPLAS SOP21VB62A","code_information":[{"code":"HC27210929","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":59.13,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"HC PAK VERTEBROPLAS SOP21VB62A","code_information":[{"code":"HC27210929","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.95,"maximum":59.13,"gross_charge":73,"discounted_cash":21.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"}]}]},{"description":"HC PARTICLE EMB PVA G09664","code_information":[{"code":"HC27210930","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":294.03,"maximum":294.03,"gross_charge":363,"discounted_cash":107.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":294.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":294.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":294.03,"methodology":"fee schedule"}]}]},{"description":"HC PARTICLE EMB PVA G09664","code_information":[{"code":"HC27210930","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":54.45,"maximum":294.03,"gross_charge":363,"discounted_cash":107.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":294.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":294.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":294.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"}]}]},{"description":"HC POWERWAND QU 4FR 10CM 72623","code_information":[{"code":"HC27210936","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":362.07,"maximum":362.07,"gross_charge":447,"discounted_cash":132.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.07,"methodology":"fee schedule"}]}]},{"description":"HC POWERWAND QU 4FR 10CM 72623","code_information":[{"code":"HC27210936","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":67.05,"maximum":362.07,"gross_charge":447,"discounted_cash":132.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.4,"methodology":"fee schedule"}]}]},{"description":"HC POWRWAND XL QK 94104","code_information":[{"code":"HC27210938","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":289.17,"maximum":289.17,"gross_charge":357,"discounted_cash":105.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.17,"methodology":"fee schedule"}]}]},{"description":"HC POWRWAND XL QK 94104","code_information":[{"code":"HC27210938","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":53.55,"maximum":289.17,"gross_charge":357,"discounted_cash":105.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.4,"methodology":"fee schedule"}]}]},{"description":"HC POWRWAND XL SINGLE 94103","code_information":[{"code":"HC27210940","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":243,"maximum":243,"gross_charge":300,"discounted_cash":88.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":243,"methodology":"fee schedule"}]}]},{"description":"HC POWRWAND XL SINGLE 94103","code_information":[{"code":"HC27210940","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":45,"maximum":243,"gross_charge":300,"discounted_cash":88.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":243,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH CATH 14F G14241","code_information":[{"code":"HC27210945","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":149.04,"maximum":149.04,"gross_charge":184,"discounted_cash":54.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.04,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH CATH 14F G14241","code_information":[{"code":"HC27210945","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.6,"maximum":149.04,"gross_charge":184,"discounted_cash":54.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"}]}]},{"description":"HC QUADRASPHERE V32QS","code_information":[{"code":"HC27210946","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2778.3,"maximum":2778.3,"gross_charge":3430,"discounted_cash":1015.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2778.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2778.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2778.3,"methodology":"fee schedule"}]}]},{"description":"HC QUADRASPHERE V32QS","code_information":[{"code":"HC27210946","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":514.5,"maximum":2778.3,"gross_charge":3430,"discounted_cash":1015.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2778.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2778.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2778.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":686,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":686,"methodology":"fee schedule"}]}]},{"description":"HC SCOPE AMBU 403-001-00","code_information":[{"code":"HC27210950","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":634.23,"maximum":634.23,"gross_charge":783,"discounted_cash":231.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":634.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.23,"methodology":"fee schedule"}]}]},{"description":"HC SCOPE AMBU 403-001-00","code_information":[{"code":"HC27210950","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":634.23,"gross_charge":783,"discounted_cash":231.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":634.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.6,"methodology":"fee schedule"}]}]},{"description":"HC SENSOR 02 PULSE 407705-006","code_information":[{"code":"HC27210952","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":565.38,"maximum":565.38,"gross_charge":698,"discounted_cash":206.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.38,"methodology":"fee schedule"}]}]},{"description":"HC SENSOR 02 PULSE 407705-006","code_information":[{"code":"HC27210952","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":104.7,"maximum":565.38,"gross_charge":698,"discounted_cash":206.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":565.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.6,"methodology":"fee schedule"}]}]},{"description":"HC SEPARATOR PERCU ASPIRAT SEP8","code_information":[{"code":"HC27210954","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4057.29,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"}]}]},{"description":"HC SEPARATOR PERCU ASPIRAT SEP8","code_information":[{"code":"HC27210954","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":751.35,"maximum":4057.29,"gross_charge":5009,"discounted_cash":1482.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4057.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":951.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.8,"methodology":"fee schedule"}]}]},{"description":"HC SET ADMIN IV PMP TUB500","code_information":[{"code":"HC27210956","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":75.33,"maximum":75.33,"gross_charge":93,"discounted_cash":27.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.33,"methodology":"fee schedule"}]}]},{"description":"HC SET ADMIN IV PMP TUB500","code_information":[{"code":"HC27210956","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.95,"maximum":75.33,"gross_charge":93,"discounted_cash":27.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"}]}]},{"description":"HC SET CATH PNEUM G09764","code_information":[{"code":"HC27210959","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":253.53,"maximum":253.53,"gross_charge":313,"discounted_cash":92.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.53,"methodology":"fee schedule"}]}]},{"description":"HC SET CATH PNEUM G09764","code_information":[{"code":"HC27210959","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":46.95,"maximum":253.53,"gross_charge":313,"discounted_cash":92.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.6,"methodology":"fee schedule"}]}]},{"description":"HC SET CATH TRNSJUG G29769","code_information":[{"code":"HC27210960","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1025.46,"maximum":1025.46,"gross_charge":1266,"discounted_cash":374.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1025.46,"methodology":"fee schedule"}]}]},{"description":"HC SET CATH TRNSJUG G29769","code_information":[{"code":"HC27210960","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":189.9,"maximum":1025.46,"gross_charge":1266,"discounted_cash":374.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1025.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.2,"methodology":"fee schedule"}]}]},{"description":"HC SET OTIA IDL SPECTRA 10310","code_information":[{"code":"HC27210972","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":646.38,"maximum":646.38,"gross_charge":798,"discounted_cash":236.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":646.38,"methodology":"fee schedule"}]}]},{"description":"HC SET OTIA IDL SPECTRA 10310","code_information":[{"code":"HC27210972","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":119.7,"maximum":646.38,"gross_charge":798,"discounted_cash":236.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":646.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.6,"methodology":"fee schedule"}]}]},{"description":"HC SET RING TRNS G31478","code_information":[{"code":"HC27210975","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":845.64,"maximum":845.64,"gross_charge":1044,"discounted_cash":309.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":845.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":845.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":845.64,"methodology":"fee schedule"}]}]},{"description":"HC SET RING TRNS G31478","code_information":[{"code":"HC27210975","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":156.6,"maximum":845.64,"gross_charge":1044,"discounted_cash":309.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":845.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":845.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":845.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.8,"methodology":"fee schedule"}]}]},{"description":"HC SET THERA PLASM EXCHG 70500","code_information":[{"code":"HC27210977","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":520.83,"maximum":520.83,"gross_charge":643,"discounted_cash":190.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":520.83,"methodology":"fee schedule"}]}]},{"description":"HC SET THERA PLASM EXCHG 70500","code_information":[{"code":"HC27210977","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":96.45,"maximum":520.83,"gross_charge":643,"discounted_cash":190.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":520.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.6,"methodology":"fee schedule"}]}]},{"description":"HC SOL SALINE 1000CC BAG","code_information":[{"code":"HC27211023","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":34.83,"maximum":34.83,"gross_charge":43,"discounted_cash":12.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.83,"methodology":"fee schedule"}]}]},{"description":"HC SOL SALINE 1000CC BAG","code_information":[{"code":"HC27211023","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.45,"maximum":34.83,"gross_charge":43,"discounted_cash":12.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"}]}]},{"description":"HC STYLET BEVEL","code_information":[{"code":"HC27211030","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":86.67,"maximum":86.67,"gross_charge":107,"discounted_cash":31.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.67,"methodology":"fee schedule"}]}]},{"description":"HC STYLET BEVEL","code_information":[{"code":"HC27211030","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.05,"maximum":86.67,"gross_charge":107,"discounted_cash":31.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.4,"methodology":"fee schedule"}]}]},{"description":"HC SYR CT FAST LOAD *017344","code_information":[{"code":"HC27211054","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":26.73,"maximum":26.73,"gross_charge":33,"discounted_cash":9.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.73,"methodology":"fee schedule"}]}]},{"description":"HC SYR CT FAST LOAD *017344","code_information":[{"code":"HC27211054","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":4.95,"maximum":26.73,"gross_charge":33,"discounted_cash":9.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"}]}]},{"description":"HC SYR DUAL STELLAN SDS-CTP-SPK","code_information":[{"code":"HC27211055","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":41.31,"maximum":41.31,"gross_charge":51,"discounted_cash":15.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"}]}]},{"description":"HC SYR DUAL STELLAN SDS-CTP-SPK","code_information":[{"code":"HC27211055","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":7.65,"maximum":41.31,"gross_charge":51,"discounted_cash":15.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"}]}]},{"description":"HC SYRINGE EMBOZENE 15020-S1","code_information":[{"code":"HC27211058","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":364.5,"maximum":364.5,"gross_charge":450,"discounted_cash":133.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.5,"methodology":"fee schedule"}]}]},{"description":"HC SYRINGE EMBOZENE 15020-S1","code_information":[{"code":"HC27211058","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":67.5,"maximum":364.5,"gross_charge":450,"discounted_cash":133.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"}]}]},{"description":"HC TRANSDUCER CR LINE 10021021","code_information":[{"code":"HC27211063","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":51.03,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"}]}]},{"description":"HC TRANSDUCER CR LINE 10021021","code_information":[{"code":"HC27211063","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9.45,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"HC TRAY MYELOGRAM A4324ASP","code_information":[{"code":"HC27211067","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"HC TRAY MYELOGRAM A4324ASP","code_information":[{"code":"HC27211067","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5.1,"maximum":27.54,"gross_charge":34,"discounted_cash":10.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"}]}]},{"description":"HC TRAY BIOPSY 9402-VC-006","code_information":[{"code":"HC27211068","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":285.93,"maximum":285.93,"gross_charge":353,"discounted_cash":104.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.93,"methodology":"fee schedule"}]}]},{"description":"HC TRAY BIOPSY 9402-VC-006","code_information":[{"code":"HC27211068","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":52.95,"maximum":285.93,"gross_charge":353,"discounted_cash":104.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"}]}]},{"description":"HC TRAY CHEST TB G04220","code_information":[{"code":"HC27211072","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":307.8,"maximum":307.8,"gross_charge":380,"discounted_cash":112.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.8,"methodology":"fee schedule"}]}]},{"description":"HC TRAY CHEST TB G04220","code_information":[{"code":"HC27211072","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":57,"maximum":307.8,"gross_charge":380,"discounted_cash":112.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"}]}]},{"description":"HC TRAY LUMBAR PUNCTURE 4301C","code_information":[{"code":"HC27211083","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.63,"maximum":18.63,"gross_charge":23,"discounted_cash":6.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"}]}]},{"description":"HC TRAY LUMBAR PUNCTURE 4301C","code_information":[{"code":"HC27211083","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3.45,"maximum":18.63,"gross_charge":23,"discounted_cash":6.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"}]}]},{"description":"HC TRIMARKER TD-25-13-MR","code_information":[{"code":"HC27211084","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":134.46,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"}]}]},{"description":"HC TRIMARKER TD-25-13-MR","code_information":[{"code":"HC27211084","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":24.9,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"}]}]},{"description":"HC TUBE CATH MIC 021022","code_information":[{"code":"HC27211085","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":391.23,"maximum":391.23,"gross_charge":483,"discounted_cash":142.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":391.23,"methodology":"fee schedule"}]}]},{"description":"HC TUBE CATH MIC 021022","code_information":[{"code":"HC27211085","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":72.45,"maximum":391.23,"gross_charge":483,"discounted_cash":142.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":391.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEED 0270-18-2.5-45","code_information":[{"code":"HC27211087","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":751.68,"maximum":751.68,"gross_charge":928,"discounted_cash":274.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":751.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":751.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":751.68,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEED 0270-18-2.5-45","code_information":[{"code":"HC27211087","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":139.2,"maximum":751.68,"gross_charge":928,"discounted_cash":274.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":751.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":751.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":751.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEEDING GAST 0100-16LV","code_information":[{"code":"HC27211089","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":68.85,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEEDING GAST 0100-16LV","code_information":[{"code":"HC27211089","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.75,"maximum":68.85,"gross_charge":85,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTRO T W/FAST 98701","code_information":[{"code":"HC27211090","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":261.63,"maximum":261.63,"gross_charge":323,"discounted_cash":95.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":261.63,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTRO T W/FAST 98701","code_information":[{"code":"HC27211090","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":48.45,"maximum":261.63,"gross_charge":323,"discounted_cash":95.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":261.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTROENT MIC 0210-30","code_information":[{"code":"HC27211091","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":386.37,"maximum":386.37,"gross_charge":477,"discounted_cash":141.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":386.37,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTROENT MIC 0210-30","code_information":[{"code":"HC27211091","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":71.55,"maximum":386.37,"gross_charge":477,"discounted_cash":141.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"}]}]},{"description":"HC TUBE LOW PROF 0230-18-2.0","code_information":[{"code":"HC27211100","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":387.99,"maximum":387.99,"gross_charge":479,"discounted_cash":141.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":387.99,"methodology":"fee schedule"}]}]},{"description":"HC TUBE LOW PROF 0230-18-2.0","code_information":[{"code":"HC27211100","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":71.85,"maximum":387.99,"gross_charge":479,"discounted_cash":141.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":387.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.8,"methodology":"fee schedule"}]}]},{"description":"HC TUBE MIC JEJUNAL 02501845","code_information":[{"code":"HC27211101","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":605.07,"maximum":605.07,"gross_charge":747,"discounted_cash":221.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":605.07,"methodology":"fee schedule"}]}]},{"description":"HC TUBE MIC JEJUNAL 02501845","code_information":[{"code":"HC27211101","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.05,"maximum":605.07,"gross_charge":747,"discounted_cash":221.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":605.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.4,"methodology":"fee schedule"}]}]},{"description":"HC TUBNG ASPIRATION IST3","code_information":[{"code":"HC27211105","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":951.75,"maximum":951.75,"gross_charge":1175,"discounted_cash":347.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":951.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":951.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":951.75,"methodology":"fee schedule"}]}]},{"description":"HC TUBNG ASPIRATION IST3","code_information":[{"code":"HC27211105","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":176.25,"maximum":951.75,"gross_charge":1175,"discounted_cash":347.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":951.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":951.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":951.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":235,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":235,"methodology":"fee schedule"}]}]},{"description":"HC TUBNG ETCO2 76651993","code_information":[{"code":"HC27211106","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":46.17,"maximum":46.17,"gross_charge":57,"discounted_cash":16.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"}]}]},{"description":"HC TUBNG ETCO2 76651993","code_information":[{"code":"HC27211106","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":8.55,"maximum":46.17,"gross_charge":57,"discounted_cash":16.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"}]}]},{"description":"HC TUBNG PD CASSETTE 5C4469","code_information":[{"code":"HC27211107","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":62.37,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"HC TUBNG PD CASSETTE 5C4469","code_information":[{"code":"HC27211107","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"}]}]},{"description":"HC ULTRACLIP COIL DUAL 864017D","code_information":[{"code":"HC27211108","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":157.14,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"}]}]},{"description":"HC ULTRACLIP COIL DUAL 864017D","code_information":[{"code":"HC27211108","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.1,"maximum":157.14,"gross_charge":194,"discounted_cash":57.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":157.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"}]}]},{"description":"HC VALVE TRACH MUIR PMV2001","code_information":[{"code":"HC27211110","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":161.19,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"}]}]},{"description":"HC VALVE TRACH MUIR PMV2001","code_information":[{"code":"HC27211110","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.85,"maximum":161.19,"gross_charge":199,"discounted_cash":58.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"}]}]},{"description":"HC VALVE TRACH SPEAK PMV007","code_information":[{"code":"HC27211111","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":153.9,"maximum":153.9,"gross_charge":190,"discounted_cash":56.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.9,"methodology":"fee schedule"}]}]},{"description":"HC VALVE TRACH SPEAK PMV007","code_information":[{"code":"HC27211111","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.5,"maximum":153.9,"gross_charge":190,"discounted_cash":56.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"}]}]},{"description":"HC VEST WRAP LG P300632000","code_information":[{"code":"HC27211112","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":148.23,"maximum":148.23,"gross_charge":183,"discounted_cash":54.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.23,"methodology":"fee schedule"}]}]},{"description":"HC VEST WRAP LG P300632000","code_information":[{"code":"HC27211112","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.45,"maximum":148.23,"gross_charge":183,"discounted_cash":54.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEED W/STYLET 20-6438","code_information":[{"code":"HC27211376","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":383.13,"maximum":383.13,"gross_charge":473,"discounted_cash":140.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.13,"methodology":"fee schedule"}]}]},{"description":"HC TUBE FEED W/STYLET 20-6438","code_information":[{"code":"HC27211376","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":70.95,"maximum":383.13,"gross_charge":473,"discounted_cash":140.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.6,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTROSTOMY 30CC 32-2020","code_information":[{"code":"HC27211380","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":831.06,"maximum":831.06,"gross_charge":1026,"discounted_cash":303.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.06,"methodology":"fee schedule"}]}]},{"description":"HC TUBE GASTROSTOMY 30CC 32-2020","code_information":[{"code":"HC27211380","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":153.9,"maximum":831.06,"gross_charge":1026,"discounted_cash":303.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":831.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":194.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.2,"methodology":"fee schedule"}]}]},{"description":"HC SSVACUUM SPRING BIOP CELERO-12","code_information":[{"code":"HC27220001","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":421.2,"maximum":421.2,"gross_charge":520,"discounted_cash":153.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.2,"methodology":"fee schedule"}]}]},{"description":"HC SSVACUUM SPRING BIOP CELERO-12","code_information":[{"code":"HC27220001","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":78,"maximum":421.2,"gross_charge":520,"discounted_cash":153.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BIOPSY HY 4010-04-09-T3","code_information":[{"code":"HC27220002","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":203.31,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BIOPSY HY 4010-04-09-T3","code_information":[{"code":"HC27220002","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.65,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BI0PSY 4010-04-06-T4","code_information":[{"code":"HC27220003","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":93.15,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"}]}]},{"description":"HC MARKER BI0PSY 4010-04-06-T4","code_information":[{"code":"HC27220003","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":17.25,"maximum":93.15,"gross_charge":115,"discounted_cash":34.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23,"methodology":"fee schedule"}]}]},{"description":"STYLET LD BALL EXT 608262","code_information":[{"code":"HC27220027","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"STYLET LD BALL EXT 608262","code_information":[{"code":"HC27220027","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"NDL BIO ACT2015 TEMNO A.C.T.","code_information":[{"code":"HC27220030","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":162,"maximum":162,"gross_charge":200,"discounted_cash":59.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162,"methodology":"fee schedule"}]}]},{"description":"NDL BIO ACT2015 TEMNO A.C.T.","code_information":[{"code":"HC27220030","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":30,"maximum":162,"gross_charge":200,"discounted_cash":59.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"}]}]},{"description":"NDL BIO ACT1811 TEMNO A.C.T.","code_information":[{"code":"HC27220031","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":81.81,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"}]}]},{"description":"NDL BIO ACT1811 TEMNO A.C.T.","code_information":[{"code":"HC27220031","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.15,"maximum":81.81,"gross_charge":101,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"}]}]},{"description":"NDL BIO ACT2011 TEMNO A.C.T.","code_information":[{"code":"HC27220033","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":358.02,"maximum":358.02,"gross_charge":442,"discounted_cash":130.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":358.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":358.02,"methodology":"fee schedule"}]}]},{"description":"NDL BIO ACT2011 TEMNO A.C.T.","code_information":[{"code":"HC27220033","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":66.3,"maximum":358.02,"gross_charge":442,"discounted_cash":130.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":358.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":358.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.4,"methodology":"fee schedule"}]}]},{"description":"KYPHO FRACTURE KIT 080-101-800","code_information":[{"code":"HC27220034","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":2027.03,"maximum":2027.03,"gross_charge":2502.5,"discounted_cash":740.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2027.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2027.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2027.03,"methodology":"fee schedule"}]}]},{"description":"KYPHO FRACTURE KIT 080-101-800","code_information":[{"code":"HC27220034","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":375.38,"maximum":2027.03,"gross_charge":2502.5,"discounted_cash":740.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2027.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2027.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2027.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":375.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":500.5,"methodology":"fee schedule"}]}]},{"description":"PWRWAND XL MAX KT 10CM 94107","code_information":[{"code":"HC27220037","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":349.92,"maximum":349.92,"gross_charge":432,"discounted_cash":127.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.92,"methodology":"fee schedule"}]}]},{"description":"PWRWAND XL MAX KT 10CM 94107","code_information":[{"code":"HC27220037","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":64.8,"maximum":349.92,"gross_charge":432,"discounted_cash":127.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":349.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"}]}]},{"description":"TRANSCRANIAL PACK NA-DSP2PK","code_information":[{"code":"HC27220041","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":397.71,"maximum":397.71,"gross_charge":491,"discounted_cash":145.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.71,"methodology":"fee schedule"}]}]},{"description":"TRANSCRANIAL PACK NA-DSP2PK","code_information":[{"code":"HC27220041","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":73.65,"maximum":397.71,"gross_charge":491,"discounted_cash":145.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.2,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BX 20GX20CM ACT2020","code_information":[{"code":"HC27220043","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":82.62,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"}]}]},{"description":"NEEDLE BX 20GX20CM ACT2020","code_information":[{"code":"HC27220043","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":15.3,"maximum":82.62,"gross_charge":102,"discounted_cash":30.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"}]}]},{"description":"NEEDLE 22G 2225-20-B","code_information":[{"code":"HC27220052","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":315.9,"maximum":315.9,"gross_charge":390,"discounted_cash":115.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.9,"methodology":"fee schedule"}]}]},{"description":"NEEDLE 22G 2225-20-B","code_information":[{"code":"HC27220052","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":58.5,"maximum":315.9,"gross_charge":390,"discounted_cash":115.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78,"methodology":"fee schedule"}]}]},{"description":"TUBE MCLEAN 9.L5FX130 G02647","code_information":[{"code":"HC27220068","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":160.38,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"}]}]},{"description":"TUBE MCLEAN 9.L5FX130 G02647","code_information":[{"code":"HC27220068","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":29.7,"maximum":160.38,"gross_charge":198,"discounted_cash":58.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"}]}]},{"description":"RBY LOW PROFILE HANDLE RLPH1","code_information":[{"code":"HC27220072","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":578.34,"maximum":578.34,"gross_charge":714,"discounted_cash":211.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.34,"methodology":"fee schedule"}]}]},{"description":"RBY LOW PROFILE HANDLE RLPH1","code_information":[{"code":"HC27220072","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":107.1,"maximum":578.34,"gross_charge":714,"discounted_cash":211.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.8,"methodology":"fee schedule"}]}]},{"description":"BLLN AVAFLEX 11G 20MM","code_information":[{"code":"HC27220102","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":5473.17,"maximum":5473.17,"gross_charge":6757,"discounted_cash":2000.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5473.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5473.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5473.17,"methodology":"fee schedule"}]}]},{"description":"BLLN AVAFLEX 11G 20MM","code_information":[{"code":"HC27220102","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1013.55,"maximum":5473.17,"gross_charge":6757,"discounted_cash":2000.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5473.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5473.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5473.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1283.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1351.4,"methodology":"fee schedule"}]}]},{"description":"KIT CATH PWG 20GX10CM ST020100","code_information":[{"code":"HC27220122","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":240.57,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"}]}]},{"description":"KIT CATH PWG 20GX10CM ST020100","code_information":[{"code":"HC27220122","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.4,"methodology":"fee schedule"}]}]},{"description":"14FR JTUBE 8200-14","code_information":[{"code":"HC27220126","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":312.66,"maximum":312.66,"gross_charge":386,"discounted_cash":114.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.66,"methodology":"fee schedule"}]}]},{"description":"14FR JTUBE 8200-14","code_information":[{"code":"HC27220126","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":57.9,"maximum":312.66,"gross_charge":386,"discounted_cash":114.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.2,"methodology":"fee schedule"}]}]},{"description":"16FR TB FDG MIC 8100-16LV","code_information":[{"code":"HC27220129","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":73.71,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"}]}]},{"description":"16FR TB FDG MIC 8100-16LV","code_information":[{"code":"HC27220129","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.65,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"}]}]},{"description":"22FR TB GAST JEJUN 8250-22","code_information":[{"code":"HC27220134","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":537.84,"maximum":537.84,"gross_charge":664,"discounted_cash":196.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":537.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":537.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":537.84,"methodology":"fee schedule"}]}]},{"description":"22FR TB GAST JEJUN 8250-22","code_information":[{"code":"HC27220134","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":99.6,"maximum":537.84,"gross_charge":664,"discounted_cash":196.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":537.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":537.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":537.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.8,"methodology":"fee schedule"}]}]},{"description":"NEEDLE CO-AXIAL 360-1080-03","code_information":[{"code":"HC27220141","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":154.71,"maximum":154.71,"gross_charge":191,"discounted_cash":56.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.71,"methodology":"fee schedule"}]}]},{"description":"NEEDLE CO-AXIAL 360-1080-03","code_information":[{"code":"HC27220141","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.65,"maximum":154.71,"gross_charge":191,"discounted_cash":56.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"}]}]},{"description":"SIMPLUS FULL FACE 400477SL","code_information":[{"code":"HC27220146","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"SIMPLUS FULL FACE 400477SL","code_information":[{"code":"HC27220146","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":9,"maximum":48.6,"gross_charge":60,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"PARTICLE EMB 2ML S620GH","code_information":[{"code":"HC27221232","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":583.2,"maximum":583.2,"gross_charge":720,"discounted_cash":213.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":583.2,"methodology":"fee schedule"}]}]},{"description":"PARTICLE EMB 2ML S620GH","code_information":[{"code":"HC27221232","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":108,"maximum":583.2,"gross_charge":720,"discounted_cash":213.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":583.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":144,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":144,"methodology":"fee schedule"}]}]},{"description":"HC TB INJ TRANSFER 0909400500","code_information":[{"code":"HC27221371","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":146.61,"maximum":146.61,"gross_charge":181,"discounted_cash":53.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.61,"methodology":"fee schedule"}]}]},{"description":"HC TB INJ TRANSFER 0909400500","code_information":[{"code":"HC27221371","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.15,"maximum":146.61,"gross_charge":181,"discounted_cash":53.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"}]}]},{"description":"HC TB INJ TRANSFER 0909400400","code_information":[{"code":"HC27221372","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":330.48,"maximum":330.48,"gross_charge":408,"discounted_cash":120.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.48,"methodology":"fee schedule"}]}]},{"description":"HC TB INJ TRANSFER 0909400400","code_information":[{"code":"HC27221372","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":61.2,"maximum":330.48,"gross_charge":408,"discounted_cash":120.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.6,"methodology":"fee schedule"}]}]},{"description":"LANTERN45 PXSLIMLAN150T45","code_information":[{"code":"HC27221379","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1385.91,"maximum":1385.91,"gross_charge":1711,"discounted_cash":506.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1385.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1385.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1385.91,"methodology":"fee schedule"}]}]},{"description":"LANTERN45 PXSLIMLAN150T45","code_information":[{"code":"HC27221379","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":256.65,"maximum":1385.91,"gross_charge":1711,"discounted_cash":506.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1385.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1385.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1385.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.2,"methodology":"fee schedule"}]}]},{"description":"CONCERTO NV-6-20-HELIX","code_information":[{"code":"HC27221383","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":1351.08,"maximum":1351.08,"gross_charge":1668,"discounted_cash":493.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1351.08,"methodology":"fee schedule"}]}]},{"description":"CONCERTO NV-6-20-HELIX","code_information":[{"code":"HC27221383","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":250.2,"maximum":1351.08,"gross_charge":1668,"discounted_cash":493.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1351.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.6,"methodology":"fee schedule"}]}]},{"description":"CATH ASP INDIGO LITNFHT80H1","code_information":[{"code":"HC27221404","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21104.55,"maximum":21104.55,"gross_charge":26055,"discounted_cash":7712.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21104.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21104.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21104.55,"methodology":"fee schedule"}]}]},{"description":"CATH ASP INDIGO LITNFHT80H1","code_information":[{"code":"HC27221404","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":3908.25,"maximum":21104.55,"gross_charge":26055,"discounted_cash":7712.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21104.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21104.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21104.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4950.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5211,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3908.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5211,"methodology":"fee schedule"}]}]},{"description":"HC SUPPLY SHELL 278 NO HCPCS","code_information":[{"code":"HC27807000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":48.6,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"}]}]},{"description":"HC SUPPLY SHELL 278 NO HCPCS","code_information":[{"code":"HC27807000","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":12.15,"maximum":65.61,"gross_charge":81,"discounted_cash":23.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"HC CEMENT KT PCD 0507-589-000","code_information":[{"code":"HC27807007","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":643.8,"maximum":869.13,"gross_charge":1073,"discounted_cash":317.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":869.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":869.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":869.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":697.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":751.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"}]}]},{"description":"HC CEMENT KT PCD 0507-589-000","code_information":[{"code":"HC27807007","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":160.95,"maximum":869.13,"gross_charge":1073,"discounted_cash":317.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":869.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":869.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":869.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":686.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":375.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":429.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":482.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":751.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":643.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.6,"methodology":"fee schedule"}]}]},{"description":"HC CEMENT PCD 0505-589-000","code_information":[{"code":"HC27807008","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":948,"maximum":1279.8,"gross_charge":1580,"discounted_cash":467.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1027,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":948,"methodology":"fee schedule"}]}]},{"description":"HC CEMENT PCD 0505-589-000","code_information":[{"code":"HC27807008","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":237,"maximum":1279.8,"gross_charge":1580,"discounted_cash":467.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":553,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":632,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":711,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1106,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":948,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":300.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":316,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":237,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":316,"methodology":"fee schedule"}]}]},{"description":"HC COIL 400 2MMX2CM RBY4C0202","code_information":[{"code":"HC27807010","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1279.8,"maximum":1727.73,"gross_charge":2133,"discounted_cash":631.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1727.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1727.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1727.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1386.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1493.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1279.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL 400 2MMX2CM RBY4C0202","code_information":[{"code":"HC27807010","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":319.95,"maximum":1727.73,"gross_charge":2133,"discounted_cash":631.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1727.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1727.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1727.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1365.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":746.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":853.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":959.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1493.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1279.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL 400 4MMX10CM RBY2C0410","code_information":[{"code":"HC27807011","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1587.6,"maximum":2143.26,"gross_charge":2646,"discounted_cash":783.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2143.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2143.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2143.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1719.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1852.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1587.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL 400 4MMX10CM RBY2C0410","code_information":[{"code":"HC27807011","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":396.9,"maximum":2143.26,"gross_charge":2646,"discounted_cash":783.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2143.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2143.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2143.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1693.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":926.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1058.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1190.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1852.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1587.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":502.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL PACK RUBY 5CM RBYPODJ5","code_information":[{"code":"HC27807014","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1603.8,"maximum":2165.13,"gross_charge":2673,"discounted_cash":791.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2165.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2165.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2165.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1737.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1871.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1603.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL PACK RUBY 5CM RBYPODJ5","code_information":[{"code":"HC27807014","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":400.95,"maximum":2165.13,"gross_charge":2673,"discounted_cash":791.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2165.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2165.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2165.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1710.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":935.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1069.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1202.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1871.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1603.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":507.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL .038 8CM 8M G20546","code_information":[{"code":"HC27807015","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":144,"maximum":194.4,"gross_charge":240,"discounted_cash":71.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":168,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144,"methodology":"fee schedule"}]}]},{"description":"HC COIL .038 8CM 8M G20546","code_information":[{"code":"HC27807015","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":36,"maximum":194.4,"gross_charge":240,"discounted_cash":71.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":194.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":153.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":108,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":168,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":144,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"}]}]},{"description":"HC COIL 4X14 NESTER G26993","code_information":[{"code":"HC27807019","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":192.6,"maximum":260.01,"gross_charge":321,"discounted_cash":95.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":208.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":224.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL 4X14 NESTER G26993","code_information":[{"code":"HC27807019","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":48.15,"maximum":260.01,"gross_charge":321,"discounted_cash":95.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":205.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":112.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":128.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":144.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":224.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR 18D FRAM 45-680820","code_information":[{"code":"HC27807027","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1214.4,"maximum":1639.44,"gross_charge":2024,"discounted_cash":599.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1639.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1639.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1639.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1315.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1416.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1214.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR 18D FRAM 45-680820","code_information":[{"code":"HC27807027","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":303.6,"maximum":1639.44,"gross_charge":2024,"discounted_cash":599.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1639.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1639.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1639.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1295.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":708.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":809.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":910.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1416.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1214.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR CX DET 45-780516","code_information":[{"code":"HC27807028","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1215,"maximum":1640.25,"gross_charge":2025,"discounted_cash":599.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1316.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1417.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1215,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR CX DET 45-780516","code_information":[{"code":"HC27807028","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":303.75,"maximum":1640.25,"gross_charge":2025,"discounted_cash":599.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1640.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1296,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":708.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":810,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":911.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1417.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1215,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":405,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":405,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR DET 45-481530","code_information":[{"code":"HC27807035","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1605.6,"maximum":2167.56,"gross_charge":2676,"discounted_cash":792.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2167.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2167.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2167.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1739.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1873.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1605.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR DET 45-481530","code_information":[{"code":"HC27807035","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":401.4,"maximum":2167.56,"gross_charge":2676,"discounted_cash":792.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2167.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2167.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2167.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1712.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":936.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1070.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1204.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1873.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1605.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":508.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":535.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":535.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR FRAM 45-681434","code_information":[{"code":"HC27807039","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1282.2,"maximum":1730.97,"gross_charge":2137,"discounted_cash":632.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1730.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1730.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1730.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1389.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1495.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1282.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR FRAM 45-681434","code_information":[{"code":"HC27807039","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":320.55,"maximum":1730.97,"gross_charge":2137,"discounted_cash":632.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1730.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1730.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1730.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1367.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":747.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":854.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":961.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1495.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1282.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR FRAMING 45-680820","code_information":[{"code":"HC27807040","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1147.2,"maximum":1548.72,"gross_charge":1912,"discounted_cash":565.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1548.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1548.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1548.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1242.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1147.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL AZUR FRAMING 45-680820","code_information":[{"code":"HC27807040","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":286.8,"maximum":1548.72,"gross_charge":1912,"discounted_cash":565.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1548.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1548.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1548.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1223.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":669.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":764.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":860.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1338.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1147.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":363.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB DET 45-480505","code_information":[{"code":"HC27807041","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1187.4,"maximum":1602.99,"gross_charge":1979,"discounted_cash":585.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1602.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1602.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1602.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1286.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1385.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1187.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB DET 45-480505","code_information":[{"code":"HC27807041","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":296.85,"maximum":1602.99,"gross_charge":1979,"discounted_cash":585.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1602.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1602.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1602.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1266.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":692.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":791.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":890.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1385.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1187.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB G01308","code_information":[{"code":"HC27807043","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":83.4,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB G01308","code_information":[{"code":"HC27807043","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":20.85,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB G09215","code_information":[{"code":"HC27807044","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":132.6,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":143.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":154.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":132.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB G09215","code_information":[{"code":"HC27807044","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":141.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":77.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":88.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":99.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":154.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":132.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB HEL 3MMX6CM 36-150","code_information":[{"code":"HC27807049","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":693.6,"maximum":936.36,"gross_charge":1156,"discounted_cash":342.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":936.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":936.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":936.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":751.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":809.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":693.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB HEL 3MMX6CM 36-150","code_information":[{"code":"HC27807049","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":173.4,"maximum":936.36,"gross_charge":1156,"discounted_cash":342.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":936.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":936.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":936.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":739.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":404.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":462.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":520.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":809.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":693.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB MICESTER G26987","code_information":[{"code":"HC27807050","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":147.6,"maximum":199.26,"gross_charge":246,"discounted_cash":72.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":159.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":172.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMB MICESTER G26987","code_information":[{"code":"HC27807050","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":36.9,"maximum":199.26,"gross_charge":246,"discounted_cash":72.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":199.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":157.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":86.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":98.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":110.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":172.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMBOLIZ HILAL G04619","code_information":[{"code":"HC27807051","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":76.8,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMBOLIZ HILAL G04619","code_information":[{"code":"HC27807051","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":19.2,"maximum":103.68,"gross_charge":128,"discounted_cash":37.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMBOLIZAT HILAT G04622","code_information":[{"code":"HC27807054","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":72,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMBOLIZAT HILAT G04622","code_information":[{"code":"HC27807054","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":18,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMBOLIZATION G01836","code_information":[{"code":"HC27807058","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":103.2,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":111.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL EMBOLIZATION G01836","code_information":[{"code":"HC27807058","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":25.8,"maximum":139.32,"gross_charge":172,"discounted_cash":50.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL OCCL SPRING G01184","code_information":[{"code":"HC27807059","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":52.8,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL OCCL SPRING G01184","code_information":[{"code":"HC27807059","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":13.2,"maximum":71.28,"gross_charge":88,"discounted_cash":26.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL PACK J-SFT RBYP0DJ30","code_information":[{"code":"HC27807063","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2089.8,"maximum":2821.23,"gross_charge":3483,"discounted_cash":1030.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2821.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2821.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2821.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2263.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2438.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2089.8,"methodology":"fee schedule"}]}]},{"description":"HC COIL PACK J-SFT RBYP0DJ30","code_information":[{"code":"HC27807063","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":522.45,"maximum":2821.23,"gross_charge":3483,"discounted_cash":1030.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2821.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2821.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2821.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2229.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1219.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1393.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1567.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2438.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2089.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":661.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":522.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":696.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL TORNADO G10411","code_information":[{"code":"HC27807066","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":202.2,"maximum":272.97,"gross_charge":337,"discounted_cash":99.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":235.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.2,"methodology":"fee schedule"}]}]},{"description":"HC COIL TORNADO G10411","code_information":[{"code":"HC27807066","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":50.55,"maximum":272.97,"gross_charge":337,"discounted_cash":99.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":215.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":117.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":134.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":151.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":235.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.4,"methodology":"fee schedule"}]}]},{"description":"HC COIL VORTES DIAMOND 382205","code_information":[{"code":"HC27807067","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":150.6,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":163.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":175.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"}]}]},{"description":"HC COIL VORTES DIAMOND 382205","code_information":[{"code":"HC27807067","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":37.65,"maximum":203.31,"gross_charge":251,"discounted_cash":74.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":175.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"}]}]},{"description":"HC EMB AZUR FRAMING 45-682050","code_information":[{"code":"HC27807068","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1349.4,"maximum":1821.69,"gross_charge":2249,"discounted_cash":665.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1821.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1821.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1821.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1461.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1574.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1349.4,"methodology":"fee schedule"}]}]},{"description":"HC EMB AZUR FRAMING 45-682050","code_information":[{"code":"HC27807068","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":337.35,"maximum":1821.69,"gross_charge":2249,"discounted_cash":665.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1821.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1821.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1821.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1439.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":899.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1012.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1574.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1349.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":449.8,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS 35D AZUR 45-450410","code_information":[{"code":"HC27807070","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1801.8,"maximum":2432.43,"gross_charge":3003,"discounted_cash":888.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1951.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2102.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1801.8,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS 35D AZUR 45-450410","code_information":[{"code":"HC27807070","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":450.45,"maximum":2432.43,"gross_charge":3003,"discounted_cash":888.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1921.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1051.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1201.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1351.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2102.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":570.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":600.6,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS 35D AZUR 45-450615","code_information":[{"code":"HC27807072","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1940.4,"maximum":2619.54,"gross_charge":3234,"discounted_cash":957.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2102.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2263.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1940.4,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS 35D AZUR 45-450615","code_information":[{"code":"HC27807072","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":485.1,"maximum":2619.54,"gross_charge":3234,"discounted_cash":957.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2619.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2069.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1131.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1293.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1455.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2263.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1940.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":485.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.8,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS 35D AZUR 45-751019","code_information":[{"code":"HC27807073","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1860,"maximum":2511,"gross_charge":3100,"discounted_cash":917.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2015,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2170,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1860,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS 35D AZUR 45-751019","code_information":[{"code":"HC27807073","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":465,"maximum":2511,"gross_charge":3100,"discounted_cash":917.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2511,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1984,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1085,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1240,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1395,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2170,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1860,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":589,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":620,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":465,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":620,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR 45-450405","code_information":[{"code":"HC27807076","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1663.2,"maximum":2245.32,"gross_charge":2772,"discounted_cash":820.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1801.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1940.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1663.2,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR 45-450405","code_information":[{"code":"HC27807076","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":415.8,"maximum":2245.32,"gross_charge":2772,"discounted_cash":820.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1774.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":970.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1108.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1247.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1940.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1663.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.4,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DET 45-480415","code_information":[{"code":"HC27807089","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1357.2,"maximum":1832.22,"gross_charge":2262,"discounted_cash":669.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1832.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1470.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1583.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1357.2,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DET 45-480415","code_information":[{"code":"HC27807089","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":339.3,"maximum":1832.22,"gross_charge":2262,"discounted_cash":669.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1832.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1832.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1832.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1447.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":791.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":904.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1017.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1583.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1357.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.4,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DET 45-480610","code_information":[{"code":"HC27807090","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1266.6,"maximum":1709.91,"gross_charge":2111,"discounted_cash":624.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1709.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1709.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1709.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1372.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1477.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1266.6,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DET 45-480610","code_information":[{"code":"HC27807090","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":316.65,"maximum":1709.91,"gross_charge":2111,"discounted_cash":624.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1709.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1709.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1709.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1351.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":738.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":844.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":949.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1477.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1266.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.2,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DET 45-480810","code_information":[{"code":"HC27807091","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1268.4,"maximum":1712.34,"gross_charge":2114,"discounted_cash":625.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1712.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1712.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1712.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1374.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1479.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1268.4,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DET 45-480810","code_information":[{"code":"HC27807091","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":317.1,"maximum":1712.34,"gross_charge":2114,"discounted_cash":625.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1712.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1712.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1712.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1352.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":739.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":845.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":951.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1479.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1268.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":401.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":422.8,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DETACH 45-480620","code_information":[{"code":"HC27807095","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1432.2,"maximum":1933.47,"gross_charge":2387,"discounted_cash":706.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1933.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1933.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1551.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1670.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1432.2,"methodology":"fee schedule"}]}]},{"description":"HC EMB SYS AZUR DETACH 45-480620","code_information":[{"code":"HC27807095","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":358.05,"maximum":1933.47,"gross_charge":2387,"discounted_cash":706.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1933.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1933.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1933.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1527.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":835.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":954.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1074.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1670.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1432.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":358.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":477.4,"methodology":"fee schedule"}]}]},{"description":"HC PLUG FISTULA G23654","code_information":[{"code":"HC27807110","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":5508,"maximum":7435.8,"gross_charge":9180,"discounted_cash":2717.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7435.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7435.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7435.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5967,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6426,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5508,"methodology":"fee schedule"}]}]},{"description":"HC PLUG FISTULA G23654","code_information":[{"code":"HC27807110","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1377,"maximum":7435.8,"gross_charge":9180,"discounted_cash":2717.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7435.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7435.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7435.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5875.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3213,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3672,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4131,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6426,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5508,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1744.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1836,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1377,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1836,"methodology":"fee schedule"}]}]},{"description":"HC SET TRANSJUGULAR IN G36126","code_information":[{"code":"HC27807112","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1053,"maximum":1421.55,"gross_charge":1755,"discounted_cash":519.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1421.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1421.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1421.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1140.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1228.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1053,"methodology":"fee schedule"}]}]},{"description":"HC SET TRANSJUGULAR IN G36126","code_information":[{"code":"HC27807112","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":263.25,"maximum":1421.55,"gross_charge":1755,"discounted_cash":519.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1421.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1421.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1421.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":614.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":702,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":789.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1228.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1053,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":333.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":351,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":351,"methodology":"fee schedule"}]}]},{"description":"BEAD 300-500 LBL CHEMO VE420GS","code_information":[{"code":"HC27820003","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1600.2,"maximum":2160.27,"gross_charge":2667,"discounted_cash":789.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2160.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2160.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2160.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1733.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1866.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1600.2,"methodology":"fee schedule"}]}]},{"description":"BEAD 300-500 LBL CHEMO VE420GS","code_information":[{"code":"HC27820003","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":400.05,"maximum":2160.27,"gross_charge":2667,"discounted_cash":789.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2160.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2160.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2160.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1706.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":933.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1066.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1200.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1866.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1600.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":400.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.4,"methodology":"fee schedule"}]}]},{"description":"EMBOSPH MICROSPH 5ML V820GH","code_information":[{"code":"HC27820152","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":441,"maximum":595.35,"gross_charge":735,"discounted_cash":217.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":595.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":595.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":595.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":477.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":514.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":441,"methodology":"fee schedule"}]}]},{"description":"EMBOSPH MICROSPH 5ML V820GH","code_information":[{"code":"HC27820152","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":110.25,"maximum":595.35,"gross_charge":735,"discounted_cash":217.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":595.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":595.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":595.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":470.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":257.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":294,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":330.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":514.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":441,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":147,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":147,"methodology":"fee schedule"}]}]},{"description":"COIL TORNADO .018IN 3X2 G47416","code_information":[{"code":"HC27820153","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":196.2,"maximum":264.87,"gross_charge":327,"discounted_cash":96.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":212.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":228.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"}]}]},{"description":"COIL TORNADO .018IN 3X2 G47416","code_information":[{"code":"HC27820153","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":49.05,"maximum":264.87,"gross_charge":327,"discounted_cash":96.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":264.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":209.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":114.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":130.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":147.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":228.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.4,"methodology":"fee schedule"}]}]},{"description":"COIL HILAL .018IN 0.5CM G47498","code_information":[{"code":"HC27820156","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":178.2,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":207.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.2,"methodology":"fee schedule"}]}]},{"description":"COIL HILAL .018IN 0.5CM G47498","code_information":[{"code":"HC27820156","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":44.55,"maximum":240.57,"gross_charge":297,"discounted_cash":87.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":240.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":190.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":103.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":118.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":207.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":178.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.4,"methodology":"fee schedule"}]}]},{"description":"JEJUNAL FEEDING TUBE 8200-14","code_information":[{"code":"HC27820158","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":229.32,"maximum":309.59,"gross_charge":382.2,"discounted_cash":113.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":309.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":309.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":309.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":248.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":267.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.32,"methodology":"fee schedule"}]}]},{"description":"JEJUNAL FEEDING TUBE 8200-14","code_information":[{"code":"HC27820158","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":57.33,"maximum":309.59,"gross_charge":382.2,"discounted_cash":113.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":309.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":309.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":309.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":244.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":133.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":152.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":171.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":267.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.44,"methodology":"fee schedule"}]}]},{"description":"GASTRIC FEEDING TUBE 8100-14LV","code_information":[{"code":"HC27820161","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":54.6,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"}]}]},{"description":"GASTRIC FEEDING TUBE 8100-14LV","code_information":[{"code":"HC27820161","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":13.65,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"}]}]},{"description":"GASTRIC FEEDING TUBE 8100-26","code_information":[{"code":"HC27820166","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":37.8,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"}]}]},{"description":"GASTRIC FEEDING TUBE 8100-26","code_information":[{"code":"HC27820166","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":9.45,"maximum":51.03,"gross_charge":63,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"GASTRIC JEJUNAL GI TUB 8250-18","code_information":[{"code":"HC27820169","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":394.8,"maximum":532.98,"gross_charge":658,"discounted_cash":194.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":427.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":460.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"}]}]},{"description":"GASTRIC JEJUNAL GI TUB 8250-18","code_information":[{"code":"HC27820169","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":98.7,"maximum":532.98,"gross_charge":658,"discounted_cash":194.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":532.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":421.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":230.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":263.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":296.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":460.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"}]}]},{"description":"ACC W/O ANTI-REFLX VALV INS8400","code_information":[{"code":"HC27822018","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":365.4,"maximum":493.29,"gross_charge":609,"discounted_cash":180.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":395.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":426.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":365.4,"methodology":"fee schedule"}]}]},{"description":"ACC W/O ANTI-REFLX VALV INS8400","code_information":[{"code":"HC27822018","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":91.35,"maximum":493.29,"gross_charge":609,"discounted_cash":180.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":493.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":389.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":213.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":243.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":274.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":426.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":365.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.8,"methodology":"fee schedule"}]}]},{"description":"RBY COIL STD 28X60 RBY2C2860","code_information":[{"code":"HC27822019","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2025,"maximum":2733.75,"gross_charge":3375,"discounted_cash":999,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2733.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2733.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2733.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2193.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2362.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2025,"methodology":"fee schedule"}]}]},{"description":"RBY COIL STD 28X60 RBY2C2860","code_information":[{"code":"HC27822019","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":506.25,"maximum":2733.75,"gross_charge":3375,"discounted_cash":999,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2733.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2733.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2733.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2160,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1181.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1350,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1518.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2362.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":675,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":506.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":675,"methodology":"fee schedule"}]}]},{"description":"RBY COIL STD 3X20 RBY2C0320","code_information":[{"code":"HC27822023","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":1539,"maximum":2077.65,"gross_charge":2565,"discounted_cash":759.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2077.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2077.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2077.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1667.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1795.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1539,"methodology":"fee schedule"}]}]},{"description":"RBY COIL STD 3X20 RBY2C0320","code_information":[{"code":"HC27822023","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":384.75,"maximum":2077.65,"gross_charge":2565,"discounted_cash":759.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2077.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2077.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2077.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1641.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":897.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1026,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1154.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1795.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1539,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":487.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":513,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":384.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":513,"methodology":"fee schedule"}]}]},{"description":"RBY COIL SFT 4X6 RBY4C0406","code_information":[{"code":"HC27822038","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2737.8,"maximum":3696.03,"gross_charge":4563,"discounted_cash":1350.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3696.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3696.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3696.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3194.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2737.8,"methodology":"fee schedule"}]}]},{"description":"RBY COIL SFT 4X6 RBY4C0406","code_information":[{"code":"HC27822038","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":684.45,"maximum":3696.03,"gross_charge":4563,"discounted_cash":1350.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3696.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3696.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3696.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2920.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1597.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1825.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2053.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3194.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2737.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":866.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":912.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":684.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":912.6,"methodology":"fee schedule"}]}]},{"description":"RBY COIL RBYLP0430","code_information":[{"code":"HC27822067","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":2073.6,"maximum":2799.36,"gross_charge":3456,"discounted_cash":1022.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2246.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2073.6,"methodology":"fee schedule"}]}]},{"description":"RBY COIL RBYLP0430","code_information":[{"code":"HC27822067","type":"CDM"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":518.4,"maximum":2799.36,"gross_charge":3456,"discounted_cash":1022.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2799.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2211.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1209.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1382.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1555.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2419.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2073.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.2,"methodology":"fee schedule"}]}]},{"description":"HC DRUG SCREEN COLL HIX (CLIENT)","code_information":[{"code":"HC30100477","type":"CDM"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":73.71,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"}]}]},{"description":"HC DRUG SCREEN COLL HIX (CLIENT)","code_information":[{"code":"HC30100477","type":"CDM"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":13.65,"maximum":73.71,"gross_charge":91,"discounted_cash":26.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"}]}]},{"description":"HC DRUG SCREEN NORTHPARK CLIENT","code_information":[{"code":"HC30100478","type":"CDM"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":118.26,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"}]}]},{"description":"HC DRUG SCREEN NORTHPARK CLIENT","code_information":[{"code":"HC30100478","type":"CDM"},{"code":"0301","type":"RC"}],"standard_charges":[{"minimum":21.9,"maximum":118.26,"gross_charge":146,"discounted_cash":43.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.2,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 1 PER MIN","code_information":[{"code":"HC3600000001","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":87.48,"maximum":87.48,"gross_charge":108,"discounted_cash":31.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 1 PER MIN","code_information":[{"code":"HC3600000001","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":5079,"gross_charge":108,"discounted_cash":31.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.6,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 2 PER MIN","code_information":[{"code":"HC3600000002","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":95.58,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 2 PER MIN","code_information":[{"code":"HC3600000002","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":17.7,"maximum":5079,"gross_charge":118,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 3 PER MIN","code_information":[{"code":"HC3600000003","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":108.54,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 3 PER MIN","code_information":[{"code":"HC3600000003","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":20.1,"maximum":5079,"gross_charge":134,"discounted_cash":39.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 4 PER MIN","code_information":[{"code":"HC3600000004","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":135.27,"maximum":135.27,"gross_charge":167,"discounted_cash":49.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 4 PER MIN","code_information":[{"code":"HC3600000004","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":25.05,"maximum":5079,"gross_charge":167,"discounted_cash":49.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.4,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 5 PER MIN","code_information":[{"code":"HC3600000005","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":179.01,"maximum":179.01,"gross_charge":221,"discounted_cash":65.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 5 PER MIN","code_information":[{"code":"HC3600000005","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":5079,"gross_charge":221,"discounted_cash":65.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 6 PER MIN","code_information":[{"code":"HC3600000006","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":191.97,"maximum":191.97,"gross_charge":237,"discounted_cash":70.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.97,"methodology":"fee schedule"}]}]},{"description":"HC SURGERY LEVEL 6 PER MIN","code_information":[{"code":"HC3600000006","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":35.55,"maximum":5079,"gross_charge":237,"discounted_cash":70.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"}]}]},{"description":"HC STIMULATION LUMBAR CORD TRIAL","code_information":[{"code":"HC36000088","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3976.29,"maximum":3976.29,"gross_charge":4909,"discounted_cash":1453.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3976.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3976.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3976.29,"methodology":"fee schedule"}]}]},{"description":"HC STIMULATION LUMBAR CORD TRIAL","code_information":[{"code":"HC36000088","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":736.35,"maximum":5079,"gross_charge":4909,"discounted_cash":1453.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3976.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3976.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3976.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":981.8,"methodology":"fee schedule"}]}]},{"description":"HC CENTRAL LINE INSERT-NON SURG","code_information":[{"code":"HC36000091","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2044.44,"maximum":2044.44,"gross_charge":2524,"discounted_cash":747.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2044.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2044.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2044.44,"methodology":"fee schedule"}]}]},{"description":"HC CENTRAL LINE INSERT-NON SURG","code_information":[{"code":"HC36000091","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":378.6,"maximum":5079,"gross_charge":2524,"discounted_cash":747.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2044.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2044.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2044.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":479.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.8,"methodology":"fee schedule"}]}]},{"description":"HC EPIDURAL BLOOD PATCH PM","code_information":[{"code":"HC36000092","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2250.18,"maximum":2250.18,"gross_charge":2778,"discounted_cash":822.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2250.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2250.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2250.18,"methodology":"fee schedule"}]}]},{"description":"HC EPIDURAL BLOOD PATCH PM","code_information":[{"code":"HC36000092","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":416.7,"maximum":5079,"gross_charge":2778,"discounted_cash":822.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2250.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2250.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2250.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.6,"methodology":"fee schedule"}]}]},{"description":"HC LUMBAR PUNCTURE THERAPEUTIC","code_information":[{"code":"HC36000093","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1993.41,"maximum":1993.41,"gross_charge":2461,"discounted_cash":728.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1993.41,"methodology":"fee schedule"}]}]},{"description":"HC LUMBAR PUNCTURE THERAPEUTIC","code_information":[{"code":"HC36000093","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":369.15,"maximum":5079,"gross_charge":2461,"discounted_cash":728.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.2,"methodology":"fee schedule"}]}]},{"description":"HC LUMBAR PUNCTURE DIAGNOSTIC","code_information":[{"code":"HC36000094","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2125.44,"maximum":2125.44,"gross_charge":2624,"discounted_cash":776.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2125.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2125.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2125.44,"methodology":"fee schedule"}]}]},{"description":"HC LUMBAR PUNCTURE DIAGNOSTIC","code_information":[{"code":"HC36000094","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":393.6,"maximum":5079,"gross_charge":2624,"discounted_cash":776.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2125.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2125.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2125.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":498.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":393.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.8,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL CENTRAL LINE (PREOP)","code_information":[{"code":"HC36000095","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2888.46,"maximum":2888.46,"gross_charge":3566,"discounted_cash":1055.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2888.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2888.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2888.46,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL CENTRAL LINE (PREOP)","code_information":[{"code":"HC36000095","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":534.9,"maximum":5079,"gross_charge":3566,"discounted_cash":1055.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2888.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2888.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2888.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.2,"methodology":"fee schedule"}]}]},{"description":"HC I&D ABSCSIMPLE FLANK PREOP","code_information":[{"code":"HC36000096","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":601.83,"maximum":601.83,"gross_charge":743,"discounted_cash":219.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.83,"methodology":"fee schedule"}]}]},{"description":"HC I&D ABSCSIMPLE FLANK PREOP","code_information":[{"code":"HC36000096","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":111.45,"maximum":5079,"gross_charge":743,"discounted_cash":219.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":601.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.6,"methodology":"fee schedule"}]}]},{"description":"HC CAPSULOTOMY YAG LASER -66830","code_information":[{"code":"HC36000097","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":7959.06,"maximum":7959.06,"gross_charge":9826,"discounted_cash":2908.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7959.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7959.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7959.06,"methodology":"fee schedule"}]}]},{"description":"HC CAPSULOTOMY YAG LASER -66830","code_information":[{"code":"HC36000097","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1473.9,"maximum":7959.06,"gross_charge":9826,"discounted_cash":2908.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7959.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7959.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7959.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1866.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1473.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1965.2,"methodology":"fee schedule"}]}]},{"description":"HC CAPSULOTOMY W/YAG LASER-66821","code_information":[{"code":"HC36000098","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2025,"maximum":2025,"gross_charge":2500,"discounted_cash":740,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2025,"methodology":"fee schedule"}]}]},{"description":"HC CAPSULOTOMY W/YAG LASER-66821","code_information":[{"code":"HC36000098","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":375,"maximum":5079,"gross_charge":2500,"discounted_cash":740,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2025,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":475,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":500,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":375,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":500,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH/BIOPSY OF SKIN-11100","code_information":[{"code":"HC36000099","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1225.53,"maximum":1225.53,"gross_charge":1513,"discounted_cash":447.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1225.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1225.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1225.53,"methodology":"fee schedule"}]}]},{"description":"HC PUNCH/BIOPSY OF SKIN-11100","code_information":[{"code":"HC36000099","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":226.95,"maximum":5079,"gross_charge":1513,"discounted_cash":447.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1225.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1225.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1225.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.6,"methodology":"fee schedule"}]}]},{"description":"HC MANIPUL/OF KNEE/ANESTH-27570","code_information":[{"code":"HC36000103","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3021.3,"maximum":3021.3,"gross_charge":3730,"discounted_cash":1104.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3021.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3021.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3021.3,"methodology":"fee schedule"}]}]},{"description":"HC MANIPUL/OF KNEE/ANESTH-27570","code_information":[{"code":"HC36000103","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":559.5,"maximum":5079,"gross_charge":3730,"discounted_cash":1104.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3021.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3021.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3021.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":708.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":746,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":559.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":746,"methodology":"fee schedule"}]}]},{"description":"HC INTRA-ARTICULR INJECT-20610","code_information":[{"code":"HC36000104","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1015.74,"maximum":1015.74,"gross_charge":1254,"discounted_cash":371.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.74,"methodology":"fee schedule"}]}]},{"description":"HC INTRA-ARTICULR INJECT-20610","code_information":[{"code":"HC36000104","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":188.1,"maximum":5079,"gross_charge":1254,"discounted_cash":371.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK PUDENTAL NERVE PM","code_information":[{"code":"HC36000105","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2346.57,"maximum":2346.57,"gross_charge":2897,"discounted_cash":857.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2346.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2346.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2346.57,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK PUDENTAL NERVE PM","code_information":[{"code":"HC36000105","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":434.55,"maximum":5079,"gross_charge":2897,"discounted_cash":857.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2346.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2346.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2346.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":434.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.4,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK STELLATE GANG PM","code_information":[{"code":"HC36000106","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1006.02,"maximum":1006.02,"gross_charge":1242,"discounted_cash":367.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1006.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1006.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1006.02,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK STELLATE GANG PM","code_information":[{"code":"HC36000106","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":186.3,"maximum":5079,"gross_charge":1242,"discounted_cash":367.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1006.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1006.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1006.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.4,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK INTERCOSTAL PM","code_information":[{"code":"HC36000107","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1304.1,"maximum":1304.1,"gross_charge":1610,"discounted_cash":476.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1304.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1304.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1304.1,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK INTERCOSTAL PM","code_information":[{"code":"HC36000107","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":241.5,"maximum":5079,"gross_charge":1610,"discounted_cash":476.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1304.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1304.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1304.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":322,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":322,"methodology":"fee schedule"}]}]},{"description":"HC PERIFORMUS BLOCK PM","code_information":[{"code":"HC36000108","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1381.86,"maximum":1381.86,"gross_charge":1706,"discounted_cash":504.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1381.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1381.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1381.86,"methodology":"fee schedule"}]}]},{"description":"HC PERIFORMUS BLOCK PM","code_information":[{"code":"HC36000108","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":255.9,"maximum":5079,"gross_charge":1706,"discounted_cash":504.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1381.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1381.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1381.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":324.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.2,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK NERVE PM","code_information":[{"code":"HC36000109","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1383.48,"maximum":1383.48,"gross_charge":1708,"discounted_cash":505.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1383.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1383.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1383.48,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK NERVE PM","code_information":[{"code":"HC36000109","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":256.2,"maximum":5079,"gross_charge":1708,"discounted_cash":505.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1383.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1383.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1383.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":324.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":341.6,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CAUDAL INJECTION PM","code_information":[{"code":"HC36000111","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1615.14,"maximum":1615.14,"gross_charge":1994,"discounted_cash":590.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1615.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1615.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1615.14,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CAUDAL INJECTION PM","code_information":[{"code":"HC36000111","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":299.1,"maximum":5079,"gross_charge":1994,"discounted_cash":590.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1615.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1615.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1615.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.8,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CELIAC PLEXUS PM","code_information":[{"code":"HC36000112","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1221.48,"maximum":1221.48,"gross_charge":1508,"discounted_cash":446.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1221.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1221.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1221.48,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CELIAC PLEXUS PM","code_information":[{"code":"HC36000112","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":226.2,"maximum":5079,"gross_charge":1508,"discounted_cash":446.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1221.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1221.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1221.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.6,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK EPIDURAL DIFFERENTIAL PM","code_information":[{"code":"HC36000113","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1270.08,"maximum":1270.08,"gross_charge":1568,"discounted_cash":464.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1270.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1270.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1270.08,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK EPIDURAL DIFFERENTIAL PM","code_information":[{"code":"HC36000113","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":235.2,"maximum":5079,"gross_charge":1568,"discounted_cash":464.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1270.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1270.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1270.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.6,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK ILEO INGUINAL NERVE PM","code_information":[{"code":"HC36000114","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1058.67,"maximum":1058.67,"gross_charge":1307,"discounted_cash":386.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1058.67,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK ILEO INGUINAL NERVE PM","code_information":[{"code":"HC36000114","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":196.05,"maximum":5079,"gross_charge":1307,"discounted_cash":386.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1058.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.4,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK LUMBAR SYMPATHETIC PM","code_information":[{"code":"HC36000115","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1449.09,"maximum":1449.09,"gross_charge":1789,"discounted_cash":529.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1449.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1449.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1449.09,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK LUMBAR SYMPATHETIC PM","code_information":[{"code":"HC36000115","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":268.35,"maximum":5079,"gross_charge":1789,"discounted_cash":529.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1449.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1449.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1449.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":357.8,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CELIAC TRIAL PM","code_information":[{"code":"HC36000116","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1427.22,"maximum":1427.22,"gross_charge":1762,"discounted_cash":521.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1427.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1427.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1427.22,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CELIAC TRIAL PM","code_information":[{"code":"HC36000116","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":264.3,"maximum":5079,"gross_charge":1762,"discounted_cash":521.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1427.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1427.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1427.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":334.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.4,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK SEL NERVE ROOT PM","code_information":[{"code":"HC36000118","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1071.63,"maximum":1071.63,"gross_charge":1323,"discounted_cash":391.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1071.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1071.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1071.63,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK SEL NERVE ROOT PM","code_information":[{"code":"HC36000118","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":198.45,"maximum":5079,"gross_charge":1323,"discounted_cash":391.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1071.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1071.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1071.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.6,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK DIAG EPI PM","code_information":[{"code":"HC36000120","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1347.84,"maximum":1347.84,"gross_charge":1664,"discounted_cash":492.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1347.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1347.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1347.84,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK DIAG EPI PM","code_information":[{"code":"HC36000120","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":249.6,"maximum":5079,"gross_charge":1664,"discounted_cash":492.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1347.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1347.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1347.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.8,"methodology":"fee schedule"}]}]},{"description":"HC INJ LUMBAR EPID STEROID PM","code_information":[{"code":"HC36000126","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1751.22,"maximum":1751.22,"gross_charge":2162,"discounted_cash":639.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1751.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1751.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1751.22,"methodology":"fee schedule"}]}]},{"description":"HC INJ LUMBAR EPID STEROID PM","code_information":[{"code":"HC36000126","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":324.3,"maximum":5079,"gross_charge":2162,"discounted_cash":639.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1751.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1751.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1751.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":410.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":324.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":432.4,"methodology":"fee schedule"}]}]},{"description":"HC INJ SACRO-ILIAC JNT PM","code_information":[{"code":"HC36000127","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3048.03,"maximum":3048.03,"gross_charge":3763,"discounted_cash":1113.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3048.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3048.03,"methodology":"fee schedule"}]}]},{"description":"HC INJ SACRO-ILIAC JNT PM","code_information":[{"code":"HC36000127","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":564.45,"maximum":5079,"gross_charge":3763,"discounted_cash":1113.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3048.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3048.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3048.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":714.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":752.6,"methodology":"fee schedule"}]}]},{"description":"HC INSERTION DUPENN CATH PM","code_information":[{"code":"HC36000129","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":4121.28,"maximum":4121.28,"gross_charge":5088,"discounted_cash":1506.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4121.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4121.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4121.28,"methodology":"fee schedule"}]}]},{"description":"HC INSERTION DUPENN CATH PM","code_information":[{"code":"HC36000129","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":763.2,"maximum":5079,"gross_charge":5088,"discounted_cash":1506.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4121.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4121.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4121.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":763.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1017.6,"methodology":"fee schedule"}]}]},{"description":"HC SHOULDER INJECTION PM","code_information":[{"code":"HC36000136","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":574.29,"maximum":574.29,"gross_charge":709,"discounted_cash":209.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.29,"methodology":"fee schedule"}]}]},{"description":"HC SHOULDER INJECTION PM","code_information":[{"code":"HC36000136","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":106.35,"maximum":5079,"gross_charge":709,"discounted_cash":209.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.8,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK BRACHIAL PLEXUS","code_information":[{"code":"HC36000137","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1185.84,"maximum":1185.84,"gross_charge":1464,"discounted_cash":433.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1185.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1185.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1185.84,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK BRACHIAL PLEXUS","code_information":[{"code":"HC36000137","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":219.6,"maximum":5079,"gross_charge":1464,"discounted_cash":433.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1185.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1185.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1185.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.8,"methodology":"fee schedule"}]}]},{"description":"HC SINGLE SHOT EPIDURAL PM","code_information":[{"code":"HC36000138","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1002.78,"maximum":1002.78,"gross_charge":1238,"discounted_cash":366.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1002.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1002.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1002.78,"methodology":"fee schedule"}]}]},{"description":"HC SINGLE SHOT EPIDURAL PM","code_information":[{"code":"HC36000138","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":185.7,"maximum":5079,"gross_charge":1238,"discounted_cash":366.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1002.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1002.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1002.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.6,"methodology":"fee schedule"}]}]},{"description":"HC SCALENE NERVE BLOCK PM","code_information":[{"code":"HC36000139","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1194.75,"maximum":1194.75,"gross_charge":1475,"discounted_cash":436.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1194.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1194.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1194.75,"methodology":"fee schedule"}]}]},{"description":"HC SCALENE NERVE BLOCK PM","code_information":[{"code":"HC36000139","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":221.25,"maximum":5079,"gross_charge":1475,"discounted_cash":436.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1194.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1194.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1194.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":295,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":295,"methodology":"fee schedule"}]}]},{"description":"HC HIP INJECTION PM","code_information":[{"code":"HC36000140","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":609.93,"maximum":609.93,"gross_charge":753,"discounted_cash":222.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":609.93,"methodology":"fee schedule"}]}]},{"description":"HC HIP INJECTION PM","code_information":[{"code":"HC36000140","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":112.95,"maximum":5079,"gross_charge":753,"discounted_cash":222.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":609.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.6,"methodology":"fee schedule"}]}]},{"description":"HC INJ TRANS EPI/LUM STER ADD LVL","code_information":[{"code":"HC36000143","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2395.98,"maximum":2395.98,"gross_charge":2958,"discounted_cash":875.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2395.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2395.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2395.98,"methodology":"fee schedule"}]}]},{"description":"HC INJ TRANS EPI/LUM STER ADD LVL","code_information":[{"code":"HC36000143","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":443.7,"maximum":5079,"gross_charge":2958,"discounted_cash":875.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2395.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2395.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2395.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.6,"methodology":"fee schedule"}]}]},{"description":"HC BIER BLOCK","code_information":[{"code":"HC36000144","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":267.3,"maximum":267.3,"gross_charge":330,"discounted_cash":97.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"}]}]},{"description":"HC BIER BLOCK","code_information":[{"code":"HC36000144","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":49.5,"maximum":5079,"gross_charge":330,"discounted_cash":97.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":267.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66,"methodology":"fee schedule"}]}]},{"description":"HC EPIDURAL (BLOCK ROOM)","code_information":[{"code":"HC36000145","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1960.2,"maximum":1960.2,"gross_charge":2420,"discounted_cash":716.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1960.2,"methodology":"fee schedule"}]}]},{"description":"HC EPIDURAL (BLOCK ROOM)","code_information":[{"code":"HC36000145","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":363,"maximum":5079,"gross_charge":2420,"discounted_cash":716.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1960.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":459.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":484,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":363,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":484,"methodology":"fee schedule"}]}]},{"description":"HC AXILLARY BLOCK","code_information":[{"code":"HC36000146","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":841.59,"maximum":841.59,"gross_charge":1039,"discounted_cash":307.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":841.59,"methodology":"fee schedule"}]}]},{"description":"HC AXILLARY BLOCK","code_information":[{"code":"HC36000146","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":155.85,"maximum":5079,"gross_charge":1039,"discounted_cash":307.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":197.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.8,"methodology":"fee schedule"}]}]},{"description":"HC INJ TRIGGER POINT PM","code_information":[{"code":"HC36000148","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1059.48,"maximum":1059.48,"gross_charge":1308,"discounted_cash":387.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1059.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1059.48,"methodology":"fee schedule"}]}]},{"description":"HC INJ TRIGGER POINT PM","code_information":[{"code":"HC36000148","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":196.2,"maximum":5079,"gross_charge":1308,"discounted_cash":387.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1059.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1059.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.6,"methodology":"fee schedule"}]}]},{"description":"HC INSERTION EPIDURAL CATH","code_information":[{"code":"HC36000150","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1348.65,"maximum":1348.65,"gross_charge":1665,"discounted_cash":492.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1348.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1348.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1348.65,"methodology":"fee schedule"}]}]},{"description":"HC INSERTION EPIDURAL CATH","code_information":[{"code":"HC36000150","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":249.75,"maximum":5079,"gross_charge":1665,"discounted_cash":492.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1348.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1348.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1348.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":316.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":249.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":333,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION THORACIC FACET","code_information":[{"code":"HC36000156","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1516.32,"maximum":1516.32,"gross_charge":1872,"discounted_cash":554.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1516.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1516.32,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION THORACIC FACET","code_information":[{"code":"HC36000156","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":280.8,"maximum":5079,"gross_charge":1872,"discounted_cash":554.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1516.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1516.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1516.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.4,"methodology":"fee schedule"}]}]},{"description":"HC PLACEMENT INTRATHECAL CATH PM","code_information":[{"code":"HC36000157","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":6223.23,"maximum":6223.23,"gross_charge":7683,"discounted_cash":2274.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6223.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6223.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6223.23,"methodology":"fee schedule"}]}]},{"description":"HC PLACEMENT INTRATHECAL CATH PM","code_information":[{"code":"HC36000157","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1152.45,"maximum":6223.23,"gross_charge":7683,"discounted_cash":2274.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6223.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6223.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6223.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1459.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1536.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1536.6,"methodology":"fee schedule"}]}]},{"description":"HC PLASMA DISK DECOMPRESSION","code_information":[{"code":"HC36000158","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":14317.56,"maximum":14317.56,"gross_charge":17676,"discounted_cash":5232.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14317.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14317.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14317.56,"methodology":"fee schedule"}]}]},{"description":"HC PLASMA DISK DECOMPRESSION","code_information":[{"code":"HC36000158","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2651.4,"maximum":14317.56,"gross_charge":17676,"discounted_cash":5232.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14317.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14317.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14317.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3358.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3535.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2651.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3535.2,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION SACRAL/COCYGEAL PM","code_information":[{"code":"HC36000160","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":877.23,"maximum":877.23,"gross_charge":1083,"discounted_cash":320.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":877.23,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION SACRAL/COCYGEAL PM","code_information":[{"code":"HC36000160","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":162.45,"maximum":5079,"gross_charge":1083,"discounted_cash":320.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":877.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.6,"methodology":"fee schedule"}]}]},{"description":"HC BIL LUMB EPIDURAL INJECTION","code_information":[{"code":"HC36000161","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1286.28,"maximum":1286.28,"gross_charge":1588,"discounted_cash":470.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1286.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1286.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1286.28,"methodology":"fee schedule"}]}]},{"description":"HC BIL LUMB EPIDURAL INJECTION","code_information":[{"code":"HC36000161","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":238.2,"maximum":5079,"gross_charge":1588,"discounted_cash":470.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1286.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1286.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1286.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":317.6,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION OVER HARDWIRE","code_information":[{"code":"HC36000162","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":814.86,"maximum":814.86,"gross_charge":1006,"discounted_cash":297.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":814.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":814.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":814.86,"methodology":"fee schedule"}]}]},{"description":"HC INJECTION OVER HARDWIRE","code_information":[{"code":"HC36000162","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":150.9,"maximum":5079,"gross_charge":1006,"discounted_cash":297.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":814.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":814.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":814.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":201.2,"methodology":"fee schedule"}]}]},{"description":"HC INTERSPINAL LIG INJ W/STER PM","code_information":[{"code":"HC36000186","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1283.85,"maximum":1283.85,"gross_charge":1585,"discounted_cash":469.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1283.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1283.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1283.85,"methodology":"fee schedule"}]}]},{"description":"HC INTERSPINAL LIG INJ W/STER PM","code_information":[{"code":"HC36000186","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":237.75,"maximum":5079,"gross_charge":1585,"discounted_cash":469.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1283.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1283.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1283.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":317,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 1","code_information":[{"code":"HC36000225","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":81,"maximum":81,"gross_charge":100,"discounted_cash":29.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 1","code_information":[{"code":"HC36000225","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":15,"maximum":5079,"gross_charge":100,"discounted_cash":29.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 2","code_information":[{"code":"HC36000226","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":97.2,"maximum":97.2,"gross_charge":120,"discounted_cash":35.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 2","code_information":[{"code":"HC36000226","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":18,"maximum":5079,"gross_charge":120,"discounted_cash":35.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 3","code_information":[{"code":"HC36000227","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":120.69,"maximum":120.69,"gross_charge":149,"discounted_cash":44.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 3","code_information":[{"code":"HC36000227","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":22.35,"maximum":5079,"gross_charge":149,"discounted_cash":44.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 4","code_information":[{"code":"HC36000228","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":127.98,"maximum":127.98,"gross_charge":158,"discounted_cash":46.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 4","code_information":[{"code":"HC36000228","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":23.7,"maximum":5079,"gross_charge":158,"discounted_cash":46.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.6,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 5","code_information":[{"code":"HC36000229","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":136.89,"maximum":136.89,"gross_charge":169,"discounted_cash":50.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.89,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 5","code_information":[{"code":"HC36000229","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":25.35,"maximum":5079,"gross_charge":169,"discounted_cash":50.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 6","code_information":[{"code":"HC36000230","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":149.85,"maximum":149.85,"gross_charge":185,"discounted_cash":54.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 6","code_information":[{"code":"HC36000230","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":27.75,"maximum":5079,"gross_charge":185,"discounted_cash":54.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 7","code_information":[{"code":"HC36000231","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":170.1,"maximum":170.1,"gross_charge":210,"discounted_cash":62.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 7","code_information":[{"code":"HC36000231","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":31.5,"maximum":5079,"gross_charge":210,"discounted_cash":62.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 8","code_information":[{"code":"HC36000232","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":180.63,"maximum":180.63,"gross_charge":223,"discounted_cash":66.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.63,"methodology":"fee schedule"}]}]},{"description":"HC OR LEVEL 8","code_information":[{"code":"HC36000232","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":33.45,"maximum":5079,"gross_charge":223,"discounted_cash":66.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.6,"methodology":"fee schedule"}]}]},{"description":"FEM/ADDUCT NERVE BLK SGL 64447","code_information":[{"code":"HC36020001","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2343.33,"maximum":2343.33,"gross_charge":2893,"discounted_cash":856.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2343.33,"methodology":"fee schedule"}]}]},{"description":"FEM/ADDUCT NERVE BLK SGL 64447","code_information":[{"code":"HC36020001","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":433.95,"maximum":5079,"gross_charge":2893,"discounted_cash":856.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2343.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":549.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":433.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.6,"methodology":"fee schedule"}]}]},{"description":"SUPRACLAV NERVE BLK SGL 64415","code_information":[{"code":"HC36020002","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2949.21,"maximum":2949.21,"gross_charge":3641,"discounted_cash":1077.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2949.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2949.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2949.21,"methodology":"fee schedule"}]}]},{"description":"SUPRACLAV NERVE BLK SGL 64415","code_information":[{"code":"HC36020002","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":546.15,"maximum":5079,"gross_charge":3641,"discounted_cash":1077.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2949.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2949.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2949.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":728.2,"methodology":"fee schedule"}]}]},{"description":"INTERSCAL NERVE BLK CATH 64415","code_information":[{"code":"HC36020003","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3038.31,"maximum":3038.31,"gross_charge":3751,"discounted_cash":1110.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3038.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3038.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3038.31,"methodology":"fee schedule"}]}]},{"description":"INTERSCAL NERVE BLK CATH 64415","code_information":[{"code":"HC36020003","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":562.65,"maximum":5079,"gross_charge":3751,"discounted_cash":1110.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3038.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3038.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3038.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":562.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":750.2,"methodology":"fee schedule"}]}]},{"description":"TAP NERVE BLK BILAT SGL 64488","code_information":[{"code":"HC36020005","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3513.78,"maximum":3513.78,"gross_charge":4338,"discounted_cash":1284.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3513.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3513.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3513.78,"methodology":"fee schedule"}]}]},{"description":"TAP NERVE BLK BILAT SGL 64488","code_information":[{"code":"HC36020005","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":650.7,"maximum":5079,"gross_charge":4338,"discounted_cash":1284.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3513.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3513.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3513.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.6,"methodology":"fee schedule"}]}]},{"description":"ERECT SPIN NERV BLK CATH 64999","code_information":[{"code":"HC36020006","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":967.14,"maximum":967.14,"gross_charge":1194,"discounted_cash":353.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":967.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":967.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":967.14,"methodology":"fee schedule"}]}]},{"description":"ERECT SPIN NERV BLK CATH 64999","code_information":[{"code":"HC36020006","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":179.1,"maximum":5079,"gross_charge":1194,"discounted_cash":353.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":967.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":967.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":967.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.8,"methodology":"fee schedule"}]}]},{"description":"RECTUS SHEATH BLK UNI 64486","code_information":[{"code":"HC36020010","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2273.67,"maximum":2273.67,"gross_charge":2807,"discounted_cash":830.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2273.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2273.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2273.67,"methodology":"fee schedule"}]}]},{"description":"RECTUS SHEATH BLK UNI 64486","code_information":[{"code":"HC36020010","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":421.05,"maximum":5079,"gross_charge":2807,"discounted_cash":830.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2273.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2273.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2273.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":533.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":421.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.4,"methodology":"fee schedule"}]}]},{"description":"RECTUS SHEATH BLOCK 64488","code_information":[{"code":"HC36020011","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":3410.1,"maximum":3410.1,"gross_charge":4210,"discounted_cash":1246.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3410.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3410.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3410.1,"methodology":"fee schedule"}]}]},{"description":"RECTUS SHEATH BLOCK 64488","code_information":[{"code":"HC36020011","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":631.5,"maximum":5079,"gross_charge":4210,"discounted_cash":1246.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3410.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3410.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3410.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":842,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":842,"methodology":"fee schedule"}]}]},{"description":"SAPHENOUS NERVE BLK 64450","code_information":[{"code":"HC36020012","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2236.41,"maximum":2236.41,"gross_charge":2761,"discounted_cash":817.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2236.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2236.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2236.41,"methodology":"fee schedule"}]}]},{"description":"SAPHENOUS NERVE BLK 64450","code_information":[{"code":"HC36020012","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":414.15,"maximum":5079,"gross_charge":2761,"discounted_cash":817.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2236.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2236.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2236.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":524.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":414.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":552.2,"methodology":"fee schedule"}]}]},{"description":"HC BEDSIDE TRACH 31600","code_information":[{"code":"HC36020014","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":9628.47,"maximum":9628.47,"gross_charge":11887,"discounted_cash":3518.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9628.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9628.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9628.47,"methodology":"fee schedule"}]}]},{"description":"HC BEDSIDE TRACH 31600","code_information":[{"code":"HC36020014","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1783.05,"maximum":9628.47,"gross_charge":11887,"discounted_cash":3518.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9628.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9628.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9628.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2258.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2377.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1783.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2377.4,"methodology":"fee schedule"}]}]},{"description":"RFA CERV/THOR SNGL LVL-64633","code_information":[{"code":"HC36020015","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":5444.01,"maximum":5444.01,"gross_charge":6721,"discounted_cash":1989.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5444.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5444.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5444.01,"methodology":"fee schedule"}]}]},{"description":"RFA CERV/THOR SNGL LVL-64633","code_information":[{"code":"HC36020015","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1008.15,"maximum":5444.01,"gross_charge":6721,"discounted_cash":1989.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5444.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5444.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5444.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1276.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1008.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1344.2,"methodology":"fee schedule"}]}]},{"description":"RFA CERV/THOR ADD LVL-64634","code_information":[{"code":"HC36020016","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":2724.03,"maximum":2724.03,"gross_charge":3363,"discounted_cash":995.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2724.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2724.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2724.03,"methodology":"fee schedule"}]}]},{"description":"RFA CERV/THOR ADD LVL-64634","code_information":[{"code":"HC36020016","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":504.45,"maximum":5079,"gross_charge":3363,"discounted_cash":995.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2724.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2724.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2724.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.6,"methodology":"fee schedule"}]}]},{"description":"ARTHRCNTS ASP/INJ JNT/BURSA -20605","code_information":[{"code":"HC36020019","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":332.1,"maximum":332.1,"gross_charge":410,"discounted_cash":121.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.1,"methodology":"fee schedule"}]}]},{"description":"ARTHRCNTS ASP/INJ JNT/BURSA -20605","code_information":[{"code":"HC36020019","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":61.5,"maximum":5079,"gross_charge":410,"discounted_cash":121.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82,"methodology":"fee schedule"}]}]},{"description":"INJ FAC LUMB/SAC 3RD ADDL 64495","code_information":[{"code":"HC36020020","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":643.95,"maximum":643.95,"gross_charge":795,"discounted_cash":235.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.95,"methodology":"fee schedule"}]}]},{"description":"INJ FAC LUMB/SAC 3RD ADDL 64495","code_information":[{"code":"HC36020020","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":119.25,"maximum":5079,"gross_charge":795,"discounted_cash":235.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":643.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159,"methodology":"fee schedule"}]}]},{"description":"INJ FORAMEN LUMB/SAC ADDL 64484","code_information":[{"code":"HC36020021","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1232.01,"maximum":1232.01,"gross_charge":1521,"discounted_cash":450.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1232.01,"methodology":"fee schedule"}]}]},{"description":"INJ FORAMEN LUMB/SAC ADDL 64484","code_information":[{"code":"HC36020021","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":228.15,"maximum":5079,"gross_charge":1521,"discounted_cash":450.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1232.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":288.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.2,"methodology":"fee schedule"}]}]},{"description":"DRUG INDUCED SLEEP ENDOSC 42975","code_information":[{"code":"HC36020022","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":542.7,"maximum":542.7,"gross_charge":670,"discounted_cash":198.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":542.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":542.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":542.7,"methodology":"fee schedule"}]}]},{"description":"DRUG INDUCED SLEEP ENDOSC 42975","code_information":[{"code":"HC36020022","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":100.5,"maximum":5079,"gross_charge":670,"discounted_cash":198.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":542.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":542.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":542.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":134,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":134,"methodology":"fee schedule"}]}]},{"description":"CLOSED RX SHLDER DISLOCATION 23650","code_information":[{"code":"HC36020023","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":680.4,"maximum":680.4,"gross_charge":840,"discounted_cash":248.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":680.4,"methodology":"fee schedule"}]}]},{"description":"CLOSED RX SHLDER DISLOCATION 23650","code_information":[{"code":"HC36020023","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":126,"maximum":5079,"gross_charge":840,"discounted_cash":248.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":680.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":168,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":168,"methodology":"fee schedule"}]}]},{"description":"BIOPSY BREAST NEEDLE CORE- 19100","code_information":[{"code":"HC36020024","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":631.8,"maximum":631.8,"gross_charge":780,"discounted_cash":230.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.8,"methodology":"fee schedule"}]}]},{"description":"BIOPSY BREAST NEEDLE CORE- 19100","code_information":[{"code":"HC36020024","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":117,"maximum":5079,"gross_charge":780,"discounted_cash":230.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":631.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"}]}]},{"description":"QUADRATUS LUMBORUM BLK 64999","code_information":[{"code":"HC36020025","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":855.36,"maximum":855.36,"gross_charge":1056,"discounted_cash":312.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":855.36,"methodology":"fee schedule"}]}]},{"description":"QUADRATUS LUMBORUM BLK 64999","code_information":[{"code":"HC36020025","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":158.4,"maximum":5079,"gross_charge":1056,"discounted_cash":312.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":855.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.2,"methodology":"fee schedule"}]}]},{"description":"HC OPEN FEM ARTERY FOR CONDUIT 34714","code_information":[{"code":"HC36020026","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":9068.76,"maximum":9068.76,"gross_charge":11196,"discounted_cash":3314.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9068.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9068.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9068.76,"methodology":"fee schedule"}]}]},{"description":"HC OPEN FEM ARTERY FOR CONDUIT 34714","code_information":[{"code":"HC36020026","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1679.4,"maximum":9068.76,"gross_charge":11196,"discounted_cash":3314.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9068.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9068.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9068.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2127.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1679.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2239.2,"methodology":"fee schedule"}]}]},{"description":"HC ENDARTERECTOMY PROFUNDA 35372","code_information":[{"code":"HC36020028","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":5721.03,"maximum":5721.03,"gross_charge":7063,"discounted_cash":2090.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5721.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5721.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5721.03,"methodology":"fee schedule"}]}]},{"description":"HC ENDARTERECTOMY PROFUNDA 35372","code_information":[{"code":"HC36020028","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1059.45,"maximum":5721.03,"gross_charge":7063,"discounted_cash":2090.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5721.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5721.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5721.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1341.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1412.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1059.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1412.6,"methodology":"fee schedule"}]}]},{"description":"TRCATH MITRAL VALVE REPL-TMVR 0483T","code_information":[{"code":"HC36020030","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":8705.88,"maximum":8705.88,"gross_charge":10748,"discounted_cash":3181.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8705.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8705.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8705.88,"methodology":"fee schedule"}]}]},{"description":"TRCATH MITRAL VALVE REPL-TMVR 0483T","code_information":[{"code":"HC36020030","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1612.2,"maximum":8705.88,"gross_charge":10748,"discounted_cash":3181.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8705.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8705.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8705.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2042.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2149.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1612.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2149.6,"methodology":"fee schedule"}]}]},{"description":"EPIDURL INTRLMNR CERV/THOR 62321","code_information":[{"code":"HC36020455","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":949.32,"maximum":949.32,"gross_charge":1172,"discounted_cash":346.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":949.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":949.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":949.32,"methodology":"fee schedule"}]}]},{"description":"EPIDURL INTRLMNR CERV/THOR 62321","code_information":[{"code":"HC36020455","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":175.8,"maximum":5079,"gross_charge":1172,"discounted_cash":346.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":949.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":949.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":949.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.4,"methodology":"fee schedule"}]}]},{"description":"INJ(S) FORAMEN LUMB/SAC 64483","code_information":[{"code":"HC36020456","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":1296.81,"maximum":1296.81,"gross_charge":1601,"discounted_cash":473.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1296.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1296.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1296.81,"methodology":"fee schedule"}]}]},{"description":"INJ(S) FORAMEN LUMB/SAC 64483","code_information":[{"code":"HC36020456","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"minimum":240.15,"maximum":5079,"gross_charge":1601,"discounted_cash":473.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1296.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1296.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1296.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":320.2,"methodology":"fee schedule"}]}]},{"description":"HC ALLURION GASTRIC BALLN REM-SP","code_information":[{"code":"HC36100200","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":500.58,"maximum":500.58,"gross_charge":618,"discounted_cash":182.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":500.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":500.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":500.58,"methodology":"fee schedule"}]}]},{"description":"HC ALLURION GASTRIC BALLN REM-SP","code_information":[{"code":"HC36100200","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":92.7,"maximum":5079,"gross_charge":618,"discounted_cash":182.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":500.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":500.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":500.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.6,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOSCOPY W/STENT REM -52310","code_information":[{"code":"HC36100201","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3424.68,"maximum":3424.68,"gross_charge":4228,"discounted_cash":1251.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3424.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3424.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3424.68,"methodology":"fee schedule"}]}]},{"description":"HC CYSTOSCOPY W/STENT REM -52310","code_information":[{"code":"HC36100201","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":634.2,"maximum":5079,"gross_charge":4228,"discounted_cash":1251.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3424.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3424.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3424.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":803.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":634.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":845.6,"methodology":"fee schedule"}]}]},{"description":"HC BONE MARROW BIOPSY - 38221","code_information":[{"code":"HC36100202","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1989.36,"maximum":1989.36,"gross_charge":2456,"discounted_cash":726.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1989.36,"methodology":"fee schedule"}]}]},{"description":"HC BONE MARROW BIOPSY - 38221","code_information":[{"code":"HC36100202","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":368.4,"maximum":5079,"gross_charge":2456,"discounted_cash":726.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.2,"methodology":"fee schedule"}]}]},{"description":"HC LUMBAR PUNCTURE DIAGNOSTIC","code_information":[{"code":"HC36100204","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2683.53,"maximum":2683.53,"gross_charge":3313,"discounted_cash":980.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2683.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2683.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2683.53,"methodology":"fee schedule"}]}]},{"description":"HC LUMBAR PUNCTURE DIAGNOSTIC","code_information":[{"code":"HC36100204","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":496.95,"maximum":5079,"gross_charge":3313,"discounted_cash":980.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2683.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2683.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2683.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":496.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":662.6,"methodology":"fee schedule"}]}]},{"description":"HC THORACENTESIS","code_information":[{"code":"HC36100205","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1607.04,"maximum":1607.04,"gross_charge":1984,"discounted_cash":587.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1607.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1607.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1607.04,"methodology":"fee schedule"}]}]},{"description":"HC THORACENTESIS","code_information":[{"code":"HC36100205","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":297.6,"maximum":5079,"gross_charge":1984,"discounted_cash":587.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1607.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1607.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1607.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":297.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.8,"methodology":"fee schedule"}]}]},{"description":"HC CHEST TUBE INSERT","code_information":[{"code":"HC36100208","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2687.58,"maximum":2687.58,"gross_charge":3318,"discounted_cash":982.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2687.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2687.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2687.58,"methodology":"fee schedule"}]}]},{"description":"HC CHEST TUBE INSERT","code_information":[{"code":"HC36100208","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":497.7,"maximum":5079,"gross_charge":3318,"discounted_cash":982.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2687.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2687.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2687.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":630.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.6,"methodology":"fee schedule"}]}]},{"description":"HC FLURO NEEDLE ASP","code_information":[{"code":"HC36100211","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2045.25,"maximum":2045.25,"gross_charge":2525,"discounted_cash":747.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2045.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2045.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2045.25,"methodology":"fee schedule"}]}]},{"description":"HC FLURO NEEDLE ASP","code_information":[{"code":"HC36100211","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":378.75,"maximum":5079,"gross_charge":2525,"discounted_cash":747.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2045.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2045.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2045.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":479.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":505,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":378.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":505,"methodology":"fee schedule"}]}]},{"description":"HC PLEUREX REMOVAL","code_information":[{"code":"HC36100212","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3027.78,"maximum":3027.78,"gross_charge":3738,"discounted_cash":1106.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3027.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3027.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3027.78,"methodology":"fee schedule"}]}]},{"description":"HC PLEUREX REMOVAL","code_information":[{"code":"HC36100212","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":560.7,"maximum":5079,"gross_charge":3738,"discounted_cash":1106.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3027.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3027.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3027.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":560.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":747.6,"methodology":"fee schedule"}]}]},{"description":"HC PLEURAL CATH INSERTION","code_information":[{"code":"HC36100213","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":9475.38,"maximum":9475.38,"gross_charge":11698,"discounted_cash":3462.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9475.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9475.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9475.38,"methodology":"fee schedule"}]}]},{"description":"HC PLEURAL CATH INSERTION","code_information":[{"code":"HC36100213","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1754.7,"maximum":9475.38,"gross_charge":11698,"discounted_cash":3462.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9475.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9475.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9475.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2222.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2339.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1754.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2339.6,"methodology":"fee schedule"}]}]},{"description":"HC REV/REMOVAL/REPLAC STENT","code_information":[{"code":"HC36100215","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":5145.93,"maximum":5145.93,"gross_charge":6353,"discounted_cash":1880.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5145.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5145.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5145.93,"methodology":"fee schedule"}]}]},{"description":"HC REV/REMOVAL/REPLAC STENT","code_information":[{"code":"HC36100215","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":952.95,"maximum":5145.93,"gross_charge":6353,"discounted_cash":1880.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5145.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5145.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5145.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1207.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":952.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1270.6,"methodology":"fee schedule"}]}]},{"description":"HC VAGINOSCOPY","code_information":[{"code":"HC36100221","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":771.93,"maximum":771.93,"gross_charge":953,"discounted_cash":282.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":771.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":771.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":771.93,"methodology":"fee schedule"}]}]},{"description":"HC VAGINOSCOPY","code_information":[{"code":"HC36100221","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":142.95,"maximum":5079,"gross_charge":953,"discounted_cash":282.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":771.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":771.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":771.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.6,"methodology":"fee schedule"}]}]},{"description":"HC PLEURAL BIOPSY","code_information":[{"code":"HC36100222","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2598.48,"maximum":2598.48,"gross_charge":3208,"discounted_cash":949.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2598.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2598.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2598.48,"methodology":"fee schedule"}]}]},{"description":"HC PLEURAL BIOPSY","code_information":[{"code":"HC36100222","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":481.2,"maximum":5079,"gross_charge":3208,"discounted_cash":949.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2598.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2598.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2598.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":481.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.6,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST STEREO UNILATERAL","code_information":[{"code":"HC36100240","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3968.19,"maximum":3968.19,"gross_charge":4899,"discounted_cash":1450.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3968.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3968.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3968.19,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST STEREO UNILATERAL","code_information":[{"code":"HC36100240","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":734.85,"maximum":5079,"gross_charge":4899,"discounted_cash":1450.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3968.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3968.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3968.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":930.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":734.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":979.8,"methodology":"fee schedule"}]}]},{"description":"HC BX BRST STEREO EA ADDL-19082","code_information":[{"code":"HC36100241","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2144.88,"maximum":2144.88,"gross_charge":2648,"discounted_cash":783.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2144.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2144.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2144.88,"methodology":"fee schedule"}]}]},{"description":"HC BX BRST STEREO EA ADDL-19082","code_information":[{"code":"HC36100241","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":397.2,"maximum":5079,"gross_charge":2648,"discounted_cash":783.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2144.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2144.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2144.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.6,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION BREAST CYST -19000","code_information":[{"code":"HC36100244","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":920.16,"maximum":920.16,"gross_charge":1136,"discounted_cash":336.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"}]}]},{"description":"HC ASPIRATION BREAST CYST -19000","code_information":[{"code":"HC36100244","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":170.4,"maximum":5079,"gross_charge":1136,"discounted_cash":336.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":920.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":215.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.2,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR BREAST CYST EA ADD-19001","code_information":[{"code":"HC36100245","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":651.24,"maximum":651.24,"gross_charge":804,"discounted_cash":237.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.24,"methodology":"fee schedule"}]}]},{"description":"HC ASPIR BREAST CYST EA ADD-19001","code_information":[{"code":"HC36100245","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":120.6,"maximum":5079,"gross_charge":804,"discounted_cash":237.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"}]}]},{"description":"HC LOC MAMMO WIRE EA ADDL-19282","code_information":[{"code":"HC36100246","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1486.35,"maximum":1486.35,"gross_charge":1835,"discounted_cash":543.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1486.35,"methodology":"fee schedule"}]}]},{"description":"HC LOC MAMMO WIRE EA ADDL-19282","code_information":[{"code":"HC36100246","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":275.25,"maximum":5079,"gross_charge":1835,"discounted_cash":543.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1486.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":367,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":367,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST STEREO BIL-19081","code_information":[{"code":"HC36100247","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4577.31,"maximum":4577.31,"gross_charge":5651,"discounted_cash":1672.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4577.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4577.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4577.31,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST STEREO BIL-19081","code_information":[{"code":"HC36100247","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":847.65,"maximum":5079,"gross_charge":5651,"discounted_cash":1672.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4577.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4577.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4577.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1073.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":847.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.2,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US UNILATERAL","code_information":[{"code":"HC36100248","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2886.03,"maximum":2886.03,"gross_charge":3563,"discounted_cash":1054.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2886.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2886.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2886.03,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US UNILATERAL","code_information":[{"code":"HC36100248","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":534.45,"maximum":5079,"gross_charge":3563,"discounted_cash":1054.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2886.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2886.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2886.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":676.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":534.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":712.6,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US BIL-19083","code_information":[{"code":"HC36100249","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":4329.45,"maximum":4329.45,"gross_charge":5345,"discounted_cash":1582.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4329.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4329.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4329.45,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US BIL-19083","code_information":[{"code":"HC36100249","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":801.75,"maximum":5079,"gross_charge":5345,"discounted_cash":1582.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4329.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4329.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4329.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1015.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1069,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US EA ADDL-19084","code_information":[{"code":"HC36100250","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1578.69,"maximum":1578.69,"gross_charge":1949,"discounted_cash":576.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1578.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1578.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1578.69,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US EA ADDL-19084","code_information":[{"code":"HC36100250","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":292.35,"maximum":5079,"gross_charge":1949,"discounted_cash":576.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1578.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1578.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1578.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":389.8,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL BR US NDL WR PL UNILATERAL","code_information":[{"code":"HC36100251","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2504.52,"maximum":2504.52,"gross_charge":3092,"discounted_cash":915.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2504.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2504.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2504.52,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL BR US NDL WR PL UNILATERAL","code_information":[{"code":"HC36100251","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":463.8,"maximum":5079,"gross_charge":3092,"discounted_cash":915.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2504.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2504.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2504.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.4,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL BR US WR PL EA ADD-19286","code_information":[{"code":"HC36100254","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":567,"maximum":567,"gross_charge":700,"discounted_cash":207.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL BR US WR PL EA ADD-19286","code_information":[{"code":"HC36100254","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":105,"maximum":5079,"gross_charge":700,"discounted_cash":207.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":567,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL MAMMO WIRE PLC UNILATERAL","code_information":[{"code":"HC36100256","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2039.58,"maximum":2039.58,"gross_charge":2518,"discounted_cash":745.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2039.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2039.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2039.58,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL MAMMO WIRE PLC UNILATERAL","code_information":[{"code":"HC36100256","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":377.7,"maximum":5079,"gross_charge":2518,"discounted_cash":745.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2039.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2039.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2039.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":478.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":377.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":503.6,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL MAMMO WIRE PLC BIL-19281","code_information":[{"code":"HC36100258","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3060.18,"maximum":3060.18,"gross_charge":3778,"discounted_cash":1118.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3060.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3060.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3060.18,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL MAMMO WIRE PLC BIL-19281","code_information":[{"code":"HC36100258","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":566.7,"maximum":5079,"gross_charge":3778,"discounted_cash":1118.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3060.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3060.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3060.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":755.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":755.6,"methodology":"fee schedule"}]}]},{"description":"HC PLACEMNT BRST LOCAL-REDU 19283","code_information":[{"code":"HC36100260","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1993.41,"maximum":1993.41,"gross_charge":2461,"discounted_cash":728.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1993.41,"methodology":"fee schedule"}]}]},{"description":"HC PLACEMNT BRST LOCAL-REDU 19283","code_information":[{"code":"HC36100260","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":369.15,"maximum":5079,"gross_charge":2461,"discounted_cash":728.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1993.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.2,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST STEREO 19081","code_information":[{"code":"HC36100264","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3049.65,"maximum":3049.65,"gross_charge":3765,"discounted_cash":1114.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3049.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3049.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3049.65,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST STEREO 19081","code_information":[{"code":"HC36100264","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":564.75,"maximum":5079,"gross_charge":3765,"discounted_cash":1114.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3049.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3049.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3049.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":753,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":753,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US 19083","code_information":[{"code":"HC36100265","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":2617.92,"maximum":2617.92,"gross_charge":3232,"discounted_cash":956.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2617.92,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US 19083","code_information":[{"code":"HC36100265","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":484.8,"maximum":5079,"gross_charge":3232,"discounted_cash":956.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2617.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":614.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":484.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":646.4,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US EA ADDL-19084","code_information":[{"code":"HC36100267","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":1432.89,"maximum":1432.89,"gross_charge":1769,"discounted_cash":523.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1432.89,"methodology":"fee schedule"}]}]},{"description":"HC BX BREAST US EA ADDL-19084","code_information":[{"code":"HC36100267","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":265.35,"maximum":5079,"gross_charge":1769,"discounted_cash":523.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1432.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":353.8,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL BR US NDL WR PL BI-19285","code_information":[{"code":"HC36100268","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":3757.59,"maximum":3757.59,"gross_charge":4639,"discounted_cash":1373.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3757.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3757.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3757.59,"methodology":"fee schedule"}]}]},{"description":"HC LOCAL BR US NDL WR PL BI-19285","code_information":[{"code":"HC36100268","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":695.85,"maximum":5079,"gross_charge":4639,"discounted_cash":1373.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3757.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3757.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3757.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.8,"methodology":"fee schedule"}]}]},{"description":"HC OBALON GASTRIC BALLN REM-SP","code_information":[{"code":"HC36100332","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":525.69,"maximum":525.69,"gross_charge":649,"discounted_cash":192.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":525.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":525.69,"methodology":"fee schedule"}]}]},{"description":"HC OBALON GASTRIC BALLN REM-SP","code_information":[{"code":"HC36100332","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"minimum":97.35,"maximum":5079,"gross_charge":649,"discounted_cash":192.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":525.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":525.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.8,"methodology":"fee schedule"}]}]},{"description":"HC ANES-EPI/SPINAL","code_information":[{"code":"HC37000001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":236.52,"maximum":236.52,"gross_charge":292,"discounted_cash":86.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.52,"methodology":"fee schedule"}]}]},{"description":"HC ANES-EPI/SPINAL","code_information":[{"code":"HC37000001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":43.8,"maximum":236.52,"gross_charge":292,"discounted_cash":86.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"}]}]},{"description":"HC ANES-GENERAL INITIAL","code_information":[{"code":"HC37000002","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":272.97,"maximum":272.97,"gross_charge":337,"discounted_cash":99.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.97,"methodology":"fee schedule"}]}]},{"description":"HC ANES-GENERAL INITIAL","code_information":[{"code":"HC37000002","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":50.55,"maximum":272.97,"gross_charge":337,"discounted_cash":99.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.4,"methodology":"fee schedule"}]}]},{"description":"HC ANES-REGIONAL BLOCK","code_information":[{"code":"HC37000006","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":618.03,"maximum":618.03,"gross_charge":763,"discounted_cash":225.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":618.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":618.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":618.03,"methodology":"fee schedule"}]}]},{"description":"HC ANES-REGIONAL BLOCK","code_information":[{"code":"HC37000006","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":114.45,"maximum":618.03,"gross_charge":763,"discounted_cash":225.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":618.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":618.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":618.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.6,"methodology":"fee schedule"}]}]},{"description":"TOTAL IV ANESTHESIA (TIVA)","code_information":[{"code":"HC37020001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":328.86,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"}]}]},{"description":"TOTAL IV ANESTHESIA (TIVA)","code_information":[{"code":"HC37020001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":60.9,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"}]}]},{"description":"REGIONAL ANESTHESIA","code_information":[{"code":"HC37020002","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":743.58,"maximum":743.58,"gross_charge":918,"discounted_cash":271.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.58,"methodology":"fee schedule"}]}]},{"description":"REGIONAL ANESTHESIA","code_information":[{"code":"HC37020002","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":137.7,"maximum":743.58,"gross_charge":918,"discounted_cash":271.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.6,"methodology":"fee schedule"}]}]},{"description":"EPI/SPINAL ANESTHESIA","code_information":[{"code":"HC37020003","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":285.93,"maximum":285.93,"gross_charge":353,"discounted_cash":104.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.93,"methodology":"fee schedule"}]}]},{"description":"EPI/SPINAL ANESTHESIA","code_information":[{"code":"HC37020003","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":52.95,"maximum":285.93,"gross_charge":353,"discounted_cash":104.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":285.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"}]}]},{"description":"LOCAL ANESTHESIA","code_information":[{"code":"HC37020004","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":1293.57,"maximum":1293.57,"gross_charge":1597,"discounted_cash":472.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1293.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1293.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1293.57,"methodology":"fee schedule"}]}]},{"description":"LOCAL ANESTHESIA","code_information":[{"code":"HC37020004","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":239.55,"maximum":1293.57,"gross_charge":1597,"discounted_cash":472.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1293.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1293.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1293.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":303.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.4,"methodology":"fee schedule"}]}]},{"description":"HC ANESTHESIA/MAC PER 10 MIN","code_information":[{"code":"HC37100001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":221.94,"maximum":221.94,"gross_charge":274,"discounted_cash":81.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.94,"methodology":"fee schedule"}]}]},{"description":"HC ANESTHESIA/MAC PER 10 MIN","code_information":[{"code":"HC37100001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"minimum":41.1,"maximum":221.94,"gross_charge":274,"discounted_cash":81.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.8,"methodology":"fee schedule"}]}]},{"description":"ANKLE BRACH INDEX SCREENING - SELF PAY","code_information":[{"code":"HC40220006","type":"CDM"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"ANKLE BRACH INDEX SCREENING - SELF PAY","code_information":[{"code":"HC40220006","type":"CDM"},{"code":"0402","type":"RC"}],"standard_charges":[{"minimum":3.75,"maximum":698,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"HC MAJOR ER PROCEDURE","code_information":[{"code":"HC45000560","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":3063.42,"maximum":3063.42,"gross_charge":3782,"discounted_cash":1119.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3063.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3063.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3063.42,"methodology":"fee schedule"}]}]},{"description":"HC MAJOR ER PROCEDURE","code_information":[{"code":"HC45000560","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":339,"maximum":3063.42,"gross_charge":3782,"discounted_cash":1119.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3063.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3063.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3063.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":567.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.4,"methodology":"fee schedule"}]}]},{"description":"HC MINOR ER PROCEDURE","code_information":[{"code":"HC45000562","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":805.14,"maximum":805.14,"gross_charge":994,"discounted_cash":294.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":805.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":805.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":805.14,"methodology":"fee schedule"}]}]},{"description":"HC MINOR ER PROCEDURE","code_information":[{"code":"HC45000562","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"minimum":149.1,"maximum":805.14,"gross_charge":994,"discounted_cash":294.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":805.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":805.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":805.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":659,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":339,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.8,"methodology":"fee schedule"}]}]},{"description":"HC MENTAL HEALTH COUNSELING -SP","code_information":[{"code":"HC51000017","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":43.74,"maximum":43.74,"gross_charge":54,"discounted_cash":15.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"}]}]},{"description":"HC MENTAL HEALTH COUNSELING -SP","code_information":[{"code":"HC51000017","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":110,"gross_charge":54,"discounted_cash":15.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"}]}]},{"description":"ENROLLEE FEE","code_information":[{"code":"HC51000018","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":8.1,"maximum":8.1,"gross_charge":10,"discounted_cash":2.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"ENROLLEE FEE","code_information":[{"code":"HC51000018","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":1.5,"maximum":110,"gross_charge":10,"discounted_cash":2.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"CLIENT NAVIGATION 0-14 MINUTES","code_information":[{"code":"HC51000019","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":4.05,"maximum":4.05,"gross_charge":5,"discounted_cash":1.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.05,"methodology":"fee schedule"}]}]},{"description":"CLIENT NAVIGATION 0-14 MINUTES","code_information":[{"code":"HC51000019","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":0.75,"maximum":110,"gross_charge":5,"discounted_cash":1.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"}]}]},{"description":"HC - MENTAL HEALTH EVAL - SP","code_information":[{"code":"HC51020001","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"HC - MENTAL HEALTH EVAL - SP","code_information":[{"code":"HC51020001","type":"CDM"},{"code":"0510","type":"RC"}],"standard_charges":[{"minimum":10.05,"maximum":110,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":110,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"HC TN DONOR SERVICE ROUND TRIP","code_information":[{"code":"HC54000000","type":"CDM"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":107.73,"maximum":107.73,"gross_charge":133,"discounted_cash":39.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.73,"methodology":"fee schedule"}]}]},{"description":"HC TN DONOR SERVICE ROUND TRIP","code_information":[{"code":"HC54000000","type":"CDM"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":19.95,"maximum":358,"gross_charge":133,"discounted_cash":39.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"}]}]},{"description":"HC TN DONOR NON-PACKAGE CHRG","code_information":[{"code":"HC54000002","type":"CDM"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":188.73,"maximum":188.73,"gross_charge":233,"discounted_cash":68.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"}]}]},{"description":"HC TN DONOR NON-PACKAGE CHRG","code_information":[{"code":"HC54000002","type":"CDM"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":34.95,"maximum":358,"gross_charge":233,"discounted_cash":68.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"}]}]},{"description":"HC ACCU-STICK 20-710","code_information":[{"code":"HC62100000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":250.29,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"}]}]},{"description":"HC ACCU-STICK 20-710","code_information":[{"code":"HC62100000","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":46.35,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"}]}]},{"description":"HC CATH INTO-PGTL G09764","code_information":[{"code":"HC62100006","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":328.86,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"}]}]},{"description":"HC CATH INTO-PGTL G09764","code_information":[{"code":"HC62100006","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":60.9,"maximum":328.86,"gross_charge":406,"discounted_cash":120.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.2,"methodology":"fee schedule"}]}]},{"description":"HC CATH SIMMONS 4FR 451-431H0","code_information":[{"code":"HC62100011","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":66.42,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"}]}]},{"description":"HC CATH SIMMONS 4FR 451-431H0","code_information":[{"code":"HC62100011","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":12.3,"maximum":66.42,"gross_charge":82,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.4,"methodology":"fee schedule"}]}]},{"description":"HC CATH SOFT VU KUMPE 10732701","code_information":[{"code":"HC62100013","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":156.33,"maximum":156.33,"gross_charge":193,"discounted_cash":57.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.33,"methodology":"fee schedule"}]}]},{"description":"HC CATH SOFT VU KUMPE 10732701","code_information":[{"code":"HC62100013","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":28.95,"maximum":156.33,"gross_charge":193,"discounted_cash":57.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 4F ANG TAPER CG416","code_information":[{"code":"HC62100019","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":150.66,"maximum":150.66,"gross_charge":186,"discounted_cash":55.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.66,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 4F ANG TAPER CG416","code_information":[{"code":"HC62100019","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":27.9,"maximum":150.66,"gross_charge":186,"discounted_cash":55.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 6.5FR RNL-6-308J","code_information":[{"code":"HC62100026","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":127.17,"maximum":127.17,"gross_charge":157,"discounted_cash":46.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.17,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER 6.5FR RNL-6-308J","code_information":[{"code":"HC62100026","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":23.55,"maximum":127.17,"gross_charge":157,"discounted_cash":46.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.4,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER G07274","code_information":[{"code":"HC62100030","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":189.54,"maximum":189.54,"gross_charge":234,"discounted_cash":69.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":189.54,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER G07274","code_information":[{"code":"HC62100030","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":35.1,"maximum":189.54,"gross_charge":234,"discounted_cash":69.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":189.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER IMA 6F 532-660","code_information":[{"code":"HC62100033","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":108.54,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER IMA 6F 532-660","code_information":[{"code":"HC62100033","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.1,"maximum":108.54,"gross_charge":134,"discounted_cash":39.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER SIZING 20 13709705","code_information":[{"code":"HC62100034","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":273.78,"maximum":273.78,"gross_charge":338,"discounted_cash":100.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":273.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":273.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":273.78,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER SIZING 20 13709705","code_information":[{"code":"HC62100034","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.7,"maximum":273.78,"gross_charge":338,"discounted_cash":100.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":273.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":273.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":273.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER SOS 1 4F 10711401","code_information":[{"code":"HC62100036","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":37.26,"maximum":37.26,"gross_charge":46,"discounted_cash":13.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"}]}]},{"description":"HC CATHETER SOS 1 4F 10711401","code_information":[{"code":"HC62100036","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":6.9,"maximum":37.26,"gross_charge":46,"discounted_cash":13.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"}]}]},{"description":"HC CONN Y DOUBLE 610401","code_information":[{"code":"HC62100048","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":138.51,"maximum":138.51,"gross_charge":171,"discounted_cash":50.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.51,"methodology":"fee schedule"}]}]},{"description":"HC CONN Y DOUBLE 610401","code_information":[{"code":"HC62100048","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":25.65,"maximum":138.51,"gross_charge":171,"discounted_cash":50.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"}]}]},{"description":"HC GUN BIOPSY MONOPTY BI 121816","code_information":[{"code":"HC62100072","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":100.44,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"}]}]},{"description":"HC GUN BIOPSY MONOPTY BI 121816","code_information":[{"code":"HC62100072","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.6,"maximum":100.44,"gross_charge":124,"discounted_cash":36.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER SKATER 651506300","code_information":[{"code":"HC62100074","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":187.92,"maximum":187.92,"gross_charge":232,"discounted_cash":68.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.92,"methodology":"fee schedule"}]}]},{"description":"HC INTRODUCER SKATER 651506300","code_information":[{"code":"HC62100074","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":187.92,"gross_charge":232,"discounted_cash":68.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.4,"methodology":"fee schedule"}]}]},{"description":"HC MICROPUNCT STIFF KIT-011-43","code_information":[{"code":"HC62100075","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":117.45,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"}]}]},{"description":"HC MICROPUNCT STIFF KIT-011-43","code_information":[{"code":"HC62100075","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.75,"maximum":117.45,"gross_charge":145,"discounted_cash":42.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIO MONOPTY 121616","code_information":[{"code":"HC62100077","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":98.82,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIO MONOPTY 121616","code_information":[{"code":"HC62100077","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":18.3,"maximum":98.82,"gross_charge":122,"discounted_cash":36.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOSPY 18CX25 MC1825","code_information":[{"code":"HC62100081","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":126.36,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE BIOSPY 18CX25 MC1825","code_information":[{"code":"HC62100081","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":23.4,"maximum":126.36,"gross_charge":156,"discounted_cash":46.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.2,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE CO-AXIAL 360-2080-01","code_information":[{"code":"HC62100084","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":112.59,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE CO-AXIAL 360-2080-01","code_information":[{"code":"HC62100084","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":20.85,"maximum":112.59,"gross_charge":139,"discounted_cash":41.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE COAXIAL BIOPSY CT1615","code_information":[{"code":"HC62100087","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":115.02,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE COAXIAL BIOPSY CT1615","code_information":[{"code":"HC62100087","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":21.3,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE MPTY 121810","code_information":[{"code":"HC62100095","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":90.72,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE MPTY 121810","code_information":[{"code":"HC62100095","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":16.8,"maximum":90.72,"gross_charge":112,"discounted_cash":33.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.4,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE SMART 75010","code_information":[{"code":"HC62100096","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":247.05,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE SMART 75010","code_information":[{"code":"HC62100096","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":45.75,"maximum":247.05,"gross_charge":305,"discounted_cash":90.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE TEMNO BIOP CT2215","code_information":[{"code":"HC62100097","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":195.21,"maximum":195.21,"gross_charge":241,"discounted_cash":71.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.21,"methodology":"fee schedule"}]}]},{"description":"HC NEEDLE TEMNO BIOP CT2215","code_information":[{"code":"HC62100097","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":36.15,"maximum":195.21,"gross_charge":241,"discounted_cash":71.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.2,"methodology":"fee schedule"}]}]},{"description":"HC SHEALTH TERUMO 15-723B","code_information":[{"code":"HC62100102","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"HC SHEALTH TERUMO 15-723B","code_information":[{"code":"HC62100102","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":10.05,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"HC SUMP RING-MCLEAN G07504","code_information":[{"code":"HC62100110","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":270.54,"maximum":270.54,"gross_charge":334,"discounted_cash":98.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":270.54,"methodology":"fee schedule"}]}]},{"description":"HC SUMP RING-MCLEAN G07504","code_information":[{"code":"HC62100110","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":50.1,"maximum":270.54,"gross_charge":334,"discounted_cash":98.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":270.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.8,"methodology":"fee schedule"}]}]},{"description":"HC TRANSJUGULAR ACCESS 15700101","code_information":[{"code":"HC62100115","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":651.24,"maximum":651.24,"gross_charge":804,"discounted_cash":237.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.24,"methodology":"fee schedule"}]}]},{"description":"HC TRANSJUGULAR ACCESS 15700101","code_information":[{"code":"HC62100115","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":120.6,"maximum":651.24,"gross_charge":804,"discounted_cash":237.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.8,"methodology":"fee schedule"}]}]},{"description":"HC VALVE HEMOSTATIC 421242","code_information":[{"code":"HC62100127","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"HC VALVE HEMOSTATIC 421242","code_information":[{"code":"HC62100127","type":"CDM"},{"code":"0272","type":"RC"}],"standard_charges":[{"minimum":13.35,"maximum":72.09,"gross_charge":89,"discounted_cash":26.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.8,"methodology":"fee schedule"}]}]},{"description":"ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS SYRINGE KIT","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3731.39,"maximum":5037.38,"gross_charge":6218.98,"discounted_cash":1840.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5037.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5037.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5037.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4042.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4353.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3731.39,"methodology":"fee schedule"}]}]},{"description":"ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS SYRINGE KIT","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":932.85,"maximum":5037.38,"gross_charge":6218.98,"discounted_cash":1840.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5037.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5037.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5037.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3980.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3109.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3109.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2798.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4353.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3731.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1181.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1243.8,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.1,"maximum":58.18,"gross_charge":71.82,"discounted_cash":21.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.78,"maximum":58.18,"gross_charge":71.82,"discounted_cash":21.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":52.24,"maximum":70.52,"gross_charge":87.06,"discounted_cash":25.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.24,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.06,"maximum":70.52,"gross_charge":87.06,"discounted_cash":25.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51079-0620-01","type":"NDC"}],"standard_charges":[{"minimum":0.34,"maximum":0.46,"gross_charge":0.56,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51079-0620-01","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.46,"gross_charge":0.56,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51079-0620-06","type":"NDC"}],"standard_charges":[{"minimum":13.1,"maximum":17.69,"gross_charge":21.83,"discounted_cash":6.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51079-0620-06","type":"NDC"}],"standard_charges":[{"minimum":3.28,"maximum":17.69,"gross_charge":21.83,"discounted_cash":6.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0229-01","type":"NDC"}],"standard_charges":[{"minimum":31.41,"maximum":42.4,"gross_charge":52.34,"discounted_cash":15.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":34.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0229-01","type":"NDC"}],"standard_charges":[{"minimum":7.86,"maximum":42.4,"gross_charge":52.34,"discounted_cash":15.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":33.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.47,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0229-11","type":"NDC"}],"standard_charges":[{"minimum":0.39,"maximum":0.53,"gross_charge":0.65,"discounted_cash":0.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"AZATHIOPRINE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0229-11","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":0.53,"gross_charge":0.65,"discounted_cash":0.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0321-10","type":"NDC"}],"standard_charges":[{"minimum":35.82,"maximum":48.35,"gross_charge":59.69,"discounted_cash":17.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0321-10","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":48.35,"gross_charge":59.69,"discounted_cash":17.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0570-01","type":"NDC"}],"standard_charges":[{"minimum":33.77,"maximum":45.58,"gross_charge":56.27,"discounted_cash":16.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.77,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0570-01","type":"NDC"}],"standard_charges":[{"minimum":8.45,"maximum":45.58,"gross_charge":56.27,"discounted_cash":16.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0570-04","type":"NDC"}],"standard_charges":[{"minimum":36.7,"maximum":49.54,"gross_charge":61.16,"discounted_cash":18.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.7,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0570-04","type":"NDC"}],"standard_charges":[{"minimum":9.18,"maximum":49.54,"gross_charge":61.16,"discounted_cash":18.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0572-01","type":"NDC"}],"standard_charges":[{"minimum":37.01,"maximum":49.96,"gross_charge":61.67,"discounted_cash":18.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.01,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0572-01","type":"NDC"}],"standard_charges":[{"minimum":9.26,"maximum":49.96,"gross_charge":61.67,"discounted_cash":18.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0469-40","type":"NDC"}],"standard_charges":[{"minimum":36.59,"maximum":49.39,"gross_charge":60.97,"discounted_cash":18.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.59,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0469-40","type":"NDC"}],"standard_charges":[{"minimum":9.15,"maximum":49.39,"gross_charge":60.97,"discounted_cash":18.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0470-54","type":"NDC"}],"standard_charges":[{"minimum":37.36,"maximum":50.44,"gross_charge":62.26,"discounted_cash":18.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.36,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0470-54","type":"NDC"}],"standard_charges":[{"minimum":9.34,"maximum":50.44,"gross_charge":62.26,"discounted_cash":18.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70748-0323-10","type":"NDC"}],"standard_charges":[{"minimum":34,"maximum":45.9,"gross_charge":56.66,"discounted_cash":16.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70748-0323-10","type":"NDC"}],"standard_charges":[{"minimum":8.5,"maximum":45.9,"gross_charge":56.66,"discounted_cash":16.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0405-04","type":"NDC"}],"standard_charges":[{"minimum":39.11,"maximum":52.8,"gross_charge":65.18,"discounted_cash":19.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0405-04","type":"NDC"}],"standard_charges":[{"minimum":9.78,"maximum":52.8,"gross_charge":65.18,"discounted_cash":19.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0406-10","type":"NDC"}],"standard_charges":[{"minimum":40.44,"maximum":54.6,"gross_charge":67.4,"discounted_cash":19.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.44,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0406-10","type":"NDC"}],"standard_charges":[{"minimum":10.11,"maximum":54.6,"gross_charge":67.4,"discounted_cash":19.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72205-0102-01","type":"NDC"}],"standard_charges":[{"minimum":39.74,"maximum":53.64,"gross_charge":66.22,"discounted_cash":19.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72205-0102-01","type":"NDC"}],"standard_charges":[{"minimum":9.94,"maximum":53.64,"gross_charge":66.22,"discounted_cash":19.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0040-01","type":"NDC"}],"standard_charges":[{"minimum":40.87,"maximum":55.17,"gross_charge":68.11,"discounted_cash":20.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0040-01","type":"NDC"}],"standard_charges":[{"minimum":10.22,"maximum":55.17,"gross_charge":68.11,"discounted_cash":20.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0040-10","type":"NDC"}],"standard_charges":[{"minimum":40.41,"maximum":54.56,"gross_charge":67.35,"discounted_cash":19.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0040-10","type":"NDC"}],"standard_charges":[{"minimum":10.11,"maximum":54.56,"gross_charge":67.35,"discounted_cash":19.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0041-01","type":"NDC"}],"standard_charges":[{"minimum":41.03,"maximum":55.38,"gross_charge":68.37,"discounted_cash":20.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.03,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0041-01","type":"NDC"}],"standard_charges":[{"minimum":10.26,"maximum":55.38,"gross_charge":68.37,"discounted_cash":20.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.05,"maximum":47.32,"gross_charge":58.41,"discounted_cash":17.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.77,"maximum":47.32,"gross_charge":58.41,"discounted_cash":17.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.7,"maximum":53.59,"gross_charge":66.16,"discounted_cash":19.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 0.25 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.93,"maximum":53.59,"gross_charge":66.16,"discounted_cash":19.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.3,"maximum":69.26,"gross_charge":85.5,"discounted_cash":25.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.3,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.83,"maximum":69.26,"gross_charge":85.5,"discounted_cash":25.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64253-0900-30","type":"NDC"}],"standard_charges":[{"minimum":51.28,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64253-0900-30","type":"NDC"}],"standard_charges":[{"minimum":12.82,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64253-0900-91","type":"NDC"}],"standard_charges":[{"minimum":53.02,"maximum":71.58,"gross_charge":88.36,"discounted_cash":26.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.02,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64253-0900-91","type":"NDC"}],"standard_charges":[{"minimum":13.26,"maximum":71.58,"gross_charge":88.36,"discounted_cash":26.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76329-3304-01","type":"NDC"}],"standard_charges":[{"minimum":54.94,"maximum":74.17,"gross_charge":91.56,"discounted_cash":27.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76329-3304-01","type":"NDC"}],"standard_charges":[{"minimum":13.74,"maximum":74.17,"gross_charge":91.56,"discounted_cash":27.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.32,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":56.69,"maximum":76.53,"gross_charge":94.47,"discounted_cash":27.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.69,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":14.18,"maximum":76.53,"gross_charge":94.47,"discounted_cash":27.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":64.56,"maximum":87.16,"gross_charge":107.6,"discounted_cash":31.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.56,"methodology":"fee schedule"}]}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16.14,"maximum":87.16,"gross_charge":107.6,"discounted_cash":31.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.52,"methodology":"fee schedule"}]}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51754-0103-04","type":"NDC"}],"standard_charges":[{"minimum":38.01,"maximum":51.32,"gross_charge":63.35,"discounted_cash":18.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.01,"methodology":"fee schedule"}]}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51754-0103-04","type":"NDC"}],"standard_charges":[{"minimum":9.51,"maximum":51.32,"gross_charge":63.35,"discounted_cash":18.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"}]}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":86.74,"maximum":117.1,"gross_charge":144.56,"discounted_cash":42.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":101.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.74,"methodology":"fee schedule"}]}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":21.69,"maximum":117.1,"gross_charge":144.56,"discounted_cash":42.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":92.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":72.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":101.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.92,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0937-05","type":"NDC"}],"standard_charges":[{"minimum":39.28,"maximum":53.03,"gross_charge":65.46,"discounted_cash":19.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0937-05","type":"NDC"}],"standard_charges":[{"minimum":9.82,"maximum":53.03,"gross_charge":65.46,"discounted_cash":19.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0937-10","type":"NDC"}],"standard_charges":[{"minimum":39.53,"maximum":53.37,"gross_charge":65.88,"discounted_cash":19.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0937-10","type":"NDC"}],"standard_charges":[{"minimum":9.89,"maximum":53.37,"gross_charge":65.88,"discounted_cash":19.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0937-25","type":"NDC"}],"standard_charges":[{"minimum":58.05,"maximum":78.36,"gross_charge":96.74,"discounted_cash":28.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.05,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0937-25","type":"NDC"}],"standard_charges":[{"minimum":14.52,"maximum":78.36,"gross_charge":96.74,"discounted_cash":28.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0319-05","type":"NDC"}],"standard_charges":[{"minimum":37.77,"maximum":50.99,"gross_charge":62.95,"discounted_cash":18.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.77,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0319-05","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":50.99,"gross_charge":62.95,"discounted_cash":18.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0425-10","type":"NDC"}],"standard_charges":[{"minimum":37.75,"maximum":50.96,"gross_charge":62.91,"discounted_cash":18.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.75,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0425-10","type":"NDC"}],"standard_charges":[{"minimum":9.44,"maximum":50.96,"gross_charge":62.91,"discounted_cash":18.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0301-05","type":"NDC"}],"standard_charges":[{"minimum":37.78,"maximum":51,"gross_charge":62.96,"discounted_cash":18.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0301-05","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":51,"gross_charge":62.96,"discounted_cash":18.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.91,"maximum":53.88,"gross_charge":66.51,"discounted_cash":19.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.98,"maximum":53.88,"gross_charge":66.51,"discounted_cash":19.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.95,"maximum":53.93,"gross_charge":66.58,"discounted_cash":19.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.99,"maximum":53.93,"gross_charge":66.58,"discounted_cash":19.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.29,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.75,"maximum":61.76,"gross_charge":76.24,"discounted_cash":22.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.44,"maximum":61.76,"gross_charge":76.24,"discounted_cash":22.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.25,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.74,"maximum":69.84,"gross_charge":86.22,"discounted_cash":25.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.74,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.94,"maximum":69.84,"gross_charge":86.22,"discounted_cash":25.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0644-10","type":"NDC"}],"standard_charges":[{"minimum":60.83,"maximum":82.11,"gross_charge":101.37,"discounted_cash":30.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.83,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0644-10","type":"NDC"}],"standard_charges":[{"minimum":15.21,"maximum":82.11,"gross_charge":101.37,"discounted_cash":30.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.28,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0130-17","type":"NDC"}],"standard_charges":[{"minimum":58.44,"maximum":78.9,"gross_charge":97.4,"discounted_cash":28.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.44,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0130-17","type":"NDC"}],"standard_charges":[{"minimum":14.61,"maximum":78.9,"gross_charge":97.4,"discounted_cash":28.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67457-0437-10","type":"NDC"}],"standard_charges":[{"minimum":71.32,"maximum":96.28,"gross_charge":118.86,"discounted_cash":35.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.32,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67457-0437-10","type":"NDC"}],"standard_charges":[{"minimum":17.83,"maximum":96.28,"gross_charge":118.86,"discounted_cash":35.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.78,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68382-0910-10","type":"NDC"}],"standard_charges":[{"minimum":93.66,"maximum":126.45,"gross_charge":156.1,"discounted_cash":46.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":101.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":109.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.66,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68382-0910-10","type":"NDC"}],"standard_charges":[{"minimum":23.42,"maximum":126.45,"gross_charge":156.1,"discounted_cash":46.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":70.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":109.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":60.75,"maximum":82.02,"gross_charge":101.25,"discounted_cash":29.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.19,"maximum":82.02,"gross_charge":101.25,"discounted_cash":29.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0761-06","type":"NDC"}],"standard_charges":[{"minimum":55.68,"maximum":75.16,"gross_charge":92.79,"discounted_cash":27.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.68,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"17478-0761-06","type":"NDC"}],"standard_charges":[{"minimum":13.92,"maximum":75.16,"gross_charge":92.79,"discounted_cash":27.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"42858-0867-06","type":"NDC"}],"standard_charges":[{"minimum":45.67,"maximum":61.65,"gross_charge":76.11,"discounted_cash":22.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.67,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"42858-0867-06","type":"NDC"}],"standard_charges":[{"minimum":11.42,"maximum":61.65,"gross_charge":76.11,"discounted_cash":22.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"60687-0375-11","type":"NDC"}],"standard_charges":[{"minimum":2.64,"maximum":3.57,"gross_charge":4.4,"discounted_cash":1.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"60687-0375-11","type":"NDC"}],"standard_charges":[{"minimum":0.66,"maximum":3.57,"gross_charge":4.4,"discounted_cash":1.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"60687-0375-21","type":"NDC"}],"standard_charges":[{"minimum":77.01,"maximum":103.97,"gross_charge":128.35,"discounted_cash":38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.01,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"60687-0375-21","type":"NDC"}],"standard_charges":[{"minimum":19.26,"maximum":103.97,"gross_charge":128.35,"discounted_cash":38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.67,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0568-60","type":"NDC"}],"standard_charges":[{"minimum":56.72,"maximum":76.57,"gross_charge":94.53,"discounted_cash":27.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.72,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0568-60","type":"NDC"}],"standard_charges":[{"minimum":14.18,"maximum":76.57,"gross_charge":94.53,"discounted_cash":27.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.27,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.91,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0753-60","type":"NDC"}],"standard_charges":[{"minimum":60.79,"maximum":82.07,"gross_charge":101.31,"discounted_cash":29.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.79,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0753-60","type":"NDC"}],"standard_charges":[{"minimum":15.2,"maximum":82.07,"gross_charge":101.31,"discounted_cash":29.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.27,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0174-11","type":"NDC"}],"standard_charges":[{"minimum":212.58,"maximum":286.99,"gross_charge":354.3,"discounted_cash":104.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":230.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":248.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.58,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0174-11","type":"NDC"}],"standard_charges":[{"minimum":53.15,"maximum":286.99,"gross_charge":354.3,"discounted_cash":104.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":226.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":177.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":177.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":159.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":248.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.86,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":102.31,"maximum":138.12,"gross_charge":170.51,"discounted_cash":50.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.31,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":25.58,"maximum":138.12,"gross_charge":170.51,"discounted_cash":50.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":247.94,"maximum":334.71,"gross_charge":413.22,"discounted_cash":122.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":268.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.94,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 2.5 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":61.99,"maximum":334.71,"gross_charge":413.22,"discounted_cash":122.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":264.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":206.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":206.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":185.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.65,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"42858-0868-06","type":"NDC"}],"standard_charges":[{"minimum":68.71,"maximum":92.76,"gross_charge":114.51,"discounted_cash":33.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.71,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"42858-0868-06","type":"NDC"}],"standard_charges":[{"minimum":17.18,"maximum":92.76,"gross_charge":114.51,"discounted_cash":33.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"60687-0386-11","type":"NDC"}],"standard_charges":[{"minimum":5.27,"maximum":7.12,"gross_charge":8.78,"discounted_cash":2.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"60687-0386-11","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":7.12,"gross_charge":8.78,"discounted_cash":2.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0754-60","type":"NDC"}],"standard_charges":[{"minimum":111.99,"maximum":151.19,"gross_charge":186.65,"discounted_cash":55.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":121.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":130.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.99,"methodology":"fee schedule"}]}]},{"description":"DRONABINOL 5 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0754-60","type":"NDC"}],"standard_charges":[{"minimum":28,"maximum":151.19,"gross_charge":186.65,"discounted_cash":55.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":119.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":93.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":93.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":130.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.33,"methodology":"fee schedule"}]}]},{"description":"ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25682-0001-01","type":"NDC"}],"standard_charges":[{"minimum":28400.76,"maximum":38341.03,"gross_charge":47334.6,"discounted_cash":14011.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38341.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38341.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38341.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30767.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33134.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28400.76,"methodology":"fee schedule"}]}]},{"description":"ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25682-0001-01","type":"NDC"}],"standard_charges":[{"minimum":7100.19,"maximum":38341.03,"gross_charge":47334.6,"discounted_cash":14011.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38341.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38341.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38341.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30294.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23667.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23667.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21300.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33134.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28400.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8993.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9466.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7100.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9466.92,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0739-12","type":"NDC"}],"standard_charges":[{"minimum":34.18,"maximum":46.14,"gross_charge":56.96,"discounted_cash":16.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.18,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0739-12","type":"NDC"}],"standard_charges":[{"minimum":8.55,"maximum":46.14,"gross_charge":56.96,"discounted_cash":16.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67457-0433-00","type":"NDC"}],"standard_charges":[{"minimum":34.01,"maximum":45.91,"gross_charge":56.67,"discounted_cash":16.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.01,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67457-0433-00","type":"NDC"}],"standard_charges":[{"minimum":8.51,"maximum":45.91,"gross_charge":56.67,"discounted_cash":16.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"39822-1100-01","type":"NDC"}],"standard_charges":[{"minimum":77.27,"maximum":104.32,"gross_charge":128.78,"discounted_cash":38.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.27,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"39822-1100-01","type":"NDC"}],"standard_charges":[{"minimum":19.32,"maximum":104.32,"gross_charge":128.78,"discounted_cash":38.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0184-10","type":"NDC"}],"standard_charges":[{"minimum":86.04,"maximum":116.15,"gross_charge":143.39,"discounted_cash":42.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.04,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0184-10","type":"NDC"}],"standard_charges":[{"minimum":21.51,"maximum":116.15,"gross_charge":143.39,"discounted_cash":42.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":71.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":71.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"23155-0473-32","type":"NDC"}],"standard_charges":[{"minimum":35.1,"maximum":47.39,"gross_charge":58.5,"discounted_cash":17.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"23155-0473-32","type":"NDC"}],"standard_charges":[{"minimum":8.78,"maximum":47.39,"gross_charge":58.5,"discounted_cash":17.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"23155-0473-33","type":"NDC"}],"standard_charges":[{"minimum":36.3,"maximum":49,"gross_charge":60.49,"discounted_cash":17.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"23155-0473-33","type":"NDC"}],"standard_charges":[{"minimum":9.08,"maximum":49,"gross_charge":60.49,"discounted_cash":17.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0311-02","type":"NDC"}],"standard_charges":[{"minimum":34.62,"maximum":46.73,"gross_charge":57.69,"discounted_cash":17.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.62,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0311-02","type":"NDC"}],"standard_charges":[{"minimum":8.66,"maximum":46.73,"gross_charge":57.69,"discounted_cash":17.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0311-04","type":"NDC"}],"standard_charges":[{"minimum":35.19,"maximum":47.51,"gross_charge":58.65,"discounted_cash":17.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.19,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"25021-0311-04","type":"NDC"}],"standard_charges":[{"minimum":8.8,"maximum":47.51,"gross_charge":58.65,"discounted_cash":17.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"36000-0283-25","type":"NDC"}],"standard_charges":[{"minimum":34.41,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"36000-0283-25","type":"NDC"}],"standard_charges":[{"minimum":8.61,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"36000-0284-25","type":"NDC"}],"standard_charges":[{"minimum":35.24,"maximum":47.57,"gross_charge":58.72,"discounted_cash":17.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"36000-0284-25","type":"NDC"}],"standard_charges":[{"minimum":8.81,"maximum":47.57,"gross_charge":58.72,"discounted_cash":17.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0323-25","type":"NDC"}],"standard_charges":[{"minimum":35.09,"maximum":47.37,"gross_charge":58.48,"discounted_cash":17.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0323-25","type":"NDC"}],"standard_charges":[{"minimum":8.78,"maximum":47.37,"gross_charge":58.48,"discounted_cash":17.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0280-10","type":"NDC"}],"standard_charges":[{"minimum":35.09,"maximum":47.37,"gross_charge":58.47,"discounted_cash":17.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0280-10","type":"NDC"}],"standard_charges":[{"minimum":8.78,"maximum":47.37,"gross_charge":58.47,"discounted_cash":17.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0280-26","type":"NDC"}],"standard_charges":[{"minimum":34.25,"maximum":46.23,"gross_charge":57.07,"discounted_cash":16.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.25,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0280-26","type":"NDC"}],"standard_charges":[{"minimum":8.57,"maximum":46.23,"gross_charge":57.07,"discounted_cash":16.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.54,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0759-01","type":"NDC"}],"standard_charges":[{"minimum":37.88,"maximum":51.13,"gross_charge":63.12,"discounted_cash":18.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0759-01","type":"NDC"}],"standard_charges":[{"minimum":9.47,"maximum":51.13,"gross_charge":63.12,"discounted_cash":18.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0759-03","type":"NDC"}],"standard_charges":[{"minimum":40.29,"maximum":54.39,"gross_charge":67.14,"discounted_cash":19.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0759-03","type":"NDC"}],"standard_charges":[{"minimum":10.08,"maximum":54.39,"gross_charge":67.14,"discounted_cash":19.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0759-11","type":"NDC"}],"standard_charges":[{"minimum":39.5,"maximum":53.32,"gross_charge":65.82,"discounted_cash":19.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.5,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0759-11","type":"NDC"}],"standard_charges":[{"minimum":9.88,"maximum":53.32,"gross_charge":65.82,"discounted_cash":19.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0302-10","type":"NDC"}],"standard_charges":[{"minimum":37.19,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0302-10","type":"NDC"}],"standard_charges":[{"minimum":9.3,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"71288-0203-02","type":"NDC"}],"standard_charges":[{"minimum":33.62,"maximum":45.39,"gross_charge":56.03,"discounted_cash":16.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"71288-0203-02","type":"NDC"}],"standard_charges":[{"minimum":8.41,"maximum":45.39,"gross_charge":56.03,"discounted_cash":16.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0190-01","type":"NDC"}],"standard_charges":[{"minimum":34.81,"maximum":46.99,"gross_charge":58.01,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0190-01","type":"NDC"}],"standard_charges":[{"minimum":8.71,"maximum":46.99,"gross_charge":58.01,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72603-0133-25","type":"NDC"}],"standard_charges":[{"minimum":34.37,"maximum":46.4,"gross_charge":57.28,"discounted_cash":16.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.37,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72603-0133-25","type":"NDC"}],"standard_charges":[{"minimum":8.6,"maximum":46.4,"gross_charge":57.28,"discounted_cash":16.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.94,"maximum":45.82,"gross_charge":56.56,"discounted_cash":16.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.49,"maximum":45.82,"gross_charge":56.56,"discounted_cash":16.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.27,"maximum":61.11,"gross_charge":75.44,"discounted_cash":22.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.32,"maximum":61.11,"gross_charge":75.44,"discounted_cash":22.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"}]}]},{"description":"GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50242-0125-01","type":"NDC"}],"standard_charges":[{"minimum":11484.83,"maximum":15504.51,"gross_charge":19141.37,"discounted_cash":5665.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15504.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15504.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15504.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12441.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13398.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11484.83,"methodology":"fee schedule"}]}]},{"description":"GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50242-0125-01","type":"NDC"}],"standard_charges":[{"minimum":2871.21,"maximum":15504.51,"gross_charge":19141.37,"discounted_cash":5665.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15504.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15504.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15504.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12250.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9570.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9570.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8613.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13398.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11484.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3636.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3828.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2871.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3828.28,"methodology":"fee schedule"}]}]},{"description":"GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50242-0127-01","type":"NDC"}],"standard_charges":[{"minimum":45254.28,"maximum":61093.28,"gross_charge":75423.8,"discounted_cash":22325.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61093.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61093.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61093.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49025.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52796.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45254.28,"methodology":"fee schedule"}]}]},{"description":"GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50242-0127-01","type":"NDC"}],"standard_charges":[{"minimum":11313.57,"maximum":61093.28,"gross_charge":75423.8,"discounted_cash":22325.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61093.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61093.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61093.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48271.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37711.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37711.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33940.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52796.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45254.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14330.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15084.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11313.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15084.76,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0536-01","type":"NDC"}],"standard_charges":[{"minimum":35.58,"maximum":48.04,"gross_charge":59.3,"discounted_cash":17.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0536-01","type":"NDC"}],"standard_charges":[{"minimum":8.9,"maximum":48.04,"gross_charge":59.3,"discounted_cash":17.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0292-01","type":"NDC"}],"standard_charges":[{"minimum":48.74,"maximum":65.79,"gross_charge":81.22,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.74,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0292-01","type":"NDC"}],"standard_charges":[{"minimum":12.19,"maximum":65.79,"gross_charge":81.22,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0578-11","type":"NDC"}],"standard_charges":[{"minimum":37.32,"maximum":50.38,"gross_charge":62.19,"discounted_cash":18.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0578-11","type":"NDC"}],"standard_charges":[{"minimum":9.33,"maximum":50.38,"gross_charge":62.19,"discounted_cash":18.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70069-0011-01","type":"NDC"}],"standard_charges":[{"minimum":35,"maximum":47.25,"gross_charge":58.33,"discounted_cash":17.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70069-0011-01","type":"NDC"}],"standard_charges":[{"minimum":8.75,"maximum":47.25,"gross_charge":58.33,"discounted_cash":17.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70069-0012-01","type":"NDC"}],"standard_charges":[{"minimum":36.5,"maximum":49.28,"gross_charge":60.83,"discounted_cash":18.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.5,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70069-0012-01","type":"NDC"}],"standard_charges":[{"minimum":9.13,"maximum":49.28,"gross_charge":60.83,"discounted_cash":18.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70121-1394-01","type":"NDC"}],"standard_charges":[{"minimum":41.21,"maximum":55.63,"gross_charge":68.67,"discounted_cash":20.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70121-1394-01","type":"NDC"}],"standard_charges":[{"minimum":10.31,"maximum":55.63,"gross_charge":68.67,"discounted_cash":20.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0781-01","type":"NDC"}],"standard_charges":[{"minimum":34.27,"maximum":46.26,"gross_charge":57.11,"discounted_cash":16.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"70860-0781-01","type":"NDC"}],"standard_charges":[{"minimum":8.57,"maximum":46.26,"gross_charge":57.11,"discounted_cash":16.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0226-01","type":"NDC"}],"standard_charges":[{"minimum":40.37,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0226-01","type":"NDC"}],"standard_charges":[{"minimum":10.1,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.01,"maximum":47.26,"gross_charge":58.34,"discounted_cash":17.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.76,"maximum":47.26,"gross_charge":58.34,"discounted_cash":17.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.38,"maximum":47.76,"gross_charge":58.96,"discounted_cash":17.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.38,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.85,"maximum":47.76,"gross_charge":58.96,"discounted_cash":17.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.29,"maximum":50.35,"gross_charge":62.15,"discounted_cash":18.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.29,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.33,"maximum":50.35,"gross_charge":62.15,"discounted_cash":18.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.9,"maximum":55.21,"gross_charge":68.16,"discounted_cash":20.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.23,"maximum":55.21,"gross_charge":68.16,"discounted_cash":20.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-11","type":"NDC"}],"standard_charges":[{"minimum":38.5,"maximum":51.97,"gross_charge":64.16,"discounted_cash":19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-11","type":"NDC"}],"standard_charges":[{"minimum":9.63,"maximum":51.97,"gross_charge":64.16,"discounted_cash":19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-05","type":"NDC"}],"standard_charges":[{"minimum":41.06,"maximum":55.43,"gross_charge":68.43,"discounted_cash":20.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.06,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-05","type":"NDC"}],"standard_charges":[{"minimum":10.27,"maximum":55.43,"gross_charge":68.43,"discounted_cash":20.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-96","type":"NDC"}],"standard_charges":[{"minimum":38.82,"maximum":52.4,"gross_charge":64.69,"discounted_cash":19.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-96","type":"NDC"}],"standard_charges":[{"minimum":9.71,"maximum":52.4,"gross_charge":64.69,"discounted_cash":19.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.18,"maximum":50.19,"gross_charge":61.96,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.3,"maximum":50.19,"gross_charge":61.96,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.3,"maximum":53.06,"gross_charge":65.5,"discounted_cash":19.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.3,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.83,"maximum":53.06,"gross_charge":65.5,"discounted_cash":19.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-10","type":"NDC"}],"standard_charges":[{"minimum":40.53,"maximum":54.71,"gross_charge":67.54,"discounted_cash":20,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"76045-0009-10","type":"NDC"}],"standard_charges":[{"minimum":10.14,"maximum":54.71,"gross_charge":67.54,"discounted_cash":20,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJ (WRAPPER)","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.92,"maximum":51.19,"gross_charge":63.19,"discounted_cash":18.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.92,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJ (WRAPPER)","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.48,"maximum":51.19,"gross_charge":63.19,"discounted_cash":18.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.02,"maximum":49.97,"gross_charge":61.69,"discounted_cash":18.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.02,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.26,"maximum":49.97,"gross_charge":61.69,"discounted_cash":18.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.4,"maximum":53.19,"gross_charge":65.66,"discounted_cash":19.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.85,"maximum":53.19,"gross_charge":65.66,"discounted_cash":19.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50268-0398-11","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":0.32,"gross_charge":0.39,"discounted_cash":0.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50268-0398-11","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.32,"gross_charge":0.39,"discounted_cash":0.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50268-0398-50","type":"NDC"}],"standard_charges":[{"minimum":7.73,"maximum":10.44,"gross_charge":12.88,"discounted_cash":3.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50268-0398-50","type":"NDC"}],"standard_charges":[{"minimum":1.94,"maximum":10.44,"gross_charge":12.88,"discounted_cash":3.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51079-0077-20","type":"NDC"}],"standard_charges":[{"minimum":6.02,"maximum":8.13,"gross_charge":10.03,"discounted_cash":2.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"51079-0077-20","type":"NDC"}],"standard_charges":[{"minimum":1.51,"maximum":8.13,"gross_charge":10.03,"discounted_cash":2.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0847-11","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0847-11","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.4,"maximum":5.94,"gross_charge":7.33,"discounted_cash":2.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.1,"maximum":5.94,"gross_charge":7.33,"discounted_cash":2.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.26,"maximum":8.45,"gross_charge":10.43,"discounted_cash":3.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.57,"maximum":8.45,"gross_charge":10.43,"discounted_cash":3.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16.65,"maximum":22.47,"gross_charge":27.74,"discounted_cash":8.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 25 MG CAPSULE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.17,"maximum":22.47,"gross_charge":27.74,"discounted_cash":8.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"}]}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":400.84,"maximum":541.13,"gross_charge":668.06,"discounted_cash":197.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":434.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":467.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":400.84,"methodology":"fee schedule"}]}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":100.21,"maximum":541.13,"gross_charge":668.06,"discounted_cash":197.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":541.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":427.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":334.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":334.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":300.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":467.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":400.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.62,"methodology":"fee schedule"}]}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"81284-0315-00","type":"NDC"}],"standard_charges":[{"minimum":922.61,"maximum":1245.53,"gross_charge":1537.68,"discounted_cash":455.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1245.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1245.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1245.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":999.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":922.61,"methodology":"fee schedule"}]}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"81284-0315-00","type":"NDC"}],"standard_charges":[{"minimum":230.66,"maximum":1245.53,"gross_charge":1537.68,"discounted_cash":455.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1245.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1245.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1245.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":984.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":768.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":768.84,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":691.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1076.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":922.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":292.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":307.54,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0158-72","type":"NDC"}],"standard_charges":[{"minimum":34.98,"maximum":47.22,"gross_charge":58.29,"discounted_cash":17.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0158-72","type":"NDC"}],"standard_charges":[{"minimum":8.75,"maximum":47.22,"gross_charge":58.29,"discounted_cash":17.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0159-74","type":"NDC"}],"standard_charges":[{"minimum":35.3,"maximum":47.66,"gross_charge":58.83,"discounted_cash":17.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.3,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0159-74","type":"NDC"}],"standard_charges":[{"minimum":8.83,"maximum":47.66,"gross_charge":58.83,"discounted_cash":17.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0161-02","type":"NDC"}],"standard_charges":[{"minimum":36.28,"maximum":48.98,"gross_charge":60.46,"discounted_cash":17.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.28,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0161-02","type":"NDC"}],"standard_charges":[{"minimum":9.07,"maximum":48.98,"gross_charge":60.46,"discounted_cash":17.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0162-05","type":"NDC"}],"standard_charges":[{"minimum":37.94,"maximum":51.22,"gross_charge":63.23,"discounted_cash":18.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.94,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0162-05","type":"NDC"}],"standard_charges":[{"minimum":9.49,"maximum":51.22,"gross_charge":63.23,"discounted_cash":18.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-26","type":"NDC"}],"standard_charges":[{"minimum":38.47,"maximum":51.93,"gross_charge":64.11,"discounted_cash":18.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-26","type":"NDC"}],"standard_charges":[{"minimum":9.62,"maximum":51.93,"gross_charge":64.11,"discounted_cash":18.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-36","type":"NDC"}],"standard_charges":[{"minimum":35.93,"maximum":48.51,"gross_charge":59.88,"discounted_cash":17.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.93,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-36","type":"NDC"}],"standard_charges":[{"minimum":8.99,"maximum":48.51,"gross_charge":59.88,"discounted_cash":17.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-41","type":"NDC"}],"standard_charges":[{"minimum":35.15,"maximum":47.45,"gross_charge":58.57,"discounted_cash":17.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-41","type":"NDC"}],"standard_charges":[{"minimum":8.79,"maximum":47.45,"gross_charge":58.57,"discounted_cash":17.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.29,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-97","type":"NDC"}],"standard_charges":[{"minimum":46.53,"maximum":62.81,"gross_charge":77.54,"discounted_cash":22.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0492-97","type":"NDC"}],"standard_charges":[{"minimum":11.64,"maximum":62.81,"gross_charge":77.54,"discounted_cash":22.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0370-25","type":"NDC"}],"standard_charges":[{"minimum":35.92,"maximum":48.49,"gross_charge":59.86,"discounted_cash":17.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0370-25","type":"NDC"}],"standard_charges":[{"minimum":8.98,"maximum":48.49,"gross_charge":59.86,"discounted_cash":17.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"73293-0001-01","type":"NDC"}],"standard_charges":[{"minimum":36.25,"maximum":48.94,"gross_charge":60.41,"discounted_cash":17.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"73293-0001-01","type":"NDC"}],"standard_charges":[{"minimum":9.07,"maximum":48.94,"gross_charge":60.41,"discounted_cash":17.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"73293-0001-02","type":"NDC"}],"standard_charges":[{"minimum":33.48,"maximum":45.19,"gross_charge":55.79,"discounted_cash":16.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.48,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"73293-0001-02","type":"NDC"}],"standard_charges":[{"minimum":8.37,"maximum":45.19,"gross_charge":55.79,"discounted_cash":16.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35,"maximum":47.24,"gross_charge":58.32,"discounted_cash":17.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.75,"maximum":47.24,"gross_charge":58.32,"discounted_cash":17.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.04,"maximum":47.3,"gross_charge":58.39,"discounted_cash":17.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.76,"maximum":47.3,"gross_charge":58.39,"discounted_cash":17.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.57,"maximum":48.01,"gross_charge":59.27,"discounted_cash":17.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.9,"maximum":48.01,"gross_charge":59.27,"discounted_cash":17.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.38,"maximum":53.17,"gross_charge":65.63,"discounted_cash":19.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.38,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.85,"maximum":53.17,"gross_charge":65.63,"discounted_cash":19.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0491-57","type":"NDC"}],"standard_charges":[{"minimum":64.62,"maximum":87.23,"gross_charge":107.69,"discounted_cash":31.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.62,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0491-57","type":"NDC"}],"standard_charges":[{"minimum":16.16,"maximum":87.23,"gross_charge":107.69,"discounted_cash":31.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0482-03","type":"NDC"}],"standard_charges":[{"minimum":42.74,"maximum":57.7,"gross_charge":71.23,"discounted_cash":21.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0482-03","type":"NDC"}],"standard_charges":[{"minimum":10.69,"maximum":57.7,"gross_charge":71.23,"discounted_cash":21.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.64,"maximum":50.81,"gross_charge":62.72,"discounted_cash":18.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.64,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.41,"maximum":50.81,"gross_charge":62.72,"discounted_cash":18.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.74,"maximum":50.95,"gross_charge":62.89,"discounted_cash":18.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.44,"maximum":50.95,"gross_charge":62.89,"discounted_cash":18.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.67,"maximum":54.91,"gross_charge":67.78,"discounted_cash":20.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 1 %-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.17,"maximum":54.91,"gross_charge":67.78,"discounted_cash":20.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.89,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0483-27","type":"NDC"}],"standard_charges":[{"minimum":42.84,"maximum":57.84,"gross_charge":71.4,"discounted_cash":21.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0483-27","type":"NDC"}],"standard_charges":[{"minimum":10.71,"maximum":57.84,"gross_charge":71.4,"discounted_cash":21.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.73,"maximum":49.59,"gross_charge":61.21,"discounted_cash":18.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.19,"maximum":49.59,"gross_charge":61.21,"discounted_cash":18.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.93,"maximum":49.86,"gross_charge":61.55,"discounted_cash":18.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.24,"maximum":49.86,"gross_charge":61.55,"discounted_cash":18.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.78,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0254-10","type":"NDC"}],"standard_charges":[{"minimum":36.42,"maximum":49.17,"gross_charge":60.7,"discounted_cash":17.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.42,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0254-10","type":"NDC"}],"standard_charges":[{"minimum":9.11,"maximum":49.17,"gross_charge":60.7,"discounted_cash":17.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0255-20","type":"NDC"}],"standard_charges":[{"minimum":36.38,"maximum":49.11,"gross_charge":60.62,"discounted_cash":17.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.38,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0255-20","type":"NDC"}],"standard_charges":[{"minimum":9.1,"maximum":49.11,"gross_charge":60.62,"discounted_cash":17.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0486-02","type":"NDC"}],"standard_charges":[{"minimum":41.63,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0486-02","type":"NDC"}],"standard_charges":[{"minimum":10.41,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0486-41","type":"NDC"}],"standard_charges":[{"minimum":36.48,"maximum":49.24,"gross_charge":60.79,"discounted_cash":18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0486-41","type":"NDC"}],"standard_charges":[{"minimum":9.12,"maximum":49.24,"gross_charge":60.79,"discounted_cash":18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0486-57","type":"NDC"}],"standard_charges":[{"minimum":49.21,"maximum":66.43,"gross_charge":82.01,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0486-57","type":"NDC"}],"standard_charges":[{"minimum":12.31,"maximum":66.43,"gross_charge":82.01,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.31,"maximum":47.67,"gross_charge":58.85,"discounted_cash":17.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.83,"maximum":47.67,"gross_charge":58.85,"discounted_cash":17.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0487-37","type":"NDC"}],"standard_charges":[{"minimum":42.64,"maximum":57.56,"gross_charge":71.06,"discounted_cash":21.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0487-37","type":"NDC"}],"standard_charges":[{"minimum":10.66,"maximum":57.56,"gross_charge":71.06,"discounted_cash":21.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.84,"maximum":53.78,"gross_charge":66.39,"discounted_cash":19.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.84,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 INJECTION SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.96,"maximum":53.78,"gross_charge":66.39,"discounted_cash":19.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0489-02","type":"NDC"}],"standard_charges":[{"minimum":49.71,"maximum":67.11,"gross_charge":82.85,"discounted_cash":24.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0489-02","type":"NDC"}],"standard_charges":[{"minimum":12.43,"maximum":67.11,"gross_charge":82.85,"discounted_cash":24.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.7,"maximum":68.44,"gross_charge":84.49,"discounted_cash":25.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.7,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.68,"maximum":68.44,"gross_charge":84.49,"discounted_cash":25.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.9,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.59,"maximum":69.65,"gross_charge":85.98,"discounted_cash":25.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.9,"maximum":69.65,"gross_charge":85.98,"discounted_cash":25.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"36000-0033-10","type":"NDC"}],"standard_charges":[{"minimum":34.43,"maximum":46.48,"gross_charge":57.38,"discounted_cash":16.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"36000-0033-10","type":"NDC"}],"standard_charges":[{"minimum":8.61,"maximum":46.48,"gross_charge":57.38,"discounted_cash":16.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0660-05","type":"NDC"}],"standard_charges":[{"minimum":35.13,"maximum":47.42,"gross_charge":58.54,"discounted_cash":17.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.13,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0660-05","type":"NDC"}],"standard_charges":[{"minimum":8.79,"maximum":47.42,"gross_charge":58.54,"discounted_cash":17.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72266-0122-05","type":"NDC"}],"standard_charges":[{"minimum":34.34,"maximum":46.36,"gross_charge":57.23,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72266-0122-05","type":"NDC"}],"standard_charges":[{"minimum":8.59,"maximum":46.36,"gross_charge":57.23,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0420-10","type":"NDC"}],"standard_charges":[{"minimum":43.02,"maximum":58.07,"gross_charge":71.69,"discounted_cash":21.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0420-10","type":"NDC"}],"standard_charges":[{"minimum":10.76,"maximum":58.07,"gross_charge":71.69,"discounted_cash":21.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.91,"maximum":45.78,"gross_charge":56.51,"discounted_cash":16.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.91,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":45.78,"gross_charge":56.51,"discounted_cash":16.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.04,"maximum":45.95,"gross_charge":56.72,"discounted_cash":16.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.51,"maximum":45.95,"gross_charge":56.72,"discounted_cash":16.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INTRAVENOUS SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.94,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INTRAVENOUS SYRINGE","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.99,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"66689-0307-08","type":"NDC"}],"standard_charges":[{"minimum":214.3,"maximum":289.3,"gross_charge":357.16,"discounted_cash":105.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":232.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.3,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"66689-0307-08","type":"NDC"}],"standard_charges":[{"minimum":53.58,"maximum":289.3,"gross_charge":357.16,"discounted_cash":105.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":228.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":178.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":178.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":160.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.44,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0230-22","type":"NDC"}],"standard_charges":[{"minimum":609.23,"maximum":822.46,"gross_charge":1015.38,"discounted_cash":300.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":660,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":710.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":609.23,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0230-22","type":"NDC"}],"standard_charges":[{"minimum":152.31,"maximum":822.46,"gross_charge":1015.38,"discounted_cash":300.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":649.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":507.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":507.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":456.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":710.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":609.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.08,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0230-25","type":"NDC"}],"standard_charges":[{"minimum":7.69,"maximum":10.38,"gross_charge":12.81,"discounted_cash":3.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"67877-0230-25","type":"NDC"}],"standard_charges":[{"minimum":1.93,"maximum":10.38,"gross_charge":12.81,"discounted_cash":3.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":150.26,"maximum":202.85,"gross_charge":250.42,"discounted_cash":74.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":162.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":175.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.26,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.57,"maximum":202.85,"gross_charge":250.42,"discounted_cash":74.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":160.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":175.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.09,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE (PF) 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0183-01","type":"NDC"}],"standard_charges":[{"minimum":73.33,"maximum":99,"gross_charge":122.21,"discounted_cash":36.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":85.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.33,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE (PF) 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55150-0183-01","type":"NDC"}],"standard_charges":[{"minimum":18.34,"maximum":99,"gross_charge":122.21,"discounted_cash":36.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":85.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.45,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0631-02","type":"NDC"}],"standard_charges":[{"minimum":54.29,"maximum":73.29,"gross_charge":90.47,"discounted_cash":26.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.29,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"64679-0631-02","type":"NDC"}],"standard_charges":[{"minimum":13.58,"maximum":73.29,"gross_charge":90.47,"discounted_cash":26.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72485-0116-01","type":"NDC"}],"standard_charges":[{"minimum":53.6,"maximum":72.36,"gross_charge":89.33,"discounted_cash":26.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.6,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72485-0116-01","type":"NDC"}],"standard_charges":[{"minimum":13.4,"maximum":72.36,"gross_charge":89.33,"discounted_cash":26.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0470-10","type":"NDC"}],"standard_charges":[{"minimum":81.14,"maximum":109.53,"gross_charge":135.22,"discounted_cash":40.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.14,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"72572-0470-10","type":"NDC"}],"standard_charges":[{"minimum":20.29,"maximum":109.53,"gross_charge":135.22,"discounted_cash":40.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.9,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.98,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0200-10","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.25,"gross_charge":0.3,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0200-10","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.25,"gross_charge":0.3,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0200-30","type":"NDC"}],"standard_charges":[{"minimum":3.2,"maximum":4.31,"gross_charge":5.32,"discounted_cash":1.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"16714-0200-30","type":"NDC"}],"standard_charges":[{"minimum":0.8,"maximum":4.31,"gross_charge":5.32,"discounted_cash":1.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"57237-0077-10","type":"NDC"}],"standard_charges":[{"minimum":4.49,"maximum":6.06,"gross_charge":7.48,"discounted_cash":2.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"57237-0077-10","type":"NDC"}],"standard_charges":[{"minimum":1.13,"maximum":6.06,"gross_charge":7.48,"discounted_cash":2.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"62756-0240-60","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":0.6,"gross_charge":0.74,"discounted_cash":0.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"62756-0240-60","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.6,"gross_charge":0.74,"discounted_cash":0.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"62756-0240-64","type":"NDC"}],"standard_charges":[{"minimum":11.1,"maximum":14.98,"gross_charge":18.49,"discounted_cash":5.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"62756-0240-64","type":"NDC"}],"standard_charges":[{"minimum":2.78,"maximum":14.98,"gross_charge":18.49,"discounted_cash":5.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68001-0246-16","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":0.3,"gross_charge":0.37,"discounted_cash":0.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68001-0246-16","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.3,"gross_charge":0.37,"discounted_cash":0.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68001-0246-17","type":"NDC"}],"standard_charges":[{"minimum":4.31,"maximum":5.82,"gross_charge":7.18,"discounted_cash":2.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68001-0246-17","type":"NDC"}],"standard_charges":[{"minimum":1.08,"maximum":5.82,"gross_charge":7.18,"discounted_cash":2.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0157-13","type":"NDC"}],"standard_charges":[{"minimum":3.29,"maximum":4.44,"gross_charge":5.47,"discounted_cash":1.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0157-13","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":4.44,"gross_charge":5.47,"discounted_cash":1.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0157-40","type":"NDC"}],"standard_charges":[{"minimum":0.19,"maximum":0.26,"gross_charge":0.31,"discounted_cash":0.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON 4 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0157-40","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.26,"gross_charge":0.31,"discounted_cash":0.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0351-20","type":"NDC"}],"standard_charges":[{"minimum":171.46,"maximum":231.47,"gross_charge":285.76,"discounted_cash":84.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":185.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":200.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.46,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0351-20","type":"NDC"}],"standard_charges":[{"minimum":42.87,"maximum":231.47,"gross_charge":285.76,"discounted_cash":84.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":182.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":142.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":142.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":128.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":200.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.16,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":235.42,"maximum":317.82,"gross_charge":392.36,"discounted_cash":116.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":255.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":274.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.42,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 600 MG INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58.86,"maximum":317.82,"gross_charge":392.36,"discounted_cash":116.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":251.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":196.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":196.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":176.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":274.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.48,"methodology":"fee schedule"}]}]},{"description":"ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55513-0221-01","type":"NDC"}],"standard_charges":[{"minimum":12107.51,"maximum":16345.14,"gross_charge":20179.18,"discounted_cash":5973.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16345.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16345.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16345.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13116.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14125.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12107.51,"methodology":"fee schedule"}]}]},{"description":"ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55513-0221-01","type":"NDC"}],"standard_charges":[{"minimum":3026.88,"maximum":16345.14,"gross_charge":20179.18,"discounted_cash":5973.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16345.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16345.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16345.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12914.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10089.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10089.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9080.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14125.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12107.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3834.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4035.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3026.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4035.84,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50268-0718-11","type":"NDC"}],"standard_charges":[{"minimum":3.7,"maximum":4.99,"gross_charge":6.16,"discounted_cash":1.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"50268-0718-11","type":"NDC"}],"standard_charges":[{"minimum":0.93,"maximum":4.99,"gross_charge":6.16,"discounted_cash":1.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55111-0653-01","type":"NDC"}],"standard_charges":[{"minimum":302.55,"maximum":408.44,"gross_charge":504.24,"discounted_cash":149.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":327.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.55,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55111-0653-01","type":"NDC"}],"standard_charges":[{"minimum":75.64,"maximum":408.44,"gross_charge":504.24,"discounted_cash":149.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":322.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":252.12,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":226.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":352.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.85,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0915-25","type":"NDC"}],"standard_charges":[{"minimum":114.3,"maximum":154.3,"gross_charge":190.49,"discounted_cash":56.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":133.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.3,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0915-25","type":"NDC"}],"standard_charges":[{"minimum":28.58,"maximum":154.3,"gross_charge":190.49,"discounted_cash":56.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":121.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":95.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":133.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.1,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0915-95","type":"NDC"}],"standard_charges":[{"minimum":3.89,"maximum":5.25,"gross_charge":6.48,"discounted_cash":1.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68084-0915-95","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":5.25,"gross_charge":6.48,"discounted_cash":1.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0683-01","type":"NDC"}],"standard_charges":[{"minimum":121.25,"maximum":163.68,"gross_charge":202.07,"discounted_cash":59.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.25,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68462-0683-01","type":"NDC"}],"standard_charges":[{"minimum":30.32,"maximum":163.68,"gross_charge":202.07,"discounted_cash":59.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":101.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":101.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.42,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0088-61","type":"NDC"}],"standard_charges":[{"minimum":46.9,"maximum":63.31,"gross_charge":78.16,"discounted_cash":23.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.9,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0088-61","type":"NDC"}],"standard_charges":[{"minimum":11.73,"maximum":63.31,"gross_charge":78.16,"discounted_cash":23.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0093-01","type":"NDC"}],"standard_charges":[{"minimum":39.17,"maximum":52.88,"gross_charge":65.28,"discounted_cash":19.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0093-01","type":"NDC"}],"standard_charges":[{"minimum":9.8,"maximum":52.88,"gross_charge":65.28,"discounted_cash":19.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.06,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0187-30","type":"NDC"}],"standard_charges":[{"minimum":37.54,"maximum":50.68,"gross_charge":62.56,"discounted_cash":18.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"63323-0187-30","type":"NDC"}],"standard_charges":[{"minimum":9.39,"maximum":50.68,"gross_charge":62.56,"discounted_cash":18.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"}]}]},{"description":"SULBACTAM SODIUM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68547-0211-20","type":"NDC"}],"standard_charges":[{"minimum":392.73,"maximum":530.19,"gross_charge":654.55,"discounted_cash":193.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":425.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":458.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.73,"methodology":"fee schedule"}]}]},{"description":"SULBACTAM SODIUM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"68547-0211-20","type":"NDC"}],"standard_charges":[{"minimum":98.19,"maximum":530.19,"gross_charge":654.55,"discounted_cash":193.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":418.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":327.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":327.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":294.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":458.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.68,"maximum":65.71,"gross_charge":81.12,"discounted_cash":24.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.68,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.17,"maximum":65.71,"gross_charge":81.12,"discounted_cash":24.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.73,"maximum":65.79,"gross_charge":81.21,"discounted_cash":24.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.73,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.19,"maximum":65.79,"gross_charge":81.21,"discounted_cash":24.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"}]}]},{"description":"TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55513-0059-01","type":"NDC"}],"standard_charges":[{"minimum":6837.53,"maximum":9230.67,"gross_charge":11395.88,"discounted_cash":3373.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9230.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9230.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9230.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7407.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7977.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6837.53,"methodology":"fee schedule"}]}]},{"description":"TARLATAMAB-DLLE 1 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55513-0059-01","type":"NDC"}],"standard_charges":[{"minimum":1709.39,"maximum":9230.67,"gross_charge":11395.88,"discounted_cash":3373.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9230.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9230.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9230.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7293.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5697.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5697.94,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5128.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7977.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6837.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2165.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2279.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1709.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2279.18,"methodology":"fee schedule"}]}]},{"description":"TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55513-0069-01","type":"NDC"}],"standard_charges":[{"minimum":66319.96,"maximum":89531.95,"gross_charge":110533.26,"discounted_cash":32717.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89531.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89531.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89531.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71846.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77373.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66319.96,"methodology":"fee schedule"}]}]},{"description":"TARLATAMAB-DLLE 10 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"55513-0069-01","type":"NDC"}],"standard_charges":[{"minimum":16579.99,"maximum":89531.95,"gross_charge":110533.26,"discounted_cash":32717.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89531.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89531.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89531.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70741.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55266.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55266.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49739.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77373.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66319.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21001.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22106.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16579.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22106.66,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-AAZG 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0594-20","type":"NDC"}],"standard_charges":[{"minimum":7966.37,"maximum":10754.59,"gross_charge":13277.27,"discounted_cash":3930.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10754.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10754.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10754.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8630.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9294.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7966.37,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-AAZG 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"HC63600020","type":"CDM"},{"code":"0636","type":"RC"},{"code":"65219-0594-20","type":"NDC"}],"standard_charges":[{"minimum":1991.6,"maximum":10754.59,"gross_charge":13277.27,"discounted_cash":3930.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10754.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10754.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10754.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8497.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6638.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6638.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5974.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9294.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7966.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2522.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2655.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1991.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2655.46,"methodology":"fee schedule"}]}]},{"description":"ABIRATERONE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57894-0150-12","type":"NDC"}],"standard_charges":[{"minimum":6337.63,"maximum":8555.8,"gross_charge":10562.71,"discounted_cash":3126.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8555.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8555.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8555.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6337.63,"methodology":"fee schedule"}]}]},{"description":"ABIRATERONE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57894-0150-12","type":"NDC"}],"standard_charges":[{"minimum":1584.41,"maximum":8555.8,"gross_charge":10562.71,"discounted_cash":3126.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8555.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8555.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8555.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6337.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2006.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2112.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1584.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2112.55,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.78,"maximum":3.75,"gross_charge":4.62,"discounted_cash":1.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.7,"maximum":3.75,"gross_charge":4.62,"discounted_cash":1.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.81,"maximum":5.15,"gross_charge":6.35,"discounted_cash":1.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.96,"maximum":5.15,"gross_charge":6.35,"discounted_cash":1.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0004-10","type":"NDC"}],"standard_charges":[{"minimum":29.67,"maximum":40.05,"gross_charge":49.44,"discounted_cash":14.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.67,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0004-10","type":"NDC"}],"standard_charges":[{"minimum":7.42,"maximum":40.05,"gross_charge":49.44,"discounted_cash":14.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0440-01","type":"NDC"}],"standard_charges":[{"minimum":8.63,"maximum":11.65,"gross_charge":14.38,"discounted_cash":4.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0440-01","type":"NDC"}],"standard_charges":[{"minimum":2.16,"maximum":11.65,"gross_charge":14.38,"discounted_cash":4.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0571-56","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":0.87,"gross_charge":1.07,"discounted_cash":0.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0571-56","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.87,"gross_charge":1.07,"discounted_cash":0.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.83,"maximum":1.11,"gross_charge":1.37,"discounted_cash":0.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.21,"maximum":1.11,"gross_charge":1.37,"discounted_cash":0.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.16,"maximum":1.56,"gross_charge":1.92,"discounted_cash":0.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":1.56,"gross_charge":1.92,"discounted_cash":0.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50580-0457-11","type":"NDC"}],"standard_charges":[{"minimum":33.39,"maximum":45.07,"gross_charge":55.64,"discounted_cash":16.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50580-0457-11","type":"NDC"}],"standard_charges":[{"minimum":8.35,"maximum":45.07,"gross_charge":55.64,"discounted_cash":16.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":2.78,"gross_charge":3.43,"discounted_cash":1.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.52,"maximum":2.78,"gross_charge":3.43,"discounted_cash":1.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":11.45,"gross_charge":14.13,"discounted_cash":4.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.12,"maximum":11.45,"gross_charge":14.13,"discounted_cash":4.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0730-30","type":"NDC"}],"standard_charges":[{"minimum":2.6,"maximum":3.5,"gross_charge":4.32,"discounted_cash":1.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"}]}]},{"description":"ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0730-30","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":3.5,"gross_charge":4.32,"discounted_cash":1.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4023-01","type":"NDC"}],"standard_charges":[{"minimum":20.85,"maximum":28.14,"gross_charge":34.74,"discounted_cash":10.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4023-01","type":"NDC"}],"standard_charges":[{"minimum":5.22,"maximum":28.14,"gross_charge":34.74,"discounted_cash":10.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52817-0201-10","type":"NDC"}],"standard_charges":[{"minimum":22.53,"maximum":30.41,"gross_charge":37.54,"discounted_cash":11.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52817-0201-10","type":"NDC"}],"standard_charges":[{"minimum":5.64,"maximum":30.41,"gross_charge":37.54,"discounted_cash":11.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0541-01","type":"NDC"}],"standard_charges":[{"minimum":153.83,"maximum":207.67,"gross_charge":256.38,"discounted_cash":75.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":207.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":153.83,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0541-01","type":"NDC"}],"standard_charges":[{"minimum":38.46,"maximum":207.67,"gross_charge":256.38,"discounted_cash":75.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":207.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":207.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":207.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":153.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0541-11","type":"NDC"}],"standard_charges":[{"minimum":1.62,"maximum":2.18,"gross_charge":2.69,"discounted_cash":0.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0541-11","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":2.18,"gross_charge":2.69,"discounted_cash":0.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29033-0030-01","type":"NDC"}],"standard_charges":[{"minimum":75.1,"maximum":101.38,"gross_charge":125.16,"discounted_cash":37.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29033-0030-01","type":"NDC"}],"standard_charges":[{"minimum":18.78,"maximum":101.38,"gross_charge":125.16,"discounted_cash":37.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.04,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0233-01","type":"NDC"}],"standard_charges":[{"minimum":16.59,"maximum":22.39,"gross_charge":27.64,"discounted_cash":8.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0233-01","type":"NDC"}],"standard_charges":[{"minimum":4.15,"maximum":22.39,"gross_charge":27.64,"discounted_cash":8.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0401-11","type":"NDC"}],"standard_charges":[{"minimum":55.77,"maximum":75.29,"gross_charge":92.94,"discounted_cash":27.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE ER 500 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0401-11","type":"NDC"}],"standard_charges":[{"minimum":13.95,"maximum":75.29,"gross_charge":92.94,"discounted_cash":27.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"}]}]},{"description":"ACETIC ACID (BULK) 3 % LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51552-0051-06","type":"NDC"}],"standard_charges":[{"minimum":13.28,"maximum":17.93,"gross_charge":22.13,"discounted_cash":6.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"ACETIC ACID (BULK) 3 % LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51552-0051-06","type":"NDC"}],"standard_charges":[{"minimum":3.32,"maximum":17.93,"gross_charge":22.13,"discounted_cash":6.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"}]}]},{"description":"ACETIC ACID 2 % EAR SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0889-15","type":"NDC"}],"standard_charges":[{"minimum":11.38,"maximum":15.36,"gross_charge":18.96,"discounted_cash":5.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"}]}]},{"description":"ACETIC ACID 2 % EAR SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0889-15","type":"NDC"}],"standard_charges":[{"minimum":2.85,"maximum":15.36,"gross_charge":18.96,"discounted_cash":5.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"}]}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.43,"maximum":10.02,"gross_charge":12.37,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"}]}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.86,"maximum":10.02,"gross_charge":12.37,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.07,"maximum":10.9,"gross_charge":13.45,"discounted_cash":3.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"}]}]},{"description":"ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.02,"maximum":10.9,"gross_charge":13.45,"discounted_cash":3.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-5306-01","type":"NDC"}],"standard_charges":[{"minimum":3.68,"maximum":4.97,"gross_charge":6.13,"discounted_cash":1.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-5306-01","type":"NDC"}],"standard_charges":[{"minimum":0.92,"maximum":4.97,"gross_charge":6.13,"discounted_cash":1.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"}]}]},{"description":"AFATINIB 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6870.5,"maximum":9275.18,"gross_charge":11450.83,"discounted_cash":3389.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9275.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6870.5,"methodology":"fee schedule"}]}]},{"description":"AFATINIB 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1717.63,"maximum":9275.18,"gross_charge":11450.83,"discounted_cash":3389.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9275.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6870.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2175.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2290.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1717.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2290.17,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0907-02","type":"NDC"}],"standard_charges":[{"minimum":25.74,"maximum":34.75,"gross_charge":42.89,"discounted_cash":12.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.74,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0907-02","type":"NDC"}],"standard_charges":[{"minimum":6.44,"maximum":34.75,"gross_charge":42.89,"discounted_cash":12.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0452-02","type":"NDC"}],"standard_charges":[{"minimum":29.48,"maximum":39.8,"gross_charge":49.13,"discounted_cash":14.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.48,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0452-02","type":"NDC"}],"standard_charges":[{"minimum":7.37,"maximum":39.8,"gross_charge":49.13,"discounted_cash":14.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52054-0550-22","type":"NDC"}],"standard_charges":[{"minimum":271.31,"maximum":366.26,"gross_charge":452.17,"discounted_cash":133.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":271.31,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52054-0550-22","type":"NDC"}],"standard_charges":[{"minimum":67.83,"maximum":366.26,"gross_charge":452.17,"discounted_cash":133.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":271.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54505-0055-22","type":"NDC"}],"standard_charges":[{"minimum":80.16,"maximum":108.22,"gross_charge":133.6,"discounted_cash":39.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.16,"methodology":"fee schedule"}]}]},{"description":"ALBENDAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54505-0055-22","type":"NDC"}],"standard_charges":[{"minimum":20.04,"maximum":108.22,"gross_charge":133.6,"discounted_cash":39.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.72,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0657-20","type":"NDC"}],"standard_charges":[{"minimum":338.13,"maximum":456.48,"gross_charge":563.55,"discounted_cash":166.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":338.13,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0657-20","type":"NDC"}],"standard_charges":[{"minimum":84.54,"maximum":456.48,"gross_charge":563.55,"discounted_cash":166.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":338.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.71,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53489-0177-01","type":"NDC"}],"standard_charges":[{"minimum":22.83,"maximum":30.82,"gross_charge":38.04,"discounted_cash":11.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.83,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53489-0177-01","type":"NDC"}],"standard_charges":[{"minimum":5.71,"maximum":30.82,"gross_charge":38.04,"discounted_cash":11.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.38,"maximum":0.51,"gross_charge":0.62,"discounted_cash":0.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.1,"maximum":0.51,"gross_charge":0.62,"discounted_cash":0.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE ER 4 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":79.84,"maximum":107.78,"gross_charge":133.06,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.84,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE ER 4 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.96,"maximum":107.78,"gross_charge":133.06,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.62,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0088-01","type":"NDC"}],"standard_charges":[{"minimum":20.21,"maximum":27.28,"gross_charge":33.67,"discounted_cash":9.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.21,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0088-01","type":"NDC"}],"standard_charges":[{"minimum":5.06,"maximum":27.28,"gross_charge":33.67,"discounted_cash":9.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.74,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59310-0579-22","type":"NDC"}],"standard_charges":[{"minimum":36.31,"maximum":49.02,"gross_charge":60.51,"discounted_cash":17.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59310-0579-22","type":"NDC"}],"standard_charges":[{"minimum":9.08,"maximum":49.02,"gross_charge":60.51,"discounted_cash":17.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0019-68","type":"NDC"}],"standard_charges":[{"minimum":20.18,"maximum":27.24,"gross_charge":33.62,"discounted_cash":9.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.18,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0019-68","type":"NDC"}],"standard_charges":[{"minimum":5.05,"maximum":27.24,"gross_charge":33.62,"discounted_cash":9.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0142-60","type":"NDC"}],"standard_charges":[{"minimum":20.83,"maximum":28.12,"gross_charge":34.71,"discounted_cash":10.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0142-60","type":"NDC"}],"standard_charges":[{"minimum":5.21,"maximum":28.12,"gross_charge":34.71,"discounted_cash":10.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72572-0014-01","type":"NDC"}],"standard_charges":[{"minimum":10.43,"maximum":14.07,"gross_charge":17.37,"discounted_cash":5.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72572-0014-01","type":"NDC"}],"standard_charges":[{"minimum":2.61,"maximum":14.07,"gross_charge":17.37,"discounted_cash":5.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.08,"maximum":12.25,"gross_charge":15.12,"discounted_cash":4.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.27,"maximum":12.25,"gross_charge":15.12,"discounted_cash":4.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":13.71,"gross_charge":16.92,"discounted_cash":5.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.54,"maximum":13.71,"gross_charge":16.92,"discounted_cash":5.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.87,"maximum":24.13,"gross_charge":29.78,"discounted_cash":8.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.47,"maximum":24.13,"gross_charge":29.78,"discounted_cash":8.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.02,"maximum":25.67,"gross_charge":31.69,"discounted_cash":9.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"}]}]},{"description":"ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.76,"maximum":25.67,"gross_charge":31.69,"discounted_cash":9.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.34,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0205-20","type":"NDC"}],"standard_charges":[{"minimum":18.63,"maximum":25.15,"gross_charge":31.04,"discounted_cash":9.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0205-20","type":"NDC"}],"standard_charges":[{"minimum":4.66,"maximum":25.15,"gross_charge":31.04,"discounted_cash":9.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0988-01","type":"NDC"}],"standard_charges":[{"minimum":12.8,"maximum":17.28,"gross_charge":21.33,"discounted_cash":6.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0988-01","type":"NDC"}],"standard_charges":[{"minimum":3.2,"maximum":17.28,"gross_charge":21.33,"discounted_cash":6.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.92,"maximum":13.39,"gross_charge":16.53,"discounted_cash":4.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.48,"maximum":13.39,"gross_charge":16.53,"discounted_cash":4.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0713-01","type":"NDC"}],"standard_charges":[{"minimum":24.99,"maximum":33.73,"gross_charge":41.64,"discounted_cash":12.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0713-01","type":"NDC"}],"standard_charges":[{"minimum":6.25,"maximum":33.73,"gross_charge":41.64,"discounted_cash":12.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0713-11","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":0.45,"gross_charge":0.55,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0713-11","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.45,"gross_charge":0.55,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 300 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.67,"maximum":31.95,"gross_charge":39.44,"discounted_cash":11.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.67,"methodology":"fee schedule"}]}]},{"description":"ALLOPURINOL 300 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.92,"maximum":31.95,"gross_charge":39.44,"discounted_cash":11.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"}]}]},{"description":"ALOGLIPTIN 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64764-0125-30","type":"NDC"}],"standard_charges":[{"minimum":222.48,"maximum":300.35,"gross_charge":370.8,"discounted_cash":109.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":300.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":300.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":300.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.48,"methodology":"fee schedule"}]}]},{"description":"ALOGLIPTIN 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64764-0125-30","type":"NDC"}],"standard_charges":[{"minimum":55.62,"maximum":300.35,"gross_charge":370.8,"discounted_cash":109.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":300.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":300.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":300.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.16,"methodology":"fee schedule"}]}]},{"description":"ALOGLIPTIN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0150-65","type":"NDC"}],"standard_charges":[{"minimum":105.82,"maximum":142.86,"gross_charge":176.36,"discounted_cash":52.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.82,"methodology":"fee schedule"}]}]},{"description":"ALOGLIPTIN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0150-65","type":"NDC"}],"standard_charges":[{"minimum":26.46,"maximum":142.86,"gross_charge":176.36,"discounted_cash":52.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.28,"methodology":"fee schedule"}]}]},{"description":"ALOSETRON 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54766-0895-03","type":"NDC"}],"standard_charges":[{"minimum":1396.58,"maximum":1885.39,"gross_charge":2327.63,"discounted_cash":688.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1885.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1885.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1885.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1396.58,"methodology":"fee schedule"}]}]},{"description":"ALOSETRON 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54766-0895-03","type":"NDC"}],"standard_charges":[{"minimum":349.15,"maximum":1885.39,"gross_charge":2327.63,"discounted_cash":688.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1885.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1885.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1885.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1396.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":442.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":349.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":465.53,"methodology":"fee schedule"}]}]},{"description":"ALPRAZOLAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67253-0901-10","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":1.16,"gross_charge":1.43,"discounted_cash":0.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"}]}]},{"description":"ALPRAZOLAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67253-0901-10","type":"NDC"}],"standard_charges":[{"minimum":0.22,"maximum":1.16,"gross_charge":1.43,"discounted_cash":0.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"ALUM AMMONIUM (BULK) POWDER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.04,"maximum":10.85,"gross_charge":13.39,"discounted_cash":3.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"}]}]},{"description":"ALUM AMMONIUM (BULK) POWDER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.01,"maximum":10.85,"gross_charge":13.39,"discounted_cash":3.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0611-01","type":"NDC"}],"standard_charges":[{"minimum":65.55,"maximum":88.5,"gross_charge":109.25,"discounted_cash":32.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.55,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0611-01","type":"NDC"}],"standard_charges":[{"minimum":16.39,"maximum":88.5,"gross_charge":109.25,"discounted_cash":32.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.61,"maximum":0.82,"gross_charge":1.01,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.16,"maximum":0.82,"gross_charge":1.01,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":48.45,"maximum":65.41,"gross_charge":80.75,"discounted_cash":23.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.12,"maximum":65.41,"gross_charge":80.75,"discounted_cash":23.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.29,"maximum":16.59,"gross_charge":20.47,"discounted_cash":6.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"}]}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.08,"maximum":16.59,"gross_charge":20.47,"discounted_cash":6.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"}]}]},{"description":"AMBRISENTAN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0802-01","type":"NDC"}],"standard_charges":[{"minimum":256.04,"maximum":345.66,"gross_charge":426.73,"discounted_cash":126.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":345.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":256.04,"methodology":"fee schedule"}]}]},{"description":"AMBRISENTAN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0802-01","type":"NDC"}],"standard_charges":[{"minimum":64.01,"maximum":345.66,"gross_charge":426.73,"discounted_cash":126.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":345.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":345.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":345.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":256.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.35,"methodology":"fee schedule"}]}]},{"description":"AMBRISENTAN 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0801-01","type":"NDC"}],"standard_charges":[{"minimum":222.23,"maximum":300.01,"gross_charge":370.38,"discounted_cash":109.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"}]}]},{"description":"AMBRISENTAN 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0801-01","type":"NDC"}],"standard_charges":[{"minimum":55.56,"maximum":300.01,"gross_charge":370.38,"discounted_cash":109.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":300.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":222.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.08,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49411-0050-30","type":"NDC"}],"standard_charges":[{"minimum":354,"maximum":477.9,"gross_charge":589.99,"discounted_cash":174.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49411-0050-30","type":"NDC"}],"standard_charges":[{"minimum":88.5,"maximum":477.9,"gross_charge":589.99,"discounted_cash":174.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":477.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0225-30","type":"NDC"}],"standard_charges":[{"minimum":37.76,"maximum":50.98,"gross_charge":62.93,"discounted_cash":18.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0225-30","type":"NDC"}],"standard_charges":[{"minimum":9.44,"maximum":50.98,"gross_charge":62.93,"discounted_cash":18.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0115-30","type":"NDC"}],"standard_charges":[{"minimum":107.51,"maximum":145.14,"gross_charge":179.18,"discounted_cash":53.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.51,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0115-30","type":"NDC"}],"standard_charges":[{"minimum":26.88,"maximum":145.14,"gross_charge":179.18,"discounted_cash":53.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0049-30","type":"NDC"}],"standard_charges":[{"minimum":37.15,"maximum":50.15,"gross_charge":61.91,"discounted_cash":18.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.15,"methodology":"fee schedule"}]}]},{"description":"AMINOCAPROIC ACID 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0049-30","type":"NDC"}],"standard_charges":[{"minimum":9.29,"maximum":50.15,"gross_charge":61.91,"discounted_cash":18.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.15,"maximum":32.6,"gross_charge":40.24,"discounted_cash":11.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.15,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.04,"maximum":32.6,"gross_charge":40.24,"discounted_cash":11.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0732-60","type":"NDC"}],"standard_charges":[{"minimum":9.8,"maximum":13.23,"gross_charge":16.33,"discounted_cash":4.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0732-60","type":"NDC"}],"standard_charges":[{"minimum":2.45,"maximum":13.23,"gross_charge":16.33,"discounted_cash":4.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0371-01","type":"NDC"}],"standard_charges":[{"minimum":13.58,"maximum":18.34,"gross_charge":22.63,"discounted_cash":6.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0371-01","type":"NDC"}],"standard_charges":[{"minimum":3.4,"maximum":18.34,"gross_charge":22.63,"discounted_cash":6.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.73,"maximum":19.88,"gross_charge":24.54,"discounted_cash":7.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.73,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.69,"maximum":19.88,"gross_charge":24.54,"discounted_cash":7.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.55,"maximum":23.69,"gross_charge":29.24,"discounted_cash":8.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.39,"maximum":23.69,"gross_charge":29.24,"discounted_cash":8.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0257-01","type":"NDC"}],"standard_charges":[{"minimum":3.62,"maximum":4.89,"gross_charge":6.03,"discounted_cash":1.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0257-01","type":"NDC"}],"standard_charges":[{"minimum":0.91,"maximum":4.89,"gross_charge":6.03,"discounted_cash":1.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0037-15","type":"NDC"}],"standard_charges":[{"minimum":8.03,"maximum":10.84,"gross_charge":13.38,"discounted_cash":3.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0037-15","type":"NDC"}],"standard_charges":[{"minimum":2.01,"maximum":10.84,"gross_charge":13.38,"discounted_cash":3.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0258-01","type":"NDC"}],"standard_charges":[{"minimum":4.76,"maximum":6.43,"gross_charge":7.93,"discounted_cash":2.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0258-01","type":"NDC"}],"standard_charges":[{"minimum":1.19,"maximum":6.43,"gross_charge":7.93,"discounted_cash":2.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0107-01","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":0.26,"gross_charge":0.32,"discounted_cash":0.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"AMITRIPTYLINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0107-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.26,"gross_charge":0.32,"discounted_cash":0.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"AMLODIPINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0121-16","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":1.06,"gross_charge":1.3,"discounted_cash":0.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"AMLODIPINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0121-16","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":1.06,"gross_charge":1.3,"discounted_cash":0.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"AMLODIPINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.64,"maximum":6.27,"gross_charge":7.73,"discounted_cash":2.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"}]}]},{"description":"AMLODIPINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.16,"maximum":6.27,"gross_charge":7.73,"discounted_cash":2.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"}]}]},{"description":"AMMONIUM LACTATE 12 % LOTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0525-55","type":"NDC"}],"standard_charges":[{"minimum":5.39,"maximum":7.28,"gross_charge":8.98,"discounted_cash":2.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"}]}]},{"description":"AMMONIUM LACTATE 12 % LOTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0525-55","type":"NDC"}],"standard_charges":[{"minimum":1.35,"maximum":7.28,"gross_charge":8.98,"discounted_cash":2.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.67,"maximum":2.25,"gross_charge":2.77,"discounted_cash":0.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.42,"maximum":2.25,"gross_charge":2.77,"discounted_cash":0.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0204-53","type":"NDC"}],"standard_charges":[{"minimum":62.19,"maximum":83.96,"gross_charge":103.65,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.19,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0204-53","type":"NDC"}],"standard_charges":[{"minimum":15.55,"maximum":83.96,"gross_charge":103.65,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0026-55","type":"NDC"}],"standard_charges":[{"minimum":60.12,"maximum":81.17,"gross_charge":100.2,"discounted_cash":29.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0026-55","type":"NDC"}],"standard_charges":[{"minimum":15.03,"maximum":81.17,"gross_charge":100.2,"discounted_cash":29.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0026-75","type":"NDC"}],"standard_charges":[{"minimum":27.81,"maximum":37.54,"gross_charge":46.34,"discounted_cash":13.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0026-75","type":"NDC"}],"standard_charges":[{"minimum":6.96,"maximum":37.54,"gross_charge":46.34,"discounted_cash":13.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60432-0065-47","type":"NDC"}],"standard_charges":[{"minimum":11.15,"maximum":15.05,"gross_charge":18.58,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60432-0065-47","type":"NDC"}],"standard_charges":[{"minimum":2.79,"maximum":15.05,"gross_charge":18.58,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"81964-0204-15","type":"NDC"}],"standard_charges":[{"minimum":43.02,"maximum":58.08,"gross_charge":71.7,"discounted_cash":21.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"81964-0204-15","type":"NDC"}],"standard_charges":[{"minimum":10.76,"maximum":58.08,"gross_charge":71.7,"discounted_cash":21.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0296-01","type":"NDC"}],"standard_charges":[{"minimum":6.81,"maximum":9.2,"gross_charge":11.35,"discounted_cash":3.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0296-01","type":"NDC"}],"standard_charges":[{"minimum":1.71,"maximum":9.2,"gross_charge":11.35,"discounted_cash":3.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0477-01","type":"NDC"}],"standard_charges":[{"minimum":2.7,"maximum":3.64,"gross_charge":4.49,"discounted_cash":1.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0477-01","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":3.64,"gross_charge":4.49,"discounted_cash":1.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66685-1002-02","type":"NDC"}],"standard_charges":[{"minimum":18.21,"maximum":24.58,"gross_charge":30.34,"discounted_cash":8.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66685-1002-02","type":"NDC"}],"standard_charges":[{"minimum":4.56,"maximum":24.58,"gross_charge":30.34,"discounted_cash":8.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.13,"maximum":5.57,"gross_charge":6.87,"discounted_cash":2.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.04,"maximum":5.57,"gross_charge":6.87,"discounted_cash":2.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0294-01","type":"NDC"}],"standard_charges":[{"minimum":1.75,"maximum":2.36,"gross_charge":2.91,"discounted_cash":0.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0294-01","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":2.36,"gross_charge":2.91,"discounted_cash":0.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 875 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.05,"maximum":4.11,"gross_charge":5.07,"discounted_cash":1.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 875 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.77,"maximum":4.11,"gross_charge":5.07,"discounted_cash":1.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0014-02","type":"NDC"}],"standard_charges":[{"minimum":21.51,"maximum":29.04,"gross_charge":35.84,"discounted_cash":10.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.51,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0014-02","type":"NDC"}],"standard_charges":[{"minimum":5.38,"maximum":29.04,"gross_charge":35.84,"discounted_cash":10.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0297-01","type":"NDC"}],"standard_charges":[{"minimum":5.09,"maximum":6.87,"gross_charge":8.47,"discounted_cash":2.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"}]}]},{"description":"AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0297-01","type":"NDC"}],"standard_charges":[{"minimum":1.28,"maximum":6.87,"gross_charge":8.47,"discounted_cash":2.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"}]}]},{"description":"ANAGRELIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0453-01","type":"NDC"}],"standard_charges":[{"minimum":49.11,"maximum":66.3,"gross_charge":81.85,"discounted_cash":24.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"}]}]},{"description":"ANAGRELIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0453-01","type":"NDC"}],"standard_charges":[{"minimum":12.28,"maximum":66.3,"gross_charge":81.85,"discounted_cash":24.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"}]}]},{"description":"ANAGRELIDE 0.5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":45.81,"maximum":61.85,"gross_charge":76.35,"discounted_cash":22.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"}]}]},{"description":"ANAGRELIDE 0.5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.46,"maximum":61.85,"gross_charge":76.35,"discounted_cash":22.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.27,"methodology":"fee schedule"}]}]},{"description":"ANASTROZOLE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0035-10","type":"NDC"}],"standard_charges":[{"minimum":1.94,"maximum":2.61,"gross_charge":3.22,"discounted_cash":0.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"}]}]},{"description":"ANASTROZOLE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0035-10","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":2.61,"gross_charge":3.22,"discounted_cash":0.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"APIXABAN 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":408.11,"maximum":550.94,"gross_charge":680.17,"discounted_cash":201.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":550.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":550.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":550.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":408.11,"methodology":"fee schedule"}]}]},{"description":"APIXABAN 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":102.03,"maximum":550.94,"gross_charge":680.17,"discounted_cash":201.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":550.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":550.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":550.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":408.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.04,"methodology":"fee schedule"}]}]},{"description":"APIXABAN 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":244.9,"maximum":330.61,"gross_charge":408.16,"discounted_cash":120.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.9,"methodology":"fee schedule"}]}]},{"description":"APIXABAN 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":61.23,"maximum":330.61,"gross_charge":408.16,"discounted_cash":120.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.64,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0770-79","type":"NDC"}],"standard_charges":[{"minimum":3.6,"maximum":4.86,"gross_charge":6,"discounted_cash":1.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0770-79","type":"NDC"}],"standard_charges":[{"minimum":0.9,"maximum":4.86,"gross_charge":6,"discounted_cash":1.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0911-30","type":"NDC"}],"standard_charges":[{"minimum":10.38,"maximum":14.02,"gross_charge":17.3,"discounted_cash":5.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0911-30","type":"NDC"}],"standard_charges":[{"minimum":2.6,"maximum":14.02,"gross_charge":17.3,"discounted_cash":5.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70436-0151-57","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":1.84,"gross_charge":2.27,"discounted_cash":0.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70436-0151-57","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":1.84,"gross_charge":2.27,"discounted_cash":0.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0175-01","type":"NDC"}],"standard_charges":[{"minimum":3.84,"maximum":5.18,"gross_charge":6.39,"discounted_cash":1.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0175-01","type":"NDC"}],"standard_charges":[{"minimum":0.96,"maximum":5.18,"gross_charge":6.39,"discounted_cash":1.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0257-30","type":"NDC"}],"standard_charges":[{"minimum":3.87,"maximum":5.23,"gross_charge":6.45,"discounted_cash":1.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0257-30","type":"NDC"}],"standard_charges":[{"minimum":0.97,"maximum":5.23,"gross_charge":6.45,"discounted_cash":1.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70756-0612-70","type":"NDC"}],"standard_charges":[{"minimum":0.8,"maximum":1.07,"gross_charge":1.32,"discounted_cash":0.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"}]}]},{"description":"ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70756-0612-70","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":1.07,"gross_charge":1.32,"discounted_cash":0.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0143-01","type":"NDC"}],"standard_charges":[{"minimum":2.37,"maximum":3.2,"gross_charge":3.94,"discounted_cash":1.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0143-01","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":3.2,"gross_charge":3.94,"discounted_cash":1.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0967-30","type":"NDC"}],"standard_charges":[{"minimum":3.92,"maximum":5.29,"gross_charge":6.52,"discounted_cash":1.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0967-30","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":5.29,"gross_charge":6.52,"discounted_cash":1.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0142-01","type":"NDC"}],"standard_charges":[{"minimum":4.91,"maximum":6.62,"gross_charge":8.17,"discounted_cash":2.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0142-01","type":"NDC"}],"standard_charges":[{"minimum":1.23,"maximum":6.62,"gross_charge":8.17,"discounted_cash":2.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0897-09","type":"NDC"}],"standard_charges":[{"minimum":16.29,"maximum":21.99,"gross_charge":27.14,"discounted_cash":8.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0897-09","type":"NDC"}],"standard_charges":[{"minimum":4.08,"maximum":21.99,"gross_charge":27.14,"discounted_cash":8.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0431-03","type":"NDC"}],"standard_charges":[{"minimum":3.93,"maximum":5.31,"gross_charge":6.55,"discounted_cash":1.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"ARIPIPRAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0431-03","type":"NDC"}],"standard_charges":[{"minimum":0.99,"maximum":5.31,"gross_charge":6.55,"discounted_cash":1.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULEEXT.RELEASE 12 HR MULTIPHASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0596-06","type":"NDC"}],"standard_charges":[{"minimum":35.69,"maximum":48.18,"gross_charge":59.48,"discounted_cash":17.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULEEXT.RELEASE 12 HR MULTIPHASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0596-06","type":"NDC"}],"standard_charges":[{"minimum":8.93,"maximum":48.18,"gross_charge":59.48,"discounted_cash":17.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULEEXT.RELEASE 12 HR MULTIPHASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":81.39,"maximum":109.87,"gross_charge":135.64,"discounted_cash":40.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.39,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULEEXT.RELEASE 12 HR MULTIPHASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.35,"maximum":109.87,"gross_charge":135.64,"discounted_cash":40.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.13,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 325 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0523-01","type":"NDC"}],"standard_charges":[{"minimum":11.33,"maximum":15.3,"gross_charge":18.88,"discounted_cash":5.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 325 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0523-01","type":"NDC"}],"standard_charges":[{"minimum":2.84,"maximum":15.3,"gross_charge":18.88,"discounted_cash":5.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 600 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.07,"maximum":13.6,"gross_charge":16.78,"discounted_cash":4.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 600 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.52,"maximum":13.6,"gross_charge":16.78,"discounted_cash":4.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57896-0911-36","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":0.58,"gross_charge":0.71,"discounted_cash":0.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 81 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57896-0911-36","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":0.58,"gross_charge":0.71,"discounted_cash":0.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 81 MG TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.87,"maximum":1.18,"gross_charge":1.45,"discounted_cash":0.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN 81 MG TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.22,"maximum":1.18,"gross_charge":1.45,"discounted_cash":0.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.7,"maximum":2.3,"gross_charge":2.83,"discounted_cash":0.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"}]}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.43,"maximum":2.3,"gross_charge":2.83,"discounted_cash":0.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0711-60","type":"NDC"}],"standard_charges":[{"minimum":107.02,"maximum":144.48,"gross_charge":178.36,"discounted_cash":52.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.02,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0711-60","type":"NDC"}],"standard_charges":[{"minimum":26.76,"maximum":144.48,"gross_charge":178.36,"discounted_cash":52.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0444-03","type":"NDC"}],"standard_charges":[{"minimum":93.05,"maximum":125.61,"gross_charge":155.07,"discounted_cash":45.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.05,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0444-03","type":"NDC"}],"standard_charges":[{"minimum":23.27,"maximum":125.61,"gross_charge":155.07,"discounted_cash":45.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.02,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":94.27,"maximum":127.26,"gross_charge":157.11,"discounted_cash":46.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.27,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.57,"maximum":127.26,"gross_charge":157.11,"discounted_cash":46.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":851.87,"maximum":1150.02,"gross_charge":1419.77,"discounted_cash":420.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1150.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1150.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1150.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":851.87,"methodology":"fee schedule"}]}]},{"description":"ATAZANAVIR 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":212.97,"maximum":1150.02,"gross_charge":1419.77,"discounted_cash":420.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1150.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1150.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1150.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":851.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":269.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":283.96,"methodology":"fee schedule"}]}]},{"description":"ATENOLOL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.74,"maximum":5.04,"gross_charge":6.22,"discounted_cash":1.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"}]}]},{"description":"ATENOLOL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.94,"maximum":5.04,"gross_charge":6.22,"discounted_cash":1.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"}]}]},{"description":"ATENOLOL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.88,"maximum":2.54,"gross_charge":3.13,"discounted_cash":0.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"}]}]},{"description":"ATENOLOL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.47,"maximum":2.54,"gross_charge":3.13,"discounted_cash":0.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"}]}]},{"description":"ATENOLOL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":13.72,"gross_charge":16.93,"discounted_cash":5.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"}]}]},{"description":"ATENOLOL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.54,"maximum":13.72,"gross_charge":16.93,"discounted_cash":5.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0097-01","type":"NDC"}],"standard_charges":[{"minimum":20.19,"maximum":27.25,"gross_charge":33.64,"discounted_cash":9.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0097-01","type":"NDC"}],"standard_charges":[{"minimum":5.05,"maximum":27.25,"gross_charge":33.64,"discounted_cash":9.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.3,"maximum":11.21,"gross_charge":13.83,"discounted_cash":4.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.08,"maximum":11.21,"gross_charge":13.83,"discounted_cash":4.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0094-15","type":"NDC"}],"standard_charges":[{"minimum":5.45,"maximum":7.36,"gross_charge":9.08,"discounted_cash":2.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0094-15","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":7.36,"gross_charge":9.08,"discounted_cash":2.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-2579-09","type":"NDC"}],"standard_charges":[{"minimum":12.88,"maximum":17.39,"gross_charge":21.46,"discounted_cash":6.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-2579-09","type":"NDC"}],"standard_charges":[{"minimum":3.22,"maximum":17.39,"gross_charge":21.46,"discounted_cash":6.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0095-15","type":"NDC"}],"standard_charges":[{"minimum":5.36,"maximum":7.24,"gross_charge":8.93,"discounted_cash":2.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0095-15","type":"NDC"}],"standard_charges":[{"minimum":1.34,"maximum":7.24,"gross_charge":8.93,"discounted_cash":2.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-2580-09","type":"NDC"}],"standard_charges":[{"minimum":9.59,"maximum":12.94,"gross_charge":15.97,"discounted_cash":4.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-2580-09","type":"NDC"}],"standard_charges":[{"minimum":2.4,"maximum":12.94,"gross_charge":15.97,"discounted_cash":4.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":37.59,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"ATORVASTATIN 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.4,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"}]}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0223-21","type":"NDC"}],"standard_charges":[{"minimum":87.92,"maximum":118.69,"gross_charge":146.53,"discounted_cash":43.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.92,"methodology":"fee schedule"}]}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0223-21","type":"NDC"}],"standard_charges":[{"minimum":21.98,"maximum":118.69,"gross_charge":146.53,"discounted_cash":43.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.31,"methodology":"fee schedule"}]}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0693-05","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":10.05,"gross_charge":12.4,"discounted_cash":3.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"}]}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0693-05","type":"NDC"}],"standard_charges":[{"minimum":1.86,"maximum":10.05,"gross_charge":12.4,"discounted_cash":3.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0693-88","type":"NDC"}],"standard_charges":[{"minimum":309.23,"maximum":417.45,"gross_charge":515.37,"discounted_cash":152.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":309.23,"methodology":"fee schedule"}]}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0693-88","type":"NDC"}],"standard_charges":[{"minimum":77.31,"maximum":417.45,"gross_charge":515.37,"discounted_cash":152.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":417.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":417.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":417.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":309.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.08,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50111-0787-51","type":"NDC"}],"standard_charges":[{"minimum":2.69,"maximum":3.63,"gross_charge":4.47,"discounted_cash":1.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50111-0787-51","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":3.63,"gross_charge":4.47,"discounted_cash":1.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51224-0022-06","type":"NDC"}],"standard_charges":[{"minimum":0.77,"maximum":1.03,"gross_charge":1.27,"discounted_cash":0.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51224-0022-06","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":1.03,"gross_charge":1.27,"discounted_cash":0.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51224-0022-30","type":"NDC"}],"standard_charges":[{"minimum":2.87,"maximum":3.88,"gross_charge":4.78,"discounted_cash":1.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51224-0022-30","type":"NDC"}],"standard_charges":[{"minimum":0.72,"maximum":3.88,"gross_charge":4.78,"discounted_cash":1.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0251-30","type":"NDC"}],"standard_charges":[{"minimum":38.34,"maximum":51.76,"gross_charge":63.89,"discounted_cash":18.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0251-30","type":"NDC"}],"standard_charges":[{"minimum":9.59,"maximum":51.76,"gross_charge":63.89,"discounted_cash":18.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0641-69","type":"NDC"}],"standard_charges":[{"minimum":2.51,"maximum":3.38,"gross_charge":4.17,"discounted_cash":1.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0641-69","type":"NDC"}],"standard_charges":[{"minimum":0.63,"maximum":3.38,"gross_charge":4.17,"discounted_cash":1.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0160-11","type":"NDC"}],"standard_charges":[{"minimum":4.15,"maximum":5.6,"gross_charge":6.91,"discounted_cash":2.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0160-11","type":"NDC"}],"standard_charges":[{"minimum":1.04,"maximum":5.6,"gross_charge":6.91,"discounted_cash":2.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.78,"maximum":29.4,"gross_charge":36.29,"discounted_cash":10.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.78,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.45,"maximum":29.4,"gross_charge":36.29,"discounted_cash":10.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1285-01","type":"NDC"}],"standard_charges":[{"minimum":4.58,"maximum":6.19,"gross_charge":7.63,"discounted_cash":2.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1285-01","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":6.19,"gross_charge":7.63,"discounted_cash":2.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.52,"maximum":10.15,"gross_charge":12.53,"discounted_cash":3.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.88,"maximum":10.15,"gross_charge":12.53,"discounted_cash":3.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"}]}]},{"description":"BALSALAZIDE 750 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-2575-07","type":"NDC"}],"standard_charges":[{"minimum":35.87,"maximum":48.43,"gross_charge":59.78,"discounted_cash":17.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.87,"methodology":"fee schedule"}]}]},{"description":"BALSALAZIDE 750 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-2575-07","type":"NDC"}],"standard_charges":[{"minimum":8.97,"maximum":48.43,"gross_charge":59.78,"discounted_cash":17.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"}]}]},{"description":"BALSALAZIDE 750 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":50.49,"maximum":68.17,"gross_charge":84.15,"discounted_cash":24.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.49,"methodology":"fee schedule"}]}]},{"description":"BALSALAZIDE 750 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.63,"maximum":68.17,"gross_charge":84.15,"discounted_cash":24.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"}]}]},{"description":"BALSAM PERU-CASTOR OIL 87 MG-788 MG/GRAM TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0139-60","type":"NDC"}],"standard_charges":[{"minimum":16.22,"maximum":21.89,"gross_charge":27.02,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.22,"methodology":"fee schedule"}]}]},{"description":"BALSAM PERU-CASTOR OIL 87 MG-788 MG/GRAM TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0139-60","type":"NDC"}],"standard_charges":[{"minimum":4.06,"maximum":21.89,"gross_charge":27.02,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"}]}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58980-0780-21","type":"NDC"}],"standard_charges":[{"minimum":14.99,"maximum":20.23,"gross_charge":24.97,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58980-0780-21","type":"NDC"}],"standard_charges":[{"minimum":3.75,"maximum":20.23,"gross_charge":24.97,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0139-60","type":"NDC"}],"standard_charges":[{"minimum":11.82,"maximum":15.95,"gross_charge":19.69,"discounted_cash":5.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"BALSAM PERU-CASTOR OIL TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0139-60","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":15.95,"gross_charge":19.69,"discounted_cash":5.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"}]}]},{"description":"BARICITINIB 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1571.16,"maximum":2121.07,"gross_charge":2618.6,"discounted_cash":775.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2121.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2121.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2121.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1571.16,"methodology":"fee schedule"}]}]},{"description":"BARICITINIB 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":392.79,"maximum":2121.07,"gross_charge":2618.6,"discounted_cash":775.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2121.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2121.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2121.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1571.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":497.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":392.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.72,"methodology":"fee schedule"}]}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.17,"maximum":16.43,"gross_charge":20.28,"discounted_cash":6.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"}]}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.05,"maximum":16.43,"gross_charge":20.28,"discounted_cash":6.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"}]}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":145.18,"maximum":195.99,"gross_charge":241.96,"discounted_cash":71.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.18,"methodology":"fee schedule"}]}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":36.3,"maximum":195.99,"gross_charge":241.96,"discounted_cash":71.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":195.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":195.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":195.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.4,"methodology":"fee schedule"}]}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":176.46,"maximum":238.23,"gross_charge":294.1,"discounted_cash":87.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.46,"methodology":"fee schedule"}]}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2 MG-60 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.12,"maximum":238.23,"gross_charge":294.1,"discounted_cash":87.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":238.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":238.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":238.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":176.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.82,"methodology":"fee schedule"}]}]},{"description":"BENAZEPRIL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0110-15","type":"NDC"}],"standard_charges":[{"minimum":11.87,"maximum":16.03,"gross_charge":19.78,"discounted_cash":5.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"}]}]},{"description":"BENAZEPRIL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0110-15","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":16.03,"gross_charge":19.78,"discounted_cash":5.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"}]}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54162-0100-01","type":"NDC"}],"standard_charges":[{"minimum":7.23,"maximum":9.77,"gross_charge":12.05,"discounted_cash":3.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54162-0100-01","type":"NDC"}],"standard_charges":[{"minimum":1.81,"maximum":9.77,"gross_charge":12.05,"discounted_cash":3.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"}]}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54162-0100-02","type":"NDC"}],"standard_charges":[{"minimum":6.9,"maximum":9.31,"gross_charge":11.49,"discounted_cash":3.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"}]}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54162-0100-02","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":9.31,"gross_charge":11.49,"discounted_cash":3.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.55,"maximum":26.39,"gross_charge":32.57,"discounted_cash":9.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"}]}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU BALSAM 10 %-2 %-8 %-4 % TOPICAL TINCTURE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.89,"maximum":26.39,"gross_charge":32.57,"discounted_cash":9.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"}]}]},{"description":"BENZONATATE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0143-30","type":"NDC"}],"standard_charges":[{"minimum":43.59,"maximum":58.85,"gross_charge":72.65,"discounted_cash":21.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"}]}]},{"description":"BENZONATATE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0143-30","type":"NDC"}],"standard_charges":[{"minimum":10.9,"maximum":58.85,"gross_charge":72.65,"discounted_cash":21.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.15,"maximum":28.55,"gross_charge":35.24,"discounted_cash":10.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.29,"maximum":28.55,"gross_charge":35.24,"discounted_cash":10.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % LOTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0021-46","type":"NDC"}],"standard_charges":[{"minimum":16.5,"maximum":22.28,"gross_charge":27.5,"discounted_cash":8.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % LOTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0021-46","type":"NDC"}],"standard_charges":[{"minimum":4.13,"maximum":22.28,"gross_charge":27.5,"discounted_cash":8.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % LOTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.6,"maximum":19.7,"gross_charge":24.32,"discounted_cash":7.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % LOTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.65,"maximum":19.7,"gross_charge":24.32,"discounted_cash":7.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0996-01","type":"NDC"}],"standard_charges":[{"minimum":16.43,"maximum":22.18,"gross_charge":27.38,"discounted_cash":8.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0996-01","type":"NDC"}],"standard_charges":[{"minimum":4.11,"maximum":22.18,"gross_charge":27.38,"discounted_cash":8.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.48,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.99,"maximum":18.89,"gross_charge":23.31,"discounted_cash":6.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.5,"maximum":18.89,"gross_charge":23.31,"discounted_cash":6.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0505-14","type":"NDC"}],"standard_charges":[{"minimum":3.03,"maximum":4.09,"gross_charge":5.04,"discounted_cash":1.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0505-14","type":"NDC"}],"standard_charges":[{"minimum":0.76,"maximum":4.09,"gross_charge":5.04,"discounted_cash":1.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52817-0824-15","type":"NDC"}],"standard_charges":[{"minimum":12.84,"maximum":17.33,"gross_charge":21.39,"discounted_cash":6.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52817-0824-15","type":"NDC"}],"standard_charges":[{"minimum":3.21,"maximum":17.33,"gross_charge":21.39,"discounted_cash":6.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72578-0093-01","type":"NDC"}],"standard_charges":[{"minimum":26.1,"maximum":35.24,"gross_charge":43.5,"discounted_cash":12.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72578-0093-01","type":"NDC"}],"standard_charges":[{"minimum":6.53,"maximum":35.24,"gross_charge":43.5,"discounted_cash":12.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.16,"maximum":39.36,"gross_charge":48.59,"discounted_cash":14.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.29,"maximum":39.36,"gross_charge":48.59,"discounted_cash":14.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"}]}]},{"description":"BETHANECHOL CHLORIDE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.21,"maximum":32.68,"gross_charge":40.34,"discounted_cash":11.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"}]}]},{"description":"BETHANECHOL CHLORIDE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.06,"maximum":32.68,"gross_charge":40.34,"discounted_cash":11.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"}]}]},{"description":"BICALUTAMIDE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0023-10","type":"NDC"}],"standard_charges":[{"minimum":13.2,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"}]}]},{"description":"BICALUTAMIDE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0023-10","type":"NDC"}],"standard_charges":[{"minimum":3.3,"maximum":17.82,"gross_charge":22,"discounted_cash":6.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"}]}]},{"description":"BICALUTAMIDE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.49,"maximum":6.06,"gross_charge":7.48,"discounted_cash":2.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"}]}]},{"description":"BICALUTAMIDE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.13,"maximum":6.06,"gross_charge":7.48,"discounted_cash":2.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"}]}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58980-0415-12","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":2.34,"gross_charge":2.88,"discounted_cash":0.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"}]}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58980-0415-12","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":2.34,"gross_charge":2.88,"discounted_cash":0.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.38,"maximum":1.87,"gross_charge":2.3,"discounted_cash":0.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"}]}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.35,"maximum":1.87,"gross_charge":2.3,"discounted_cash":0.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.84,"maximum":7.89,"gross_charge":9.73,"discounted_cash":2.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"}]}]},{"description":"BISACODYL 10 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.46,"maximum":7.89,"gross_charge":9.73,"discounted_cash":2.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0922-01","type":"NDC"}],"standard_charges":[{"minimum":24.51,"maximum":33.09,"gross_charge":40.84,"discounted_cash":12.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0922-01","type":"NDC"}],"standard_charges":[{"minimum":6.13,"maximum":33.09,"gross_charge":40.84,"discounted_cash":12.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0880-01","type":"NDC"}],"standard_charges":[{"minimum":6.8,"maximum":9.18,"gross_charge":11.33,"discounted_cash":3.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 10 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0880-01","type":"NDC"}],"standard_charges":[{"minimum":1.7,"maximum":9.18,"gross_charge":11.33,"discounted_cash":3.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0187-01","type":"NDC"}],"standard_charges":[{"minimum":23.73,"maximum":32.03,"gross_charge":39.54,"discounted_cash":11.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0187-01","type":"NDC"}],"standard_charges":[{"minimum":5.94,"maximum":32.03,"gross_charge":39.54,"discounted_cash":11.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0187-13","type":"NDC"}],"standard_charges":[{"minimum":8.18,"maximum":11.05,"gross_charge":13.63,"discounted_cash":4.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0187-13","type":"NDC"}],"standard_charges":[{"minimum":2.05,"maximum":11.05,"gross_charge":13.63,"discounted_cash":4.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0878-30","type":"NDC"}],"standard_charges":[{"minimum":7.55,"maximum":10.19,"gross_charge":12.58,"discounted_cash":3.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 2.5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0878-30","type":"NDC"}],"standard_charges":[{"minimum":1.89,"maximum":10.19,"gross_charge":12.58,"discounted_cash":3.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0188-13","type":"NDC"}],"standard_charges":[{"minimum":8.56,"maximum":11.56,"gross_charge":14.26,"discounted_cash":4.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.56,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL 5 MG-HYDROCHLOROTHIAZIDE 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0188-13","type":"NDC"}],"standard_charges":[{"minimum":2.14,"maximum":11.56,"gross_charge":14.26,"discounted_cash":4.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL FUMARATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0126-13","type":"NDC"}],"standard_charges":[{"minimum":4.78,"maximum":6.45,"gross_charge":7.96,"discounted_cash":2.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL FUMARATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0126-13","type":"NDC"}],"standard_charges":[{"minimum":1.2,"maximum":6.45,"gross_charge":7.96,"discounted_cash":2.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL FUMARATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0679-21","type":"NDC"}],"standard_charges":[{"minimum":23.49,"maximum":31.71,"gross_charge":39.14,"discounted_cash":11.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL FUMARATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0679-21","type":"NDC"}],"standard_charges":[{"minimum":5.88,"maximum":31.71,"gross_charge":39.14,"discounted_cash":11.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL FUMARATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0455-10","type":"NDC"}],"standard_charges":[{"minimum":3.86,"maximum":5.21,"gross_charge":6.43,"discounted_cash":1.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"}]}]},{"description":"BISOPROLOL FUMARATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0455-10","type":"NDC"}],"standard_charges":[{"minimum":0.97,"maximum":5.21,"gross_charge":6.43,"discounted_cash":1.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"}]}]},{"description":"BOSENTAN 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66215-0102-06","type":"NDC"}],"standard_charges":[{"minimum":5919.66,"maximum":7991.54,"gross_charge":9866.09,"discounted_cash":2920.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7991.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7991.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7991.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5919.66,"methodology":"fee schedule"}]}]},{"description":"BOSENTAN 125 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66215-0102-06","type":"NDC"}],"standard_charges":[{"minimum":1479.92,"maximum":7991.54,"gross_charge":9866.09,"discounted_cash":2920.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7991.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7991.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7991.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5919.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1874.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1479.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1973.22,"methodology":"fee schedule"}]}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0962-01","type":"NDC"}],"standard_charges":[{"minimum":89.38,"maximum":120.66,"gross_charge":148.96,"discounted_cash":44.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.38,"methodology":"fee schedule"}]}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0962-01","type":"NDC"}],"standard_charges":[{"minimum":22.35,"maximum":120.66,"gross_charge":148.96,"discounted_cash":44.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"}]}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0962-30","type":"NDC"}],"standard_charges":[{"minimum":23.6,"maximum":31.85,"gross_charge":39.32,"discounted_cash":11.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"}]}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0962-30","type":"NDC"}],"standard_charges":[{"minimum":5.9,"maximum":31.85,"gross_charge":39.32,"discounted_cash":11.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.87,"methodology":"fee schedule"}]}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.62,"maximum":30.54,"gross_charge":37.7,"discounted_cash":11.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"}]}]},{"description":"BROMOCRIPTINE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.66,"maximum":30.54,"gross_charge":37.7,"discounted_cash":11.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0632-48","type":"NDC"}],"standard_charges":[{"minimum":1.72,"maximum":2.32,"gross_charge":2.86,"discounted_cash":0.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0632-48","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":2.32,"gross_charge":2.86,"discounted_cash":0.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0984-30","type":"NDC"}],"standard_charges":[{"minimum":0.91,"maximum":1.23,"gross_charge":1.51,"discounted_cash":0.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0984-30","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":1.23,"gross_charge":1.51,"discounted_cash":0.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":1.19,"gross_charge":1.46,"discounted_cash":0.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.22,"maximum":1.19,"gross_charge":1.46,"discounted_cash":0.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.07,"maximum":2.8,"gross_charge":3.45,"discounted_cash":1.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.52,"maximum":2.8,"gross_charge":3.45,"discounted_cash":1.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.95,"maximum":6.68,"gross_charge":8.24,"discounted_cash":2.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.24,"maximum":6.68,"gross_charge":8.24,"discounted_cash":2.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.4,"maximum":7.29,"gross_charge":9,"discounted_cash":2.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.35,"maximum":7.29,"gross_charge":9,"discounted_cash":2.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0582-01","type":"NDC"}],"standard_charges":[{"minimum":214.26,"maximum":289.26,"gross_charge":357.1,"discounted_cash":105.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.26,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0582-01","type":"NDC"}],"standard_charges":[{"minimum":53.57,"maximum":289.26,"gross_charge":357.1,"discounted_cash":105.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.42,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0778-10","type":"NDC"}],"standard_charges":[{"minimum":113.21,"maximum":152.83,"gross_charge":188.67,"discounted_cash":55.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.21,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0778-10","type":"NDC"}],"standard_charges":[{"minimum":28.31,"maximum":152.83,"gross_charge":188.67,"discounted_cash":55.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.63,"maximum":41.35,"gross_charge":51.04,"discounted_cash":15.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.63,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.66,"maximum":41.35,"gross_charge":51.04,"discounted_cash":15.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":244.52,"maximum":330.1,"gross_charge":407.52,"discounted_cash":120.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.52,"methodology":"fee schedule"}]}]},{"description":"BUDESONIDE DR - ER 3 MG CAPSULEDELAYEDEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":61.13,"maximum":330.1,"gross_charge":407.52,"discounted_cash":120.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":330.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":330.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":330.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":244.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0131-15","type":"NDC"}],"standard_charges":[{"minimum":18.33,"maximum":24.74,"gross_charge":30.54,"discounted_cash":9.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0131-15","type":"NDC"}],"standard_charges":[{"minimum":4.59,"maximum":24.74,"gross_charge":30.54,"discounted_cash":9.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0384-95","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":1.37,"gross_charge":1.68,"discounted_cash":0.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0384-95","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":1.37,"gross_charge":1.68,"discounted_cash":0.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1490-01","type":"NDC"}],"standard_charges":[{"minimum":13.88,"maximum":18.74,"gross_charge":23.13,"discounted_cash":6.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1490-01","type":"NDC"}],"standard_charges":[{"minimum":3.47,"maximum":18.74,"gross_charge":23.13,"discounted_cash":6.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.47,"maximum":26.28,"gross_charge":32.44,"discounted_cash":9.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.87,"maximum":26.28,"gross_charge":32.44,"discounted_cash":9.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0121-01","type":"NDC"}],"standard_charges":[{"minimum":34.11,"maximum":46.05,"gross_charge":56.84,"discounted_cash":16.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0121-01","type":"NDC"}],"standard_charges":[{"minimum":8.53,"maximum":46.05,"gross_charge":56.84,"discounted_cash":16.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0121-02","type":"NDC"}],"standard_charges":[{"minimum":170.22,"maximum":229.79,"gross_charge":283.69,"discounted_cash":83.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.22,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0121-02","type":"NDC"}],"standard_charges":[{"minimum":42.56,"maximum":229.79,"gross_charge":283.69,"discounted_cash":83.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.74,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1491-01","type":"NDC"}],"standard_charges":[{"minimum":30.03,"maximum":40.54,"gross_charge":50.04,"discounted_cash":14.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.03,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1491-01","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":40.54,"gross_charge":50.04,"discounted_cash":14.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.87,"maximum":53.82,"gross_charge":66.44,"discounted_cash":19.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.87,"methodology":"fee schedule"}]}]},{"description":"BUMETANIDE 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.97,"maximum":53.82,"gross_charge":66.44,"discounted_cash":19.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0452-32","type":"NDC"}],"standard_charges":[{"minimum":8.09,"maximum":10.92,"gross_charge":13.48,"discounted_cash":4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0452-32","type":"NDC"}],"standard_charges":[{"minimum":2.03,"maximum":10.92,"gross_charge":13.48,"discounted_cash":4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0357-11","type":"NDC"}],"standard_charges":[{"minimum":1.65,"maximum":2.23,"gross_charge":2.75,"discounted_cash":0.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0357-11","type":"NDC"}],"standard_charges":[{"minimum":0.42,"maximum":2.23,"gross_charge":2.75,"discounted_cash":0.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0145-15","type":"NDC"}],"standard_charges":[{"minimum":56.43,"maximum":76.19,"gross_charge":94.05,"discounted_cash":27.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.43,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0145-15","type":"NDC"}],"standard_charges":[{"minimum":14.11,"maximum":76.19,"gross_charge":94.05,"discounted_cash":27.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.81,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0637-11","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":1.88,"gross_charge":2.31,"discounted_cash":0.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0637-11","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":1.88,"gross_charge":2.31,"discounted_cash":0.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0637-65","type":"NDC"}],"standard_charges":[{"minimum":65.49,"maximum":88.42,"gross_charge":109.15,"discounted_cash":32.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.49,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0637-65","type":"NDC"}],"standard_charges":[{"minimum":16.38,"maximum":88.42,"gross_charge":109.15,"discounted_cash":32.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0458-32","type":"NDC"}],"standard_charges":[{"minimum":16.63,"maximum":22.45,"gross_charge":27.71,"discounted_cash":8.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0458-32","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":22.45,"gross_charge":27.71,"discounted_cash":8.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0970-83","type":"NDC"}],"standard_charges":[{"minimum":10.9,"maximum":14.71,"gross_charge":18.16,"discounted_cash":5.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0970-83","type":"NDC"}],"standard_charges":[{"minimum":2.73,"maximum":14.71,"gross_charge":18.16,"discounted_cash":5.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.54,"maximum":27.72,"gross_charge":34.22,"discounted_cash":10.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.54,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.14,"maximum":27.72,"gross_charge":34.22,"discounted_cash":10.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.93,"maximum":30.96,"gross_charge":38.21,"discounted_cash":11.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.93,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.74,"maximum":30.96,"gross_charge":38.21,"discounted_cash":11.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":57.36,"maximum":77.44,"gross_charge":95.6,"discounted_cash":28.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.34,"maximum":77.44,"gross_charge":95.6,"discounted_cash":28.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.12,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0501-03","type":"NDC"}],"standard_charges":[{"minimum":5.14,"maximum":6.94,"gross_charge":8.56,"discounted_cash":2.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0501-03","type":"NDC"}],"standard_charges":[{"minimum":1.29,"maximum":6.94,"gross_charge":8.56,"discounted_cash":2.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0459-83","type":"NDC"}],"standard_charges":[{"minimum":9.53,"maximum":12.87,"gross_charge":15.88,"discounted_cash":4.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0459-83","type":"NDC"}],"standard_charges":[{"minimum":2.39,"maximum":12.87,"gross_charge":15.88,"discounted_cash":4.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.99,"maximum":9.44,"gross_charge":11.65,"discounted_cash":3.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.75,"maximum":9.44,"gross_charge":11.65,"discounted_cash":3.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.59,"maximum":30.49,"gross_charge":37.64,"discounted_cash":11.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.59,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.65,"maximum":30.49,"gross_charge":37.64,"discounted_cash":11.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0460-83","type":"NDC"}],"standard_charges":[{"minimum":30.09,"maximum":40.63,"gross_charge":50.15,"discounted_cash":14.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0460-83","type":"NDC"}],"standard_charges":[{"minimum":7.53,"maximum":40.63,"gross_charge":50.15,"discounted_cash":14.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.23,"maximum":27.31,"gross_charge":33.71,"discounted_cash":9.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.23,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.06,"maximum":27.31,"gross_charge":33.71,"discounted_cash":9.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0192-01","type":"NDC"}],"standard_charges":[{"minimum":14.55,"maximum":19.64,"gross_charge":24.24,"discounted_cash":7.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0192-01","type":"NDC"}],"standard_charges":[{"minimum":3.64,"maximum":19.64,"gross_charge":24.24,"discounted_cash":7.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24689-0120-01","type":"NDC"}],"standard_charges":[{"minimum":10.82,"maximum":14.61,"gross_charge":18.03,"discounted_cash":5.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24689-0120-01","type":"NDC"}],"standard_charges":[{"minimum":2.71,"maximum":14.61,"gross_charge":18.03,"discounted_cash":5.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0309-00","type":"NDC"}],"standard_charges":[{"minimum":37.47,"maximum":50.58,"gross_charge":62.44,"discounted_cash":18.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.47,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0309-00","type":"NDC"}],"standard_charges":[{"minimum":9.37,"maximum":50.58,"gross_charge":62.44,"discounted_cash":18.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0918-07","type":"NDC"}],"standard_charges":[{"minimum":20.01,"maximum":27.01,"gross_charge":33.34,"discounted_cash":9.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.01,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0918-07","type":"NDC"}],"standard_charges":[{"minimum":5.01,"maximum":27.01,"gross_charge":33.34,"discounted_cash":9.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0340-11","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":0.83,"gross_charge":1.02,"discounted_cash":0.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0340-11","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":0.83,"gross_charge":1.02,"discounted_cash":0.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 75 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":49.53,"maximum":66.87,"gross_charge":82.55,"discounted_cash":24.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.53,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL 75 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.39,"maximum":66.87,"gross_charge":82.55,"discounted_cash":24.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL SR 100 MG TABLET12 HR SUSTAINED-RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0697-11","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":0.64,"gross_charge":0.79,"discounted_cash":0.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL SR 100 MG TABLET12 HR SUSTAINED-RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0697-11","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.64,"gross_charge":0.79,"discounted_cash":0.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL SR 150 MG TABLET12 HR SUSTAINED-RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.44,"maximum":5.99,"gross_charge":7.39,"discounted_cash":2.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL SR 150 MG TABLET12 HR SUSTAINED-RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.11,"maximum":5.99,"gross_charge":7.39,"discounted_cash":2.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0443-10","type":"NDC"}],"standard_charges":[{"minimum":2.39,"maximum":3.22,"gross_charge":3.97,"discounted_cash":1.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0443-10","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":3.22,"gross_charge":3.97,"discounted_cash":1.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0322-03","type":"NDC"}],"standard_charges":[{"minimum":87.1,"maximum":117.58,"gross_charge":145.16,"discounted_cash":42.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0322-03","type":"NDC"}],"standard_charges":[{"minimum":21.78,"maximum":117.58,"gross_charge":145.16,"discounted_cash":42.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.04,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0322-05","type":"NDC"}],"standard_charges":[{"minimum":15.64,"maximum":21.11,"gross_charge":26.06,"discounted_cash":7.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0322-05","type":"NDC"}],"standard_charges":[{"minimum":3.91,"maximum":21.11,"gross_charge":26.06,"discounted_cash":7.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0319-09","type":"NDC"}],"standard_charges":[{"minimum":9.75,"maximum":13.16,"gross_charge":16.24,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0319-09","type":"NDC"}],"standard_charges":[{"minimum":2.44,"maximum":13.16,"gross_charge":16.24,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0353-16","type":"NDC"}],"standard_charges":[{"minimum":18.45,"maximum":24.9,"gross_charge":30.74,"discounted_cash":9.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.45,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0353-16","type":"NDC"}],"standard_charges":[{"minimum":4.62,"maximum":24.9,"gross_charge":30.74,"discounted_cash":9.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.99,"maximum":14.84,"gross_charge":18.31,"discounted_cash":5.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"}]}]},{"description":"BUPROPION HCL XL 150 MG 24 HR TABLET EXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":14.84,"gross_charge":18.31,"discounted_cash":5.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"}]}]},{"description":"BUSPIRONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0202-16","type":"NDC"}],"standard_charges":[{"minimum":12.08,"maximum":16.31,"gross_charge":20.13,"discounted_cash":5.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"}]}]},{"description":"BUSPIRONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0202-16","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":16.31,"gross_charge":20.13,"discounted_cash":5.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"}]}]},{"description":"BUSPIRONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0245-01","type":"NDC"}],"standard_charges":[{"minimum":3.08,"maximum":4.16,"gross_charge":5.13,"discounted_cash":1.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"}]}]},{"description":"BUSPIRONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0245-01","type":"NDC"}],"standard_charges":[{"minimum":0.77,"maximum":4.16,"gross_charge":5.13,"discounted_cash":1.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0253-01","type":"NDC"}],"standard_charges":[{"minimum":11,"maximum":14.85,"gross_charge":18.33,"discounted_cash":5.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0253-01","type":"NDC"}],"standard_charges":[{"minimum":2.75,"maximum":14.85,"gross_charge":18.33,"discounted_cash":5.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0553-13","type":"NDC"}],"standard_charges":[{"minimum":16.34,"maximum":22.06,"gross_charge":27.23,"discounted_cash":8.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0553-13","type":"NDC"}],"standard_charges":[{"minimum":4.09,"maximum":22.06,"gross_charge":27.23,"discounted_cash":8.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0672-11","type":"NDC"}],"standard_charges":[{"minimum":0.84,"maximum":1.13,"gross_charge":1.39,"discounted_cash":0.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0672-11","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":1.13,"gross_charge":1.39,"discounted_cash":0.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0672-65","type":"NDC"}],"standard_charges":[{"minimum":37.74,"maximum":50.95,"gross_charge":62.89,"discounted_cash":18.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0672-65","type":"NDC"}],"standard_charges":[{"minimum":9.44,"maximum":50.95,"gross_charge":62.89,"discounted_cash":18.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69367-0203-01","type":"NDC"}],"standard_charges":[{"minimum":39.09,"maximum":52.77,"gross_charge":65.14,"discounted_cash":19.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.09,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69367-0203-01","type":"NDC"}],"standard_charges":[{"minimum":9.78,"maximum":52.77,"gross_charge":65.14,"discounted_cash":19.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.79,"maximum":48.31,"gross_charge":59.64,"discounted_cash":17.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"}]}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.95,"maximum":48.31,"gross_charge":59.64,"discounted_cash":17.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0161-11","type":"NDC"}],"standard_charges":[{"minimum":21.06,"maximum":28.44,"gross_charge":35.1,"discounted_cash":10.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0161-11","type":"NDC"}],"standard_charges":[{"minimum":5.27,"maximum":28.44,"gross_charge":35.1,"discounted_cash":10.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0823-06","type":"NDC"}],"standard_charges":[{"minimum":42.86,"maximum":57.86,"gross_charge":71.43,"discounted_cash":21.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.86,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0823-06","type":"NDC"}],"standard_charges":[{"minimum":10.72,"maximum":57.86,"gross_charge":71.43,"discounted_cash":21.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0967-88","type":"NDC"}],"standard_charges":[{"minimum":13.46,"maximum":18.17,"gross_charge":22.43,"discounted_cash":6.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0967-88","type":"NDC"}],"standard_charges":[{"minimum":3.37,"maximum":18.17,"gross_charge":22.43,"discounted_cash":6.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0723-06","type":"NDC"}],"standard_charges":[{"minimum":10.52,"maximum":14.2,"gross_charge":17.53,"discounted_cash":5.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0723-06","type":"NDC"}],"standard_charges":[{"minimum":2.63,"maximum":14.2,"gross_charge":17.53,"discounted_cash":5.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0207-13","type":"NDC"}],"standard_charges":[{"minimum":2.8,"maximum":3.78,"gross_charge":4.66,"discounted_cash":1.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0207-13","type":"NDC"}],"standard_charges":[{"minimum":0.7,"maximum":3.78,"gross_charge":4.66,"discounted_cash":1.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0207-20","type":"NDC"}],"standard_charges":[{"minimum":16.05,"maximum":21.66,"gross_charge":26.74,"discounted_cash":7.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 0.25 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0207-20","type":"NDC"}],"standard_charges":[{"minimum":4.02,"maximum":21.66,"gross_charge":26.74,"discounted_cash":7.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 1 MCG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":50.05,"maximum":67.57,"gross_charge":83.41,"discounted_cash":24.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 1 MCG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.52,"maximum":67.57,"gross_charge":83.41,"discounted_cash":24.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"}]}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0988-33","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":0.69,"gross_charge":0.85,"discounted_cash":0.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"}]}]},{"description":"CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0988-33","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.69,"gross_charge":0.85,"discounted_cash":0.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"CALCIUM 600 MG (AS CARBONATE)-VITAMIN D3 10 MCG (400 UNIT) TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"20555-0017-00","type":"NDC"}],"standard_charges":[{"minimum":3.41,"maximum":4.61,"gross_charge":5.68,"discounted_cash":1.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"}]}]},{"description":"CALCIUM 600 MG (AS CARBONATE)-VITAMIN D3 10 MCG (400 UNIT) TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"20555-0017-00","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":4.61,"gross_charge":5.68,"discounted_cash":1.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0813-20","type":"NDC"}],"standard_charges":[{"minimum":20.37,"maximum":27.5,"gross_charge":33.94,"discounted_cash":10.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.37,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0813-20","type":"NDC"}],"standard_charges":[{"minimum":5.1,"maximum":27.5,"gross_charge":33.94,"discounted_cash":10.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.79,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0531-02","type":"NDC"}],"standard_charges":[{"minimum":30.09,"maximum":40.62,"gross_charge":50.14,"discounted_cash":14.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0531-02","type":"NDC"}],"standard_charges":[{"minimum":7.53,"maximum":40.62,"gross_charge":50.14,"discounted_cash":14.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24689-0793-02","type":"NDC"}],"standard_charges":[{"minimum":46.65,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24689-0793-02","type":"NDC"}],"standard_charges":[{"minimum":11.67,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29033-0026-02","type":"NDC"}],"standard_charges":[{"minimum":27.57,"maximum":37.22,"gross_charge":45.94,"discounted_cash":13.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29033-0026-02","type":"NDC"}],"standard_charges":[{"minimum":6.9,"maximum":37.22,"gross_charge":45.94,"discounted_cash":13.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62135-0191-22","type":"NDC"}],"standard_charges":[{"minimum":77.14,"maximum":104.14,"gross_charge":128.56,"discounted_cash":38.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.14,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62135-0191-22","type":"NDC"}],"standard_charges":[{"minimum":19.29,"maximum":104.14,"gross_charge":128.56,"discounted_cash":38.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.72,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0590-20","type":"NDC"}],"standard_charges":[{"minimum":65.61,"maximum":88.58,"gross_charge":109.35,"discounted_cash":32.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0590-20","type":"NDC"}],"standard_charges":[{"minimum":16.41,"maximum":88.58,"gross_charge":109.35,"discounted_cash":32.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.56,"maximum":18.31,"gross_charge":22.6,"discounted_cash":6.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.39,"maximum":18.31,"gross_charge":22.6,"discounted_cash":6.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":32.49,"maximum":43.86,"gross_charge":54.14,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"}]}]},{"description":"CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.13,"maximum":43.86,"gross_charge":54.14,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"}]}]},{"description":"CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.88,"maximum":3.88,"gross_charge":4.79,"discounted_cash":1.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"}]}]},{"description":"CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.72,"maximum":3.88,"gross_charge":4.79,"discounted_cash":1.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"}]}]},{"description":"CAPSAICIN 0.025 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.74,"maximum":2.35,"gross_charge":2.89,"discounted_cash":0.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"}]}]},{"description":"CAPSAICIN 0.025 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.44,"maximum":2.35,"gross_charge":2.89,"discounted_cash":0.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0160-01","type":"NDC"}],"standard_charges":[{"minimum":48.09,"maximum":64.93,"gross_charge":80.15,"discounted_cash":23.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0160-01","type":"NDC"}],"standard_charges":[{"minimum":12.03,"maximum":64.93,"gross_charge":80.15,"discounted_cash":23.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0161-01","type":"NDC"}],"standard_charges":[{"minimum":51.09,"maximum":68.98,"gross_charge":85.15,"discounted_cash":25.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.09,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0161-01","type":"NDC"}],"standard_charges":[{"minimum":12.78,"maximum":68.98,"gross_charge":85.15,"discounted_cash":25.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.03,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0142-01","type":"NDC"}],"standard_charges":[{"minimum":48.57,"maximum":65.57,"gross_charge":80.95,"discounted_cash":23.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0142-01","type":"NDC"}],"standard_charges":[{"minimum":12.15,"maximum":65.57,"gross_charge":80.95,"discounted_cash":23.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0315-21","type":"NDC"}],"standard_charges":[{"minimum":26.71,"maximum":36.06,"gross_charge":44.51,"discounted_cash":13.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.71,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0315-21","type":"NDC"}],"standard_charges":[{"minimum":6.68,"maximum":36.06,"gross_charge":44.51,"discounted_cash":13.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69292-0524-01","type":"NDC"}],"standard_charges":[{"minimum":63.69,"maximum":85.99,"gross_charge":106.15,"discounted_cash":31.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69292-0524-01","type":"NDC"}],"standard_charges":[{"minimum":15.93,"maximum":85.99,"gross_charge":106.15,"discounted_cash":31.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":50.31,"maximum":67.92,"gross_charge":83.85,"discounted_cash":24.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"}]}]},{"description":"CAPTOPRIL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.58,"maximum":67.92,"gross_charge":83.85,"discounted_cash":24.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 100 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0479-01","type":"NDC"}],"standard_charges":[{"minimum":26.85,"maximum":36.24,"gross_charge":44.74,"discounted_cash":13.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 100 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0479-01","type":"NDC"}],"standard_charges":[{"minimum":6.72,"maximum":36.24,"gross_charge":44.74,"discounted_cash":13.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60432-0129-16","type":"NDC"}],"standard_charges":[{"minimum":31.14,"maximum":42.04,"gross_charge":51.89,"discounted_cash":15.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.14,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60432-0129-16","type":"NDC"}],"standard_charges":[{"minimum":7.79,"maximum":42.04,"gross_charge":51.89,"discounted_cash":15.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0240-10","type":"NDC"}],"standard_charges":[{"minimum":38.97,"maximum":52.61,"gross_charge":64.94,"discounted_cash":19.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.97,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0240-10","type":"NDC"}],"standard_charges":[{"minimum":9.75,"maximum":52.61,"gross_charge":64.94,"discounted_cash":19.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0385-20","type":"NDC"}],"standard_charges":[{"minimum":34.71,"maximum":46.86,"gross_charge":57.84,"discounted_cash":17.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0385-20","type":"NDC"}],"standard_charges":[{"minimum":8.68,"maximum":46.86,"gross_charge":57.84,"discounted_cash":17.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0444-11","type":"NDC"}],"standard_charges":[{"minimum":0.42,"maximum":0.56,"gross_charge":0.69,"discounted_cash":0.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0444-11","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":0.56,"gross_charge":0.69,"discounted_cash":0.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":37.65,"maximum":50.82,"gross_charge":62.74,"discounted_cash":18.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.42,"maximum":50.82,"gross_charge":62.74,"discounted_cash":18.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0008-59","type":"NDC"}],"standard_charges":[{"minimum":2.36,"maximum":3.18,"gross_charge":3.92,"discounted_cash":1.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0008-59","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":3.18,"gross_charge":3.92,"discounted_cash":1.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":2.06,"gross_charge":2.54,"discounted_cash":0.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE 200 MG/10 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.39,"maximum":2.06,"gross_charge":2.54,"discounted_cash":0.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0063-01","type":"NDC"}],"standard_charges":[{"minimum":20.43,"maximum":27.58,"gross_charge":34.04,"discounted_cash":10.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0063-01","type":"NDC"}],"standard_charges":[{"minimum":5.11,"maximum":27.58,"gross_charge":34.04,"discounted_cash":10.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4123-01","type":"NDC"}],"standard_charges":[{"minimum":12.86,"maximum":17.36,"gross_charge":21.43,"discounted_cash":6.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4123-01","type":"NDC"}],"standard_charges":[{"minimum":3.22,"maximum":17.36,"gross_charge":21.43,"discounted_cash":6.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.69,"maximum":33.33,"gross_charge":41.14,"discounted_cash":12.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.18,"maximum":33.33,"gross_charge":41.14,"discounted_cash":12.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.93,"maximum":33.65,"gross_charge":41.54,"discounted_cash":12.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.93,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.24,"maximum":33.65,"gross_charge":41.54,"discounted_cash":12.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":88.6,"maximum":119.61,"gross_charge":147.66,"discounted_cash":43.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.6,"methodology":"fee schedule"}]}]},{"description":"CARBAMAZEPINE ER 100 MG TABLETEXTENDED RELEASE12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.15,"maximum":119.61,"gross_charge":147.66,"discounted_cash":43.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.54,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42037-0104-78","type":"NDC"}],"standard_charges":[{"minimum":2.64,"maximum":3.56,"gross_charge":4.39,"discounted_cash":1.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42037-0104-78","type":"NDC"}],"standard_charges":[{"minimum":0.66,"maximum":3.56,"gross_charge":4.39,"discounted_cash":1.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42037-0104-79","type":"NDC"}],"standard_charges":[{"minimum":113.69,"maximum":153.48,"gross_charge":189.47,"discounted_cash":56.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42037-0104-79","type":"NDC"}],"standard_charges":[{"minimum":28.43,"maximum":153.48,"gross_charge":189.47,"discounted_cash":56.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46122-0557-05","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":0.91,"gross_charge":1.12,"discounted_cash":0.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46122-0557-05","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.91,"gross_charge":1.12,"discounted_cash":0.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70677-1154-01","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":1.78,"gross_charge":2.19,"discounted_cash":0.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70677-1154-01","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":1.78,"gross_charge":2.19,"discounted_cash":0.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78112-0736-21","type":"NDC"}],"standard_charges":[{"minimum":3.48,"maximum":4.69,"gross_charge":5.79,"discounted_cash":1.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78112-0736-21","type":"NDC"}],"standard_charges":[{"minimum":0.87,"maximum":4.69,"gross_charge":5.79,"discounted_cash":1.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.81,"maximum":11.9,"gross_charge":14.68,"discounted_cash":4.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"}]}]},{"description":"CARBAMIDE PEROXIDE 6.5 % EAR DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.21,"maximum":11.9,"gross_charge":14.68,"discounted_cash":4.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0077-01","type":"NDC"}],"standard_charges":[{"minimum":14.67,"maximum":19.8,"gross_charge":24.44,"discounted_cash":7.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0077-01","type":"NDC"}],"standard_charges":[{"minimum":3.67,"maximum":19.8,"gross_charge":24.44,"discounted_cash":7.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0046-10","type":"NDC"}],"standard_charges":[{"minimum":13.22,"maximum":17.85,"gross_charge":22.03,"discounted_cash":6.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0046-10","type":"NDC"}],"standard_charges":[{"minimum":3.31,"maximum":17.85,"gross_charge":22.03,"discounted_cash":6.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 12.5 MG-LEVODOPA 50 MG-ENTACAPONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0001-88","type":"NDC"}],"standard_charges":[{"minimum":169.86,"maximum":229.31,"gross_charge":283.09,"discounted_cash":83.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.86,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 12.5 MG-LEVODOPA 50 MG-ENTACAPONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0001-88","type":"NDC"}],"standard_charges":[{"minimum":42.47,"maximum":229.31,"gross_charge":283.09,"discounted_cash":83.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 12.5 MG-LEVODOPA 50 MG-ENTACAPONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.43,"maximum":47.83,"gross_charge":59.04,"discounted_cash":17.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.43,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 12.5 MG-LEVODOPA 50 MG-ENTACAPONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.86,"maximum":47.83,"gross_charge":59.04,"discounted_cash":17.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0067-01","type":"NDC"}],"standard_charges":[{"minimum":361.96,"maximum":488.65,"gross_charge":603.26,"discounted_cash":178.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":488.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":488.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":361.96,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0067-01","type":"NDC"}],"standard_charges":[{"minimum":90.49,"maximum":488.65,"gross_charge":603.26,"discounted_cash":178.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":488.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":488.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":488.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":361.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.66,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0123-01","type":"NDC"}],"standard_charges":[{"minimum":38.55,"maximum":52.04,"gross_charge":64.24,"discounted_cash":19.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0123-01","type":"NDC"}],"standard_charges":[{"minimum":9.64,"maximum":52.04,"gross_charge":64.24,"discounted_cash":19.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0200-25","type":"NDC"}],"standard_charges":[{"minimum":77.86,"maximum":105.11,"gross_charge":129.76,"discounted_cash":38.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.86,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0200-25","type":"NDC"}],"standard_charges":[{"minimum":19.47,"maximum":105.11,"gross_charge":129.76,"discounted_cash":38.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0187-88","type":"NDC"}],"standard_charges":[{"minimum":50.79,"maximum":68.57,"gross_charge":84.65,"discounted_cash":25.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.79,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0187-88","type":"NDC"}],"standard_charges":[{"minimum":12.7,"maximum":68.57,"gross_charge":84.65,"discounted_cash":25.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.56,"maximum":16.96,"gross_charge":20.93,"discounted_cash":6.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.14,"maximum":16.96,"gross_charge":20.93,"discounted_cash":6.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG-ENTACAPONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":177.48,"maximum":239.59,"gross_charge":295.79,"discounted_cash":87.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":239.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":239.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.48,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 100 MG-ENTACAPONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.37,"maximum":239.59,"gross_charge":295.79,"discounted_cash":87.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":239.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":239.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.16,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0188-88","type":"NDC"}],"standard_charges":[{"minimum":64.65,"maximum":87.28,"gross_charge":107.75,"discounted_cash":31.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.65,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0188-88","type":"NDC"}],"standard_charges":[{"minimum":16.17,"maximum":87.28,"gross_charge":107.75,"discounted_cash":31.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.55,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50228-0459-01","type":"NDC"}],"standard_charges":[{"minimum":6.86,"maximum":9.26,"gross_charge":11.43,"discounted_cash":3.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50228-0459-01","type":"NDC"}],"standard_charges":[{"minimum":1.72,"maximum":9.26,"gross_charge":11.43,"discounted_cash":3.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 37.5 MG-LEVODOPA 150 MG-ENTACAPONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.75,"maximum":53.66,"gross_charge":66.24,"discounted_cash":19.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA 37.5 MG-LEVODOPA 150 MG-ENTACAPONE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.94,"maximum":53.66,"gross_charge":66.24,"discounted_cash":19.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0078-01","type":"NDC"}],"standard_charges":[{"minimum":15.33,"maximum":20.69,"gross_charge":25.54,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.33,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0078-01","type":"NDC"}],"standard_charges":[{"minimum":3.84,"maximum":20.69,"gross_charge":25.54,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.11,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0461-88","type":"NDC"}],"standard_charges":[{"minimum":21.09,"maximum":28.47,"gross_charge":35.14,"discounted_cash":10.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0461-88","type":"NDC"}],"standard_charges":[{"minimum":5.28,"maximum":28.47,"gross_charge":35.14,"discounted_cash":10.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0079-01","type":"NDC"}],"standard_charges":[{"minimum":32.85,"maximum":44.34,"gross_charge":54.74,"discounted_cash":16.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0079-01","type":"NDC"}],"standard_charges":[{"minimum":8.22,"maximum":44.34,"gross_charge":54.74,"discounted_cash":16.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50228-0461-01","type":"NDC"}],"standard_charges":[{"minimum":30.27,"maximum":40.86,"gross_charge":50.44,"discounted_cash":14.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50228-0461-01","type":"NDC"}],"standard_charges":[{"minimum":7.57,"maximum":40.86,"gross_charge":50.44,"discounted_cash":14.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0172-00","type":"NDC"}],"standard_charges":[{"minimum":17.67,"maximum":23.85,"gross_charge":29.44,"discounted_cash":8.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0172-00","type":"NDC"}],"standard_charges":[{"minimum":4.42,"maximum":23.85,"gross_charge":29.44,"discounted_cash":8.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0282-11","type":"NDC"}],"standard_charges":[{"minimum":43.11,"maximum":58.2,"gross_charge":71.85,"discounted_cash":21.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.11,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0282-11","type":"NDC"}],"standard_charges":[{"minimum":10.78,"maximum":58.2,"gross_charge":71.85,"discounted_cash":21.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.27,"maximum":53.01,"gross_charge":65.44,"discounted_cash":19.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"}]}]},{"description":"CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.82,"maximum":53.01,"gross_charge":65.44,"discounted_cash":19.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.56,"maximum":4.8,"gross_charge":5.92,"discounted_cash":1.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"}]}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.89,"maximum":4.8,"gross_charge":5.92,"discounted_cash":1.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"}]}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.69,"maximum":7.68,"gross_charge":9.48,"discounted_cash":2.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"}]}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS IN A DROPPERETTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.43,"maximum":7.68,"gross_charge":9.48,"discounted_cash":2.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"}]}]},{"description":"CARIPRAZINE 3 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61874-0130-11","type":"NDC"}],"standard_charges":[{"minimum":264.72,"maximum":357.38,"gross_charge":441.2,"discounted_cash":130.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":357.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.72,"methodology":"fee schedule"}]}]},{"description":"CARIPRAZINE 3 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61874-0130-11","type":"NDC"}],"standard_charges":[{"minimum":66.18,"maximum":357.38,"gross_charge":441.2,"discounted_cash":130.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":357.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"}]}]},{"description":"CARIPRAZINE 3 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61874-0130-20","type":"NDC"}],"standard_charges":[{"minimum":529.37,"maximum":714.65,"gross_charge":882.28,"discounted_cash":261.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":714.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":714.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":714.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":529.37,"methodology":"fee schedule"}]}]},{"description":"CARIPRAZINE 3 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61874-0130-20","type":"NDC"}],"standard_charges":[{"minimum":132.35,"maximum":714.65,"gross_charge":882.28,"discounted_cash":261.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":714.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":714.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":714.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":529.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.46,"methodology":"fee schedule"}]}]},{"description":"CARIPRAZINE 3 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61874-0130-30","type":"NDC"}],"standard_charges":[{"minimum":794.01,"maximum":1071.92,"gross_charge":1323.35,"discounted_cash":391.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1071.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1071.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1071.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":794.01,"methodology":"fee schedule"}]}]},{"description":"CARIPRAZINE 3 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61874-0130-30","type":"NDC"}],"standard_charges":[{"minimum":198.51,"maximum":1071.92,"gross_charge":1323.35,"discounted_cash":391.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1071.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1071.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1071.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":794.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":251.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.67,"methodology":"fee schedule"}]}]},{"description":"CARVEDILOL 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0930-20","type":"NDC"}],"standard_charges":[{"minimum":4.46,"maximum":6.02,"gross_charge":7.43,"discounted_cash":2.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"}]}]},{"description":"CARVEDILOL 6.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0930-20","type":"NDC"}],"standard_charges":[{"minimum":1.12,"maximum":6.02,"gross_charge":7.43,"discounted_cash":2.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0391-02","type":"NDC"}],"standard_charges":[{"minimum":14.78,"maximum":19.95,"gross_charge":24.62,"discounted_cash":7.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0391-02","type":"NDC"}],"standard_charges":[{"minimum":3.7,"maximum":19.95,"gross_charge":24.62,"discounted_cash":7.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0099-60","type":"NDC"}],"standard_charges":[{"minimum":30.08,"maximum":40.6,"gross_charge":50.12,"discounted_cash":14.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0099-60","type":"NDC"}],"standard_charges":[{"minimum":7.52,"maximum":40.6,"gross_charge":50.12,"discounted_cash":14.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0177-60","type":"NDC"}],"standard_charges":[{"minimum":26.98,"maximum":36.42,"gross_charge":44.96,"discounted_cash":13.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0177-60","type":"NDC"}],"standard_charges":[{"minimum":6.75,"maximum":36.42,"gross_charge":44.96,"discounted_cash":13.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0150-06","type":"NDC"}],"standard_charges":[{"minimum":128.45,"maximum":173.4,"gross_charge":214.07,"discounted_cash":63.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.45,"methodology":"fee schedule"}]}]},{"description":"CEFDINIR 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0150-06","type":"NDC"}],"standard_charges":[{"minimum":32.12,"maximum":173.4,"gross_charge":214.07,"discounted_cash":63.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0400-01","type":"NDC"}],"standard_charges":[{"minimum":13.74,"maximum":18.55,"gross_charge":22.89,"discounted_cash":6.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0400-01","type":"NDC"}],"standard_charges":[{"minimum":3.44,"maximum":18.55,"gross_charge":22.89,"discounted_cash":6.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0400-02","type":"NDC"}],"standard_charges":[{"minimum":7.57,"maximum":10.22,"gross_charge":12.61,"discounted_cash":3.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0400-02","type":"NDC"}],"standard_charges":[{"minimum":1.9,"maximum":10.22,"gross_charge":12.61,"discounted_cash":3.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0058-60","type":"NDC"}],"standard_charges":[{"minimum":32.02,"maximum":43.23,"gross_charge":53.36,"discounted_cash":15.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.02,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0058-60","type":"NDC"}],"standard_charges":[{"minimum":8.01,"maximum":43.23,"gross_charge":53.36,"discounted_cash":15.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0215-60","type":"NDC"}],"standard_charges":[{"minimum":7.71,"maximum":10.41,"gross_charge":12.85,"discounted_cash":3.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0215-60","type":"NDC"}],"standard_charges":[{"minimum":1.93,"maximum":10.41,"gross_charge":12.85,"discounted_cash":3.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0401-01","type":"NDC"}],"standard_charges":[{"minimum":7.79,"maximum":10.51,"gross_charge":12.97,"discounted_cash":3.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0401-01","type":"NDC"}],"standard_charges":[{"minimum":1.95,"maximum":10.51,"gross_charge":12.97,"discounted_cash":3.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0059-20","type":"NDC"}],"standard_charges":[{"minimum":3.37,"maximum":4.55,"gross_charge":5.61,"discounted_cash":1.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0059-20","type":"NDC"}],"standard_charges":[{"minimum":0.85,"maximum":4.55,"gross_charge":5.61,"discounted_cash":1.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0283-11","type":"NDC"}],"standard_charges":[{"minimum":1.98,"maximum":2.67,"gross_charge":3.29,"discounted_cash":0.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0283-11","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":2.67,"gross_charge":3.29,"discounted_cash":0.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0283-94","type":"NDC"}],"standard_charges":[{"minimum":37.96,"maximum":51.25,"gross_charge":63.26,"discounted_cash":18.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.96,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0283-94","type":"NDC"}],"standard_charges":[{"minimum":9.49,"maximum":51.25,"gross_charge":63.26,"discounted_cash":18.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0216-20","type":"NDC"}],"standard_charges":[{"minimum":20.04,"maximum":27.06,"gross_charge":33.4,"discounted_cash":9.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0216-20","type":"NDC"}],"standard_charges":[{"minimum":5.01,"maximum":27.06,"gross_charge":33.4,"discounted_cash":9.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0216-60","type":"NDC"}],"standard_charges":[{"minimum":49.45,"maximum":66.76,"gross_charge":82.41,"discounted_cash":24.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME AXETIL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0216-60","type":"NDC"}],"standard_charges":[{"minimum":12.37,"maximum":66.76,"gross_charge":82.41,"discounted_cash":24.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.49,"methodology":"fee schedule"}]}]},{"description":"CELECOXIB 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":48.99,"maximum":66.14,"gross_charge":81.65,"discounted_cash":24.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"}]}]},{"description":"CELECOXIB 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.25,"maximum":66.14,"gross_charge":81.65,"discounted_cash":24.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.33,"methodology":"fee schedule"}]}]},{"description":"CELECOXIB 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0142-31","type":"NDC"}],"standard_charges":[{"minimum":29.73,"maximum":40.13,"gross_charge":49.54,"discounted_cash":14.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.73,"methodology":"fee schedule"}]}]},{"description":"CELECOXIB 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0142-31","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":40.13,"gross_charge":49.54,"discounted_cash":14.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"}]}]},{"description":"CELECOXIB 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":119.69,"maximum":161.58,"gross_charge":199.47,"discounted_cash":59.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.69,"methodology":"fee schedule"}]}]},{"description":"CELECOXIB 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.93,"maximum":161.58,"gross_charge":199.47,"discounted_cash":59.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"}]}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0374-20","type":"NDC"}],"standard_charges":[{"minimum":35.37,"maximum":47.75,"gross_charge":58.94,"discounted_cash":17.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"}]}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0374-20","type":"NDC"}],"standard_charges":[{"minimum":8.85,"maximum":47.75,"gross_charge":58.94,"discounted_cash":17.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"}]}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.3,"maximum":15.26,"gross_charge":18.83,"discounted_cash":5.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"}]}]},{"description":"CHLORDIAZEPOXIDE 5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.83,"maximum":15.26,"gross_charge":18.83,"discounted_cash":5.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0720-15","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":0.6,"gross_charge":0.73,"discounted_cash":0.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0720-15","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":0.6,"gross_charge":0.73,"discounted_cash":0.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0052-74","type":"NDC"}],"standard_charges":[{"minimum":1.05,"maximum":1.42,"gross_charge":1.75,"discounted_cash":0.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0052-74","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":1.42,"gross_charge":1.75,"discounted_cash":0.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0028-61","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":1.58,"gross_charge":1.95,"discounted_cash":0.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0028-61","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":1.58,"gross_charge":1.95,"discounted_cash":0.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0138-15","type":"NDC"}],"standard_charges":[{"minimum":1.11,"maximum":1.5,"gross_charge":1.84,"discounted_cash":0.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0138-15","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":1.5,"gross_charge":1.84,"discounted_cash":0.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0138-19","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":1.44,"gross_charge":1.77,"discounted_cash":0.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0138-19","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":1.44,"gross_charge":1.77,"discounted_cash":0.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.55,"maximum":0.74,"gross_charge":0.91,"discounted_cash":0.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.14,"maximum":0.74,"gross_charge":0.91,"discounted_cash":0.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.85,"maximum":1.15,"gross_charge":1.41,"discounted_cash":0.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.22,"maximum":1.15,"gross_charge":1.41,"discounted_cash":0.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.14,"maximum":1.54,"gross_charge":1.89,"discounted_cash":0.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":1.54,"gross_charge":1.89,"discounted_cash":0.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.5,"maximum":2.03,"gross_charge":2.5,"discounted_cash":0.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"}]}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.38,"maximum":2.03,"gross_charge":2.5,"discounted_cash":0.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"CHLORTHALIDONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0170-01","type":"NDC"}],"standard_charges":[{"minimum":2.54,"maximum":3.43,"gross_charge":4.23,"discounted_cash":1.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"}]}]},{"description":"CHLORTHALIDONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0170-01","type":"NDC"}],"standard_charges":[{"minimum":0.64,"maximum":3.43,"gross_charge":4.23,"discounted_cash":1.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"}]}]},{"description":"CHLORTHALIDONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0058-01","type":"NDC"}],"standard_charges":[{"minimum":1.2,"maximum":1.62,"gross_charge":2,"discounted_cash":0.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"}]}]},{"description":"CHLORTHALIDONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0058-01","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":1.62,"gross_charge":2,"discounted_cash":0.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0270-95","type":"NDC"}],"standard_charges":[{"minimum":27.84,"maximum":37.59,"gross_charge":46.4,"discounted_cash":13.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.84,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0270-95","type":"NDC"}],"standard_charges":[{"minimum":6.96,"maximum":37.59,"gross_charge":46.4,"discounted_cash":13.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0906-20","type":"NDC"}],"standard_charges":[{"minimum":46.25,"maximum":62.43,"gross_charge":77.07,"discounted_cash":22.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.25,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0906-20","type":"NDC"}],"standard_charges":[{"minimum":11.57,"maximum":62.43,"gross_charge":77.07,"discounted_cash":22.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0529-60","type":"NDC"}],"standard_charges":[{"minimum":30.58,"maximum":41.28,"gross_charge":50.96,"discounted_cash":15.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.58,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0529-60","type":"NDC"}],"standard_charges":[{"minimum":7.65,"maximum":41.28,"gross_charge":50.96,"discounted_cash":15.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.29,"maximum":40.89,"gross_charge":50.48,"discounted_cash":14.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.29,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.58,"maximum":40.89,"gross_charge":50.48,"discounted_cash":14.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":72.82,"maximum":98.31,"gross_charge":121.36,"discounted_cash":35.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.82,"methodology":"fee schedule"}]}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.21,"maximum":98.31,"gross_charge":121.36,"discounted_cash":35.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"}]}]},{"description":"CILOSTAZOL 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.93,"maximum":3.95,"gross_charge":4.87,"discounted_cash":1.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"}]}]},{"description":"CILOSTAZOL 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.74,"maximum":3.95,"gross_charge":4.87,"discounted_cash":1.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"CILOSTAZOL 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.67,"maximum":14.4,"gross_charge":17.77,"discounted_cash":5.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"}]}]},{"description":"CILOSTAZOL 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.67,"maximum":14.4,"gross_charge":17.77,"discounted_cash":5.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0440-10","type":"NDC"}],"standard_charges":[{"minimum":8.33,"maximum":11.24,"gross_charge":13.87,"discounted_cash":4.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0440-10","type":"NDC"}],"standard_charges":[{"minimum":2.09,"maximum":11.24,"gross_charge":13.87,"discounted_cash":4.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0459-30","type":"NDC"}],"standard_charges":[{"minimum":7.34,"maximum":9.9,"gross_charge":12.22,"discounted_cash":3.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.34,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0459-30","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":9.9,"gross_charge":12.22,"discounted_cash":3.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0379-83","type":"NDC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0379-83","type":"NDC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55513-0073-30","type":"NDC"}],"standard_charges":[{"minimum":305.32,"maximum":412.18,"gross_charge":508.86,"discounted_cash":150.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":305.32,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55513-0073-30","type":"NDC"}],"standard_charges":[{"minimum":76.33,"maximum":412.18,"gross_charge":508.86,"discounted_cash":150.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":412.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":305.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.78,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0883-04","type":"NDC"}],"standard_charges":[{"minimum":9.08,"maximum":12.26,"gross_charge":15.13,"discounted_cash":4.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0883-04","type":"NDC"}],"standard_charges":[{"minimum":2.27,"maximum":12.26,"gross_charge":15.13,"discounted_cash":4.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0503-30","type":"NDC"}],"standard_charges":[{"minimum":8.83,"maximum":11.92,"gross_charge":14.71,"discounted_cash":4.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"}]}]},{"description":"CINACALCET 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0503-30","type":"NDC"}],"standard_charges":[{"minimum":2.21,"maximum":11.92,"gross_charge":14.71,"discounted_cash":4.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0656-05","type":"NDC"}],"standard_charges":[{"minimum":4.55,"maximum":6.14,"gross_charge":7.58,"discounted_cash":2.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0656-05","type":"NDC"}],"standard_charges":[{"minimum":1.14,"maximum":6.14,"gross_charge":7.58,"discounted_cash":2.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":66.48,"maximum":89.74,"gross_charge":110.79,"discounted_cash":32.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.48,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 0.3 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.62,"maximum":89.74,"gross_charge":110.79,"discounted_cash":32.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0077-01","type":"NDC"}],"standard_charges":[{"minimum":8.42,"maximum":11.37,"gross_charge":14.03,"discounted_cash":4.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0077-01","type":"NDC"}],"standard_charges":[{"minimum":2.11,"maximum":11.37,"gross_charge":14.03,"discounted_cash":4.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"}]}]},{"description":"CLARITHROMYCIN 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.26,"maximum":47.6,"gross_charge":58.76,"discounted_cash":17.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.26,"methodology":"fee schedule"}]}]},{"description":"CLARITHROMYCIN 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.82,"maximum":47.6,"gross_charge":58.76,"discounted_cash":17.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0161-01","type":"NDC"}],"standard_charges":[{"minimum":6.62,"maximum":8.93,"gross_charge":11.02,"discounted_cash":3.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0161-01","type":"NDC"}],"standard_charges":[{"minimum":1.66,"maximum":8.93,"gross_charge":11.02,"discounted_cash":3.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0900-94","type":"NDC"}],"standard_charges":[{"minimum":6.87,"maximum":9.27,"gross_charge":11.44,"discounted_cash":3.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0900-94","type":"NDC"}],"standard_charges":[{"minimum":1.72,"maximum":9.27,"gross_charge":11.44,"discounted_cash":3.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-3743-01","type":"NDC"}],"standard_charges":[{"minimum":19.01,"maximum":25.66,"gross_charge":31.67,"discounted_cash":9.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-3743-01","type":"NDC"}],"standard_charges":[{"minimum":4.76,"maximum":25.66,"gross_charge":31.67,"discounted_cash":9.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.34,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-5009-01","type":"NDC"}],"standard_charges":[{"minimum":51.38,"maximum":69.37,"gross_charge":85.63,"discounted_cash":25.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.38,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-5009-01","type":"NDC"}],"standard_charges":[{"minimum":12.85,"maximum":69.37,"gross_charge":85.63,"discounted_cash":25.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.83,"maximum":53.77,"gross_charge":66.38,"discounted_cash":19.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.96,"maximum":53.77,"gross_charge":66.38,"discounted_cash":19.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.61,"maximum":56.17,"gross_charge":69.34,"discounted_cash":20.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 2 % VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.41,"maximum":56.17,"gross_charge":69.34,"discounted_cash":20.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.87,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.12,"maximum":10.96,"gross_charge":13.53,"discounted_cash":4.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN HCL 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.03,"maximum":10.96,"gross_charge":13.53,"discounted_cash":4.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0423-21","type":"NDC"}],"standard_charges":[{"minimum":46.19,"maximum":62.36,"gross_charge":76.98,"discounted_cash":22.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0423-21","type":"NDC"}],"standard_charges":[{"minimum":11.55,"maximum":62.36,"gross_charge":76.98,"discounted_cash":22.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0314-01","type":"NDC"}],"standard_charges":[{"minimum":1637.34,"maximum":2210.41,"gross_charge":2728.9,"discounted_cash":807.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2210.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2210.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.34,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0314-01","type":"NDC"}],"standard_charges":[{"minimum":409.34,"maximum":2210.41,"gross_charge":2728.9,"discounted_cash":807.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2210.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2210.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2210.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.78,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1305-01","type":"NDC"}],"standard_charges":[{"minimum":16.11,"maximum":21.75,"gross_charge":26.84,"discounted_cash":7.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1305-01","type":"NDC"}],"standard_charges":[{"minimum":4.03,"maximum":21.75,"gross_charge":26.84,"discounted_cash":7.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 5 MG HALFTAB","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.33,"maximum":12.6,"gross_charge":15.55,"discounted_cash":4.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"}]}]},{"description":"CLOBAZAM 5 MG HALFTAB","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.34,"maximum":12.6,"gross_charge":15.55,"discounted_cash":4.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0992-02","type":"NDC"}],"standard_charges":[{"minimum":2.82,"maximum":3.8,"gross_charge":4.69,"discounted_cash":1.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0992-02","type":"NDC"}],"standard_charges":[{"minimum":0.71,"maximum":3.8,"gross_charge":4.69,"discounted_cash":1.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0016-05","type":"NDC"}],"standard_charges":[{"minimum":5.57,"maximum":7.52,"gross_charge":9.28,"discounted_cash":2.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0016-05","type":"NDC"}],"standard_charges":[{"minimum":1.4,"maximum":7.52,"gross_charge":9.28,"discounted_cash":2.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0076-30","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":2.66,"gross_charge":3.28,"discounted_cash":0.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0076-30","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":2.66,"gross_charge":3.28,"discounted_cash":0.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1258-01","type":"NDC"}],"standard_charges":[{"minimum":5.46,"maximum":7.37,"gross_charge":9.09,"discounted_cash":2.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1258-01","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":7.37,"gross_charge":9.09,"discounted_cash":2.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1258-02","type":"NDC"}],"standard_charges":[{"minimum":4.35,"maximum":5.87,"gross_charge":7.24,"discounted_cash":2.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1258-02","type":"NDC"}],"standard_charges":[{"minimum":1.09,"maximum":5.87,"gross_charge":7.24,"discounted_cash":2.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52565-0051-30","type":"NDC"}],"standard_charges":[{"minimum":12.09,"maximum":16.32,"gross_charge":20.14,"discounted_cash":5.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52565-0051-30","type":"NDC"}],"standard_charges":[{"minimum":3.03,"maximum":16.32,"gross_charge":20.14,"discounted_cash":5.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0956-02","type":"NDC"}],"standard_charges":[{"minimum":6.4,"maximum":8.64,"gross_charge":10.66,"discounted_cash":3.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0956-02","type":"NDC"}],"standard_charges":[{"minimum":1.6,"maximum":8.64,"gross_charge":10.66,"discounted_cash":3.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1532-03","type":"NDC"}],"standard_charges":[{"minimum":5.41,"maximum":7.3,"gross_charge":9.01,"discounted_cash":2.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1532-03","type":"NDC"}],"standard_charges":[{"minimum":1.36,"maximum":7.3,"gross_charge":9.01,"discounted_cash":2.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0782-02","type":"NDC"}],"standard_charges":[{"minimum":5.1,"maximum":6.89,"gross_charge":8.5,"discounted_cash":2.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0782-02","type":"NDC"}],"standard_charges":[{"minimum":1.28,"maximum":6.89,"gross_charge":8.5,"discounted_cash":2.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0017-05","type":"NDC"}],"standard_charges":[{"minimum":5.91,"maximum":7.98,"gross_charge":9.85,"discounted_cash":2.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0017-05","type":"NDC"}],"standard_charges":[{"minimum":1.48,"maximum":7.98,"gross_charge":9.85,"discounted_cash":2.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0077-30","type":"NDC"}],"standard_charges":[{"minimum":2.69,"maximum":3.63,"gross_charge":4.48,"discounted_cash":1.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0077-30","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":3.63,"gross_charge":4.48,"discounted_cash":1.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1259-02","type":"NDC"}],"standard_charges":[{"minimum":5.95,"maximum":8.03,"gross_charge":9.91,"discounted_cash":2.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.95,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1259-02","type":"NDC"}],"standard_charges":[{"minimum":1.49,"maximum":8.03,"gross_charge":9.91,"discounted_cash":2.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-2457-01","type":"NDC"}],"standard_charges":[{"minimum":4.62,"maximum":6.23,"gross_charge":7.69,"discounted_cash":2.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-2457-01","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":6.23,"gross_charge":7.69,"discounted_cash":2.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.28,"maximum":30.08,"gross_charge":37.13,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"}]}]},{"description":"CLOBETASOL 0.05 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.57,"maximum":30.08,"gross_charge":37.13,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"}]}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":147.35,"maximum":198.92,"gross_charge":245.58,"discounted_cash":72.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.35,"methodology":"fee schedule"}]}]},{"description":"CLOMIPRAMINE 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":36.84,"maximum":198.92,"gross_charge":245.58,"discounted_cash":72.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":198.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":198.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":198.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.12,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0136-00","type":"NDC"}],"standard_charges":[{"minimum":2.48,"maximum":3.35,"gross_charge":4.13,"discounted_cash":1.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0136-00","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":3.35,"gross_charge":4.13,"discounted_cash":1.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0173-15","type":"NDC"}],"standard_charges":[{"minimum":9.89,"maximum":13.35,"gross_charge":16.48,"discounted_cash":4.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0173-15","type":"NDC"}],"standard_charges":[{"minimum":2.48,"maximum":13.35,"gross_charge":16.48,"discounted_cash":4.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0881-01","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":0.76,"gross_charge":0.93,"discounted_cash":0.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0881-01","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":0.76,"gross_charge":0.93,"discounted_cash":0.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0544-01","type":"NDC"}],"standard_charges":[{"minimum":24.57,"maximum":33.17,"gross_charge":40.94,"discounted_cash":12.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.57,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0544-01","type":"NDC"}],"standard_charges":[{"minimum":6.15,"maximum":33.17,"gross_charge":40.94,"discounted_cash":12.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0174-15","type":"NDC"}],"standard_charges":[{"minimum":9.05,"maximum":12.22,"gross_charge":15.08,"discounted_cash":4.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0174-15","type":"NDC"}],"standard_charges":[{"minimum":2.27,"maximum":12.22,"gross_charge":15.08,"discounted_cash":4.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0882-20","type":"NDC"}],"standard_charges":[{"minimum":5.18,"maximum":7,"gross_charge":8.63,"discounted_cash":2.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0882-20","type":"NDC"}],"standard_charges":[{"minimum":1.3,"maximum":7,"gross_charge":8.63,"discounted_cash":2.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.5,"maximum":4.73,"gross_charge":5.83,"discounted_cash":1.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"}]}]},{"description":"CLONAZEPAM 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":4.73,"gross_charge":5.83,"discounted_cash":1.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75907-0023-48","type":"NDC"}],"standard_charges":[{"minimum":18.08,"maximum":24.4,"gross_charge":30.12,"discounted_cash":8.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75907-0023-48","type":"NDC"}],"standard_charges":[{"minimum":4.52,"maximum":24.4,"gross_charge":30.12,"discounted_cash":8.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.21,"maximum":8.38,"gross_charge":10.34,"discounted_cash":3.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.56,"maximum":8.38,"gross_charge":10.34,"discounted_cash":3.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.52,"maximum":11.51,"gross_charge":14.2,"discounted_cash":4.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.13,"maximum":11.51,"gross_charge":14.2,"discounted_cash":4.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.59,"maximum":33.19,"gross_charge":40.97,"discounted_cash":12.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.15,"maximum":33.19,"gross_charge":40.97,"discounted_cash":12.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0454-01","type":"NDC"}],"standard_charges":[{"minimum":6.21,"maximum":8.39,"gross_charge":10.35,"discounted_cash":3.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0454-01","type":"NDC"}],"standard_charges":[{"minimum":1.56,"maximum":8.39,"gross_charge":10.35,"discounted_cash":3.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0454-04","type":"NDC"}],"standard_charges":[{"minimum":24.61,"maximum":33.22,"gross_charge":41.01,"discounted_cash":12.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.61,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0454-04","type":"NDC"}],"standard_charges":[{"minimum":6.16,"maximum":33.22,"gross_charge":41.01,"discounted_cash":12.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.14,"maximum":16.38,"gross_charge":20.22,"discounted_cash":5.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.04,"maximum":16.38,"gross_charge":20.22,"discounted_cash":5.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":48.3,"maximum":65.2,"gross_charge":80.49,"discounted_cash":23.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.3,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.08,"maximum":65.2,"gross_charge":80.49,"discounted_cash":23.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0455-01","type":"NDC"}],"standard_charges":[{"minimum":18.39,"maximum":24.83,"gross_charge":30.65,"discounted_cash":9.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0455-01","type":"NDC"}],"standard_charges":[{"minimum":4.6,"maximum":24.83,"gross_charge":30.65,"discounted_cash":9.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0455-04","type":"NDC"}],"standard_charges":[{"minimum":47.48,"maximum":64.1,"gross_charge":79.13,"discounted_cash":23.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.48,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0455-04","type":"NDC"}],"standard_charges":[{"minimum":11.87,"maximum":64.1,"gross_charge":79.13,"discounted_cash":23.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75907-0025-11","type":"NDC"}],"standard_charges":[{"minimum":10.64,"maximum":14.36,"gross_charge":17.72,"discounted_cash":5.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75907-0025-11","type":"NDC"}],"standard_charges":[{"minimum":2.66,"maximum":14.36,"gross_charge":17.72,"discounted_cash":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75907-0025-48","type":"NDC"}],"standard_charges":[{"minimum":42.29,"maximum":57.09,"gross_charge":70.48,"discounted_cash":20.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75907-0025-48","type":"NDC"}],"standard_charges":[{"minimum":10.58,"maximum":57.09,"gross_charge":70.48,"discounted_cash":20.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.12,"maximum":23.11,"gross_charge":28.53,"discounted_cash":8.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.28,"maximum":23.11,"gross_charge":28.53,"discounted_cash":8.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":65.97,"maximum":89.06,"gross_charge":109.95,"discounted_cash":32.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.97,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.5,"maximum":89.06,"gross_charge":109.95,"discounted_cash":32.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":68.24,"maximum":92.13,"gross_charge":113.73,"discounted_cash":33.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.24,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.06,"maximum":92.13,"gross_charge":113.73,"discounted_cash":33.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.75,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0192-15","type":"NDC"}],"standard_charges":[{"minimum":6.71,"maximum":9.06,"gross_charge":11.18,"discounted_cash":3.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0192-15","type":"NDC"}],"standard_charges":[{"minimum":1.68,"maximum":9.06,"gross_charge":11.18,"discounted_cash":3.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0054-71","type":"NDC"}],"standard_charges":[{"minimum":11.18,"maximum":15.1,"gross_charge":18.63,"discounted_cash":5.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0054-71","type":"NDC"}],"standard_charges":[{"minimum":2.8,"maximum":15.1,"gross_charge":18.63,"discounted_cash":5.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":4,"gross_charge":4.93,"discounted_cash":1.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.74,"maximum":4,"gross_charge":4.93,"discounted_cash":1.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0238-00","type":"NDC"}],"standard_charges":[{"minimum":2.42,"maximum":3.27,"gross_charge":4.03,"discounted_cash":1.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0238-00","type":"NDC"}],"standard_charges":[{"minimum":0.61,"maximum":3.27,"gross_charge":4.03,"discounted_cash":1.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.56,"maximum":4.81,"gross_charge":5.93,"discounted_cash":1.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE HCL 0.2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.89,"maximum":4.81,"gross_charge":5.93,"discounted_cash":1.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"}]}]},{"description":"CLOPIDOGREL 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0052-11","type":"NDC"}],"standard_charges":[{"minimum":10.46,"maximum":14.12,"gross_charge":17.43,"discounted_cash":5.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"}]}]},{"description":"CLOPIDOGREL 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0052-11","type":"NDC"}],"standard_charges":[{"minimum":2.62,"maximum":14.12,"gross_charge":17.43,"discounted_cash":5.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"}]}]},{"description":"CLOPIDOGREL 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0536-01","type":"NDC"}],"standard_charges":[{"minimum":12.02,"maximum":16.23,"gross_charge":20.03,"discounted_cash":5.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"}]}]},{"description":"CLOPIDOGREL 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0536-01","type":"NDC"}],"standard_charges":[{"minimum":3.01,"maximum":16.23,"gross_charge":20.03,"discounted_cash":5.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4042-01","type":"NDC"}],"standard_charges":[{"minimum":49.71,"maximum":67.11,"gross_charge":82.85,"discounted_cash":24.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4042-01","type":"NDC"}],"standard_charges":[{"minimum":12.43,"maximum":67.11,"gross_charge":82.85,"discounted_cash":24.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":59.79,"maximum":80.72,"gross_charge":99.65,"discounted_cash":29.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.79,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.95,"maximum":80.72,"gross_charge":99.65,"discounted_cash":29.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.93,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4043-01","type":"NDC"}],"standard_charges":[{"minimum":55.59,"maximum":75.05,"gross_charge":92.65,"discounted_cash":27.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4043-01","type":"NDC"}],"standard_charges":[{"minimum":13.9,"maximum":75.05,"gross_charge":92.65,"discounted_cash":27.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0113-01","type":"NDC"}],"standard_charges":[{"minimum":57.69,"maximum":77.89,"gross_charge":96.15,"discounted_cash":28.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.69,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0113-01","type":"NDC"}],"standard_charges":[{"minimum":14.43,"maximum":77.89,"gross_charge":96.15,"discounted_cash":28.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":83.74,"maximum":113.05,"gross_charge":139.56,"discounted_cash":41.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"}]}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.94,"maximum":113.05,"gross_charge":139.56,"discounted_cash":41.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.92,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-2002-02","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":1.45,"gross_charge":1.78,"discounted_cash":0.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-2002-02","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":1.45,"gross_charge":1.78,"discounted_cash":0.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0181-35","type":"NDC"}],"standard_charges":[{"minimum":5.18,"maximum":6.99,"gross_charge":8.62,"discounted_cash":2.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0181-35","type":"NDC"}],"standard_charges":[{"minimum":1.3,"maximum":6.99,"gross_charge":8.62,"discounted_cash":2.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"73750-0091-10","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":0.84,"gross_charge":1.03,"discounted_cash":0.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"73750-0091-10","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":0.84,"gross_charge":1.03,"discounted_cash":0.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":1.16,"gross_charge":1.42,"discounted_cash":0.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.22,"maximum":1.16,"gross_charge":1.42,"discounted_cash":0.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.12,"maximum":1.51,"gross_charge":1.86,"discounted_cash":0.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":1.51,"gross_charge":1.86,"discounted_cash":0.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-2003-06","type":"NDC"}],"standard_charges":[{"minimum":1.95,"maximum":2.63,"gross_charge":3.24,"discounted_cash":0.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-2003-06","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":2.63,"gross_charge":3.24,"discounted_cash":0.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61269-0220-41","type":"NDC"}],"standard_charges":[{"minimum":2.49,"maximum":3.36,"gross_charge":4.14,"discounted_cash":1.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61269-0220-41","type":"NDC"}],"standard_charges":[{"minimum":0.63,"maximum":3.36,"gross_charge":4.14,"discounted_cash":1.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.59,"maximum":2.15,"gross_charge":2.65,"discounted_cash":0.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 1 % VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.4,"maximum":2.15,"gross_charge":2.65,"discounted_cash":0.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.19,"maximum":31.3,"gross_charge":38.64,"discounted_cash":11.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.19,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.8,"maximum":31.3,"gross_charge":38.64,"discounted_cash":11.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.45,"maximum":47.86,"gross_charge":59.08,"discounted_cash":17.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.87,"maximum":47.86,"gross_charge":59.08,"discounted_cash":17.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":37.38,"maximum":50.47,"gross_charge":62.3,"discounted_cash":18.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.35,"maximum":50.47,"gross_charge":62.3,"discounted_cash":18.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":115.52,"maximum":155.95,"gross_charge":192.53,"discounted_cash":56.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.52,"methodology":"fee schedule"}]}]},{"description":"CLOTRIMAZOLE 10 MG TROCHE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.88,"maximum":155.95,"gross_charge":192.53,"discounted_cash":56.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.51,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0922-20","type":"NDC"}],"standard_charges":[{"minimum":84.58,"maximum":114.18,"gross_charge":140.96,"discounted_cash":41.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.58,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0922-20","type":"NDC"}],"standard_charges":[{"minimum":21.15,"maximum":114.18,"gross_charge":140.96,"discounted_cash":41.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.2,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0415-01","type":"NDC"}],"standard_charges":[{"minimum":37.11,"maximum":50.1,"gross_charge":61.84,"discounted_cash":18.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0415-01","type":"NDC"}],"standard_charges":[{"minimum":9.28,"maximum":50.1,"gross_charge":61.84,"discounted_cash":18.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0404-01","type":"NDC"}],"standard_charges":[{"minimum":15.45,"maximum":20.85,"gross_charge":25.74,"discounted_cash":7.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.45,"methodology":"fee schedule"}]}]},{"description":"CLOZAPINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0404-01","type":"NDC"}],"standard_charges":[{"minimum":3.87,"maximum":20.85,"gross_charge":25.74,"discounted_cash":7.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"}]}]},{"description":"COBICISTAT 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1401-01","type":"NDC"}],"standard_charges":[{"minimum":163.27,"maximum":220.41,"gross_charge":272.11,"discounted_cash":80.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.27,"methodology":"fee schedule"}]}]},{"description":"COBICISTAT 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1401-01","type":"NDC"}],"standard_charges":[{"minimum":40.82,"maximum":220.41,"gross_charge":272.11,"discounted_cash":80.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"}]}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0252-16","type":"NDC"}],"standard_charges":[{"minimum":13.14,"maximum":17.74,"gross_charge":21.89,"discounted_cash":6.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"}]}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0252-16","type":"NDC"}],"standard_charges":[{"minimum":3.29,"maximum":17.74,"gross_charge":21.89,"discounted_cash":6.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"}]}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.31,"maximum":11.22,"gross_charge":13.85,"discounted_cash":4.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"}]}]},{"description":"CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.08,"maximum":11.22,"gross_charge":13.85,"discounted_cash":4.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":237.84,"maximum":321.09,"gross_charge":396.4,"discounted_cash":117.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":321.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.84,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":59.46,"maximum":321.09,"gross_charge":396.4,"discounted_cash":117.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":321.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.28,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0054-03","type":"NDC"}],"standard_charges":[{"minimum":83.87,"maximum":113.23,"gross_charge":139.78,"discounted_cash":41.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.87,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0054-03","type":"NDC"}],"standard_charges":[{"minimum":20.97,"maximum":113.23,"gross_charge":139.78,"discounted_cash":41.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8766-01","type":"NDC"}],"standard_charges":[{"minimum":17.25,"maximum":23.28,"gross_charge":28.74,"discounted_cash":8.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"}]}]},{"description":"COLCHICINE 0.6 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8766-01","type":"NDC"}],"standard_charges":[{"minimum":4.32,"maximum":23.28,"gross_charge":28.74,"discounted_cash":8.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"}]}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11111-0096-82","type":"NDC"}],"standard_charges":[{"minimum":15.02,"maximum":20.27,"gross_charge":25.02,"discounted_cash":7.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"}]}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11111-0096-82","type":"NDC"}],"standard_charges":[{"minimum":3.76,"maximum":20.27,"gross_charge":25.02,"discounted_cash":7.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"}]}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50484-0010-30","type":"NDC"}],"standard_charges":[{"minimum":162.8,"maximum":219.78,"gross_charge":271.33,"discounted_cash":80.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.8,"methodology":"fee schedule"}]}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50484-0010-30","type":"NDC"}],"standard_charges":[{"minimum":40.7,"maximum":219.78,"gross_charge":271.33,"discounted_cash":80.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"COMPOUNDING VEHICLE NO.8 ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.3,"maximum":13.9,"gross_charge":17.16,"discounted_cash":5.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"}]}]},{"description":"COMPOUNDING VEHICLE NO.8 ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.58,"maximum":13.9,"gross_charge":17.16,"discounted_cash":5.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"}]}]},{"description":"COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.58,"maximum":14.29,"gross_charge":17.63,"discounted_cash":5.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"}]}]},{"description":"COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.65,"maximum":14.29,"gross_charge":17.63,"discounted_cash":5.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"}]}]},{"description":"CONJUGATED ESTROGENS 0.3 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":379.3,"maximum":512.05,"gross_charge":632.16,"discounted_cash":187.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.3,"methodology":"fee schedule"}]}]},{"description":"CONJUGATED ESTROGENS 0.3 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":94.83,"maximum":512.05,"gross_charge":632.16,"discounted_cash":187.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.44,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0855-15","type":"NDC"}],"standard_charges":[{"minimum":4.43,"maximum":5.98,"gross_charge":7.38,"discounted_cash":2.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0855-15","type":"NDC"}],"standard_charges":[{"minimum":1.11,"maximum":5.98,"gross_charge":7.38,"discounted_cash":2.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.8,"maximum":2.43,"gross_charge":2.99,"discounted_cash":0.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.45,"maximum":2.43,"gross_charge":2.99,"discounted_cash":0.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0644-20","type":"NDC"}],"standard_charges":[{"minimum":6.62,"maximum":8.94,"gross_charge":11.03,"discounted_cash":3.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"}]}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0644-20","type":"NDC"}],"standard_charges":[{"minimum":1.66,"maximum":8.94,"gross_charge":11.03,"discounted_cash":3.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"}]}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0558-01","type":"NDC"}],"standard_charges":[{"minimum":10.64,"maximum":14.37,"gross_charge":17.73,"discounted_cash":5.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"}]}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0558-01","type":"NDC"}],"standard_charges":[{"minimum":2.66,"maximum":14.37,"gross_charge":17.73,"discounted_cash":5.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"}]}]},{"description":"CYPROHEPTADINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1110-01","type":"NDC"}],"standard_charges":[{"minimum":4.1,"maximum":5.54,"gross_charge":6.83,"discounted_cash":2.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"}]}]},{"description":"CYPROHEPTADINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1110-01","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":5.54,"gross_charge":6.83,"discounted_cash":2.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"DABIGATRAN ETEXILATE 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":201.15,"maximum":271.55,"gross_charge":335.24,"discounted_cash":99.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":271.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":271.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.15,"methodology":"fee schedule"}]}]},{"description":"DABIGATRAN ETEXILATE 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":50.29,"maximum":271.55,"gross_charge":335.24,"discounted_cash":99.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":271.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":271.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"}]}]},{"description":"DABIGATRAN ETEXILATE 75 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":103.57,"maximum":139.82,"gross_charge":172.61,"discounted_cash":51.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.57,"methodology":"fee schedule"}]}]},{"description":"DABIGATRAN ETEXILATE 75 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":25.9,"maximum":139.82,"gross_charge":172.61,"discounted_cash":51.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"}]}]},{"description":"DANTROLENE 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0300-11","type":"NDC"}],"standard_charges":[{"minimum":28.11,"maximum":37.95,"gross_charge":46.85,"discounted_cash":13.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.11,"methodology":"fee schedule"}]}]},{"description":"DANTROLENE 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0300-11","type":"NDC"}],"standard_charges":[{"minimum":7.03,"maximum":37.95,"gross_charge":46.85,"discounted_cash":13.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13925-0505-30","type":"NDC"}],"standard_charges":[{"minimum":39.22,"maximum":52.95,"gross_charge":65.36,"discounted_cash":19.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13925-0505-30","type":"NDC"}],"standard_charges":[{"minimum":9.81,"maximum":52.95,"gross_charge":65.36,"discounted_cash":19.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49938-0101-30","type":"NDC"}],"standard_charges":[{"minimum":46.23,"maximum":62.41,"gross_charge":77.04,"discounted_cash":22.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49938-0101-30","type":"NDC"}],"standard_charges":[{"minimum":11.56,"maximum":62.41,"gross_charge":77.04,"discounted_cash":22.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0136-10","type":"NDC"}],"standard_charges":[{"minimum":21.53,"maximum":29.06,"gross_charge":35.87,"discounted_cash":10.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0136-10","type":"NDC"}],"standard_charges":[{"minimum":5.39,"maximum":29.06,"gross_charge":35.87,"discounted_cash":10.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13925-0504-30","type":"NDC"}],"standard_charges":[{"minimum":31.98,"maximum":43.18,"gross_charge":53.3,"discounted_cash":15.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"}]}]},{"description":"DAPSONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13925-0504-30","type":"NDC"}],"standard_charges":[{"minimum":8,"maximum":43.18,"gross_charge":53.3,"discounted_cash":15.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"}]}]},{"description":"DARUNAVIR 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0086-30","type":"NDC"}],"standard_charges":[{"minimum":51.63,"maximum":69.7,"gross_charge":86.04,"discounted_cash":25.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"}]}]},{"description":"DARUNAVIR 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0086-30","type":"NDC"}],"standard_charges":[{"minimum":12.91,"maximum":69.7,"gross_charge":86.04,"discounted_cash":25.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.21,"methodology":"fee schedule"}]}]},{"description":"DARUNAVIR 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59676-0566-30","type":"NDC"}],"standard_charges":[{"minimum":1256.39,"maximum":1696.12,"gross_charge":2093.97,"discounted_cash":619.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1696.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1696.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1696.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1256.39,"methodology":"fee schedule"}]}]},{"description":"DARUNAVIR 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59676-0566-30","type":"NDC"}],"standard_charges":[{"minimum":314.1,"maximum":1696.12,"gross_charge":2093.97,"discounted_cash":619.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1696.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1696.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1696.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1256.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":397.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":418.8,"methodology":"fee schedule"}]}]},{"description":"DASATINIB 70 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11786.58,"maximum":15911.88,"gross_charge":19644.29,"discounted_cash":5814.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15911.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15911.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15911.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11786.58,"methodology":"fee schedule"}]}]},{"description":"DASATINIB 70 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2946.65,"maximum":15911.88,"gross_charge":19644.29,"discounted_cash":5814.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15911.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15911.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15911.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11786.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3732.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3928.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2946.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3928.86,"methodology":"fee schedule"}]}]},{"description":"DEFERASIROX 500 MG DISPERSIBLE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3041.04,"maximum":4105.41,"gross_charge":5068.4,"discounted_cash":1500.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4105.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4105.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4105.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3041.04,"methodology":"fee schedule"}]}]},{"description":"DEFERASIROX 500 MG DISPERSIBLE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":760.26,"maximum":4105.41,"gross_charge":5068.4,"discounted_cash":1500.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4105.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4105.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4105.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3041.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":963,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":760.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1013.68,"methodology":"fee schedule"}]}]},{"description":"DEMECLOCYCLINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0143-01","type":"NDC"}],"standard_charges":[{"minimum":709.24,"maximum":957.47,"gross_charge":1182.06,"discounted_cash":349.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":957.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":957.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.24,"methodology":"fee schedule"}]}]},{"description":"DEMECLOCYCLINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0143-01","type":"NDC"}],"standard_charges":[{"minimum":177.31,"maximum":957.47,"gross_charge":1182.06,"discounted_cash":349.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":957.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":957.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":957.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":709.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.42,"methodology":"fee schedule"}]}]},{"description":"DESIPRAMINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0711-01","type":"NDC"}],"standard_charges":[{"minimum":26.73,"maximum":36.08,"gross_charge":44.54,"discounted_cash":13.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"}]}]},{"description":"DESIPRAMINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0711-01","type":"NDC"}],"standard_charges":[{"minimum":6.69,"maximum":36.08,"gross_charge":44.54,"discounted_cash":13.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0489-01","type":"NDC"}],"standard_charges":[{"minimum":19.95,"maximum":26.93,"gross_charge":33.24,"discounted_cash":9.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0489-01","type":"NDC"}],"standard_charges":[{"minimum":4.99,"maximum":26.93,"gross_charge":33.24,"discounted_cash":9.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0257-01","type":"NDC"}],"standard_charges":[{"minimum":44.13,"maximum":59.58,"gross_charge":73.55,"discounted_cash":21.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0257-01","type":"NDC"}],"standard_charges":[{"minimum":11.04,"maximum":59.58,"gross_charge":73.55,"discounted_cash":21.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0606-11","type":"NDC"}],"standard_charges":[{"minimum":0.94,"maximum":1.27,"gross_charge":1.56,"discounted_cash":0.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0606-11","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":1.27,"gross_charge":1.56,"discounted_cash":0.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":228.49,"maximum":308.46,"gross_charge":380.81,"discounted_cash":112.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":228.49,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 0.1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":57.13,"maximum":308.46,"gross_charge":380.81,"discounted_cash":112.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":228.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.17,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0342-05","type":"NDC"}],"standard_charges":[{"minimum":104.4,"maximum":140.94,"gross_charge":174,"discounted_cash":51.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.4,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0342-05","type":"NDC"}],"standard_charges":[{"minimum":26.1,"maximum":140.94,"gross_charge":174,"discounted_cash":51.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0788-91","type":"NDC"}],"standard_charges":[{"minimum":49.52,"maximum":66.85,"gross_charge":82.52,"discounted_cash":24.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0788-91","type":"NDC"}],"standard_charges":[{"minimum":12.38,"maximum":66.85,"gross_charge":82.52,"discounted_cash":24.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0815-00","type":"NDC"}],"standard_charges":[{"minimum":22.26,"maximum":30.05,"gross_charge":37.09,"discounted_cash":10.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0815-00","type":"NDC"}],"standard_charges":[{"minimum":5.57,"maximum":30.05,"gross_charge":37.09,"discounted_cash":10.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0384-01","type":"NDC"}],"standard_charges":[{"minimum":107.82,"maximum":145.56,"gross_charge":179.7,"discounted_cash":53.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.82,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0384-01","type":"NDC"}],"standard_charges":[{"minimum":26.96,"maximum":145.56,"gross_charge":179.7,"discounted_cash":53.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69918-0501-05","type":"NDC"}],"standard_charges":[{"minimum":74.02,"maximum":99.93,"gross_charge":123.36,"discounted_cash":36.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.02,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69918-0501-05","type":"NDC"}],"standard_charges":[{"minimum":18.51,"maximum":99.93,"gross_charge":123.36,"discounted_cash":36.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0720-02","type":"NDC"}],"standard_charges":[{"minimum":30.05,"maximum":40.56,"gross_charge":50.07,"discounted_cash":14.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.05,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0720-02","type":"NDC"}],"standard_charges":[{"minimum":7.52,"maximum":40.56,"gross_charge":50.07,"discounted_cash":14.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11534-0189-01","type":"NDC"}],"standard_charges":[{"minimum":28.17,"maximum":38.03,"gross_charge":46.94,"discounted_cash":13.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.17,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11534-0189-01","type":"NDC"}],"standard_charges":[{"minimum":7.05,"maximum":38.03,"gross_charge":46.94,"discounted_cash":13.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0036-01","type":"NDC"}],"standard_charges":[{"minimum":24.87,"maximum":33.57,"gross_charge":41.44,"discounted_cash":12.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.87,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0036-01","type":"NDC"}],"standard_charges":[{"minimum":6.22,"maximum":33.57,"gross_charge":41.44,"discounted_cash":12.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52536-0510-03","type":"NDC"}],"standard_charges":[{"minimum":44.64,"maximum":60.27,"gross_charge":74.4,"discounted_cash":22.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.64,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52536-0510-03","type":"NDC"}],"standard_charges":[{"minimum":11.16,"maximum":60.27,"gross_charge":74.4,"discounted_cash":22.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":81.34,"maximum":109.81,"gross_charge":135.56,"discounted_cash":40.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.34,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE SULFATE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.34,"maximum":109.81,"gross_charge":135.56,"discounted_cash":40.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.12,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0070-01","type":"NDC"}],"standard_charges":[{"minimum":20.55,"maximum":27.74,"gross_charge":34.24,"discounted_cash":10.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0070-01","type":"NDC"}],"standard_charges":[{"minimum":5.14,"maximum":27.74,"gross_charge":34.24,"discounted_cash":10.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0341-01","type":"NDC"}],"standard_charges":[{"minimum":20.91,"maximum":28.23,"gross_charge":34.84,"discounted_cash":10.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.91,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0341-01","type":"NDC"}],"standard_charges":[{"minimum":5.23,"maximum":28.23,"gross_charge":34.84,"discounted_cash":10.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.97,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.52,"maximum":18.25,"gross_charge":22.53,"discounted_cash":6.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.38,"maximum":18.25,"gross_charge":22.53,"discounted_cash":6.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.47,"maximum":30.33,"gross_charge":37.44,"discounted_cash":11.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.62,"maximum":30.33,"gross_charge":37.44,"discounted_cash":11.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":34.95,"maximum":47.18,"gross_charge":58.24,"discounted_cash":17.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.95,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.74,"maximum":47.18,"gross_charge":58.24,"discounted_cash":17.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":52.05,"maximum":70.27,"gross_charge":86.75,"discounted_cash":25.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.05,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.02,"maximum":70.27,"gross_charge":86.75,"discounted_cash":25.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.35,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULEEXTEND RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0610-01","type":"NDC"}],"standard_charges":[{"minimum":36.09,"maximum":48.72,"gross_charge":60.14,"discounted_cash":17.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.09,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULEEXTEND RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0610-01","type":"NDC"}],"standard_charges":[{"minimum":9.03,"maximum":48.72,"gross_charge":60.14,"discounted_cash":17.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULEEXTEND RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":61.23,"maximum":82.67,"gross_charge":102.05,"discounted_cash":30.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.23,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULEEXTEND RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.31,"maximum":82.67,"gross_charge":102.05,"discounted_cash":30.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.41,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULEEXTEND RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":65.13,"maximum":87.93,"gross_charge":108.55,"discounted_cash":32.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.13,"methodology":"fee schedule"}]}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE ER 10 MG 24HR CAPSULEEXTEND RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.29,"maximum":87.93,"gross_charge":108.55,"discounted_cash":32.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.71,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0150-01","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":1.39,"gross_charge":1.71,"discounted_cash":0.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0150-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":1.39,"gross_charge":1.71,"discounted_cash":0.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63824-0056-36","type":"NDC"}],"standard_charges":[{"minimum":3.23,"maximum":4.35,"gross_charge":5.37,"discounted_cash":1.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63824-0056-36","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":4.35,"gross_charge":5.37,"discounted_cash":1.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63824-0056-40","type":"NDC"}],"standard_charges":[{"minimum":9.13,"maximum":12.33,"gross_charge":15.21,"discounted_cash":4.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63824-0056-40","type":"NDC"}],"standard_charges":[{"minimum":2.29,"maximum":12.33,"gross_charge":15.21,"discounted_cash":4.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63824-0056-50","type":"NDC"}],"standard_charges":[{"minimum":69.69,"maximum":94.09,"gross_charge":116.15,"discounted_cash":34.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.69,"methodology":"fee schedule"}]}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30 MG-600 MG TABLET EXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63824-0056-50","type":"NDC"}],"standard_charges":[{"minimum":17.43,"maximum":94.09,"gross_charge":116.15,"discounted_cash":34.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.23,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0284-20","type":"NDC"}],"standard_charges":[{"minimum":3.8,"maximum":5.13,"gross_charge":6.33,"discounted_cash":1.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0284-20","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":5.13,"gross_charge":6.33,"discounted_cash":1.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0062-01","type":"NDC"}],"standard_charges":[{"minimum":6.98,"maximum":9.43,"gross_charge":11.63,"discounted_cash":3.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.98,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0062-01","type":"NDC"}],"standard_charges":[{"minimum":1.75,"maximum":9.43,"gross_charge":11.63,"discounted_cash":3.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.84,"maximum":3.84,"gross_charge":4.73,"discounted_cash":1.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.71,"maximum":3.84,"gross_charge":4.73,"discounted_cash":1.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"}]}]},{"description":"DICLOFENAC 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0663-39","type":"NDC"}],"standard_charges":[{"minimum":2,"maximum":2.7,"gross_charge":3.33,"discounted_cash":0.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"DICLOFENAC 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0663-39","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":2.7,"gross_charge":3.33,"discounted_cash":0.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"}]}]},{"description":"DICLOFENAC 1 % TOPICAL GEL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.82,"maximum":10.56,"gross_charge":13.03,"discounted_cash":3.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"}]}]},{"description":"DICLOFENAC 1 % TOPICAL GEL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.96,"maximum":10.56,"gross_charge":13.03,"discounted_cash":3.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"}]}]},{"description":"DICLOXACILLIN 250 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.38,"maximum":36.97,"gross_charge":45.63,"discounted_cash":13.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"}]}]},{"description":"DICLOXACILLIN 250 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.85,"maximum":36.97,"gross_charge":45.63,"discounted_cash":13.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":1.03,"gross_charge":1.26,"discounted_cash":0.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.19,"maximum":1.03,"gross_charge":1.26,"discounted_cash":0.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.81,"maximum":56.44,"gross_charge":69.67,"discounted_cash":20.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.46,"maximum":56.44,"gross_charge":69.67,"discounted_cash":20.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":64.51,"maximum":87.09,"gross_charge":107.51,"discounted_cash":31.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.51,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.13,"maximum":87.09,"gross_charge":107.51,"discounted_cash":31.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.51,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0590-01","type":"NDC"}],"standard_charges":[{"minimum":23.91,"maximum":32.28,"gross_charge":39.84,"discounted_cash":11.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.91,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0590-01","type":"NDC"}],"standard_charges":[{"minimum":5.98,"maximum":32.28,"gross_charge":39.84,"discounted_cash":11.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":40.41,"maximum":54.55,"gross_charge":67.34,"discounted_cash":19.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.11,"maximum":54.55,"gross_charge":67.34,"discounted_cash":19.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":390.77,"maximum":527.53,"gross_charge":651.27,"discounted_cash":192.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":527.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":527.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":390.77,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 125 MCG (0.125 MG) TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":97.7,"maximum":527.53,"gross_charge":651.27,"discounted_cash":192.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":527.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":527.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":390.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.26,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0327-02","type":"NDC"}],"standard_charges":[{"minimum":68.78,"maximum":92.86,"gross_charge":114.63,"discounted_cash":33.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.78,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0327-02","type":"NDC"}],"standard_charges":[{"minimum":17.2,"maximum":92.86,"gross_charge":114.63,"discounted_cash":33.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.93,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.96,"maximum":9.4,"gross_charge":11.6,"discounted_cash":3.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.74,"maximum":9.4,"gross_charge":11.6,"discounted_cash":3.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":82.68,"maximum":111.62,"gross_charge":137.8,"discounted_cash":40.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":111.62,"gross_charge":137.8,"discounted_cash":40.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.56,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0006-10","type":"NDC"}],"standard_charges":[{"minimum":50.07,"maximum":67.6,"gross_charge":83.45,"discounted_cash":24.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0006-10","type":"NDC"}],"standard_charges":[{"minimum":12.52,"maximum":67.6,"gross_charge":83.45,"discounted_cash":24.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0573-01","type":"NDC"}],"standard_charges":[{"minimum":11.42,"maximum":15.42,"gross_charge":19.03,"discounted_cash":5.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0573-01","type":"NDC"}],"standard_charges":[{"minimum":2.86,"maximum":15.42,"gross_charge":19.03,"discounted_cash":5.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0007-10","type":"NDC"}],"standard_charges":[{"minimum":78.46,"maximum":105.92,"gross_charge":130.76,"discounted_cash":38.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.46,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0007-10","type":"NDC"}],"standard_charges":[{"minimum":19.62,"maximum":105.92,"gross_charge":130.76,"discounted_cash":38.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.16,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 60 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.32,"maximum":12.58,"gross_charge":15.53,"discounted_cash":4.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 60 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.33,"maximum":12.58,"gross_charge":15.53,"discounted_cash":4.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 90 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0008-10","type":"NDC"}],"standard_charges":[{"minimum":107.21,"maximum":144.73,"gross_charge":178.67,"discounted_cash":52.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.21,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM 90 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0008-10","type":"NDC"}],"standard_charges":[{"minimum":26.81,"maximum":144.73,"gross_charge":178.67,"discounted_cash":52.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.74,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 120 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0195-01","type":"NDC"}],"standard_charges":[{"minimum":25.47,"maximum":34.38,"gross_charge":42.44,"discounted_cash":12.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 120 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0195-01","type":"NDC"}],"standard_charges":[{"minimum":6.37,"maximum":34.38,"gross_charge":42.44,"discounted_cash":12.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 120 MG CAPSULEEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.61,"maximum":23.77,"gross_charge":29.34,"discounted_cash":8.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 120 MG CAPSULEEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.41,"maximum":23.77,"gross_charge":29.34,"discounted_cash":8.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 180 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0249-90","type":"NDC"}],"standard_charges":[{"minimum":11.48,"maximum":15.49,"gross_charge":19.12,"discounted_cash":5.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 180 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0249-90","type":"NDC"}],"standard_charges":[{"minimum":2.87,"maximum":15.49,"gross_charge":19.12,"discounted_cash":5.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0250-90","type":"NDC"}],"standard_charges":[{"minimum":12.66,"maximum":17.1,"gross_charge":21.1,"discounted_cash":6.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0250-90","type":"NDC"}],"standard_charges":[{"minimum":3.17,"maximum":17.1,"gross_charge":21.1,"discounted_cash":6.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0720-90","type":"NDC"}],"standard_charges":[{"minimum":10.94,"maximum":14.76,"gross_charge":18.22,"discounted_cash":5.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0720-90","type":"NDC"}],"standard_charges":[{"minimum":2.74,"maximum":14.76,"gross_charge":18.22,"discounted_cash":5.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0016-10","type":"NDC"}],"standard_charges":[{"minimum":25.53,"maximum":34.46,"gross_charge":42.54,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 240 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0016-10","type":"NDC"}],"standard_charges":[{"minimum":6.39,"maximum":34.46,"gross_charge":42.54,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 300 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0228-11","type":"NDC"}],"standard_charges":[{"minimum":0.96,"maximum":1.3,"gross_charge":1.6,"discounted_cash":0.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 300 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0228-11","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":1.3,"gross_charge":1.6,"discounted_cash":0.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 300 MG CAPSULEEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":71.49,"maximum":96.52,"gross_charge":119.15,"discounted_cash":35.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.49,"methodology":"fee schedule"}]}]},{"description":"DILTIAZEM CD 300 MG CAPSULEEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.88,"maximum":96.52,"gross_charge":119.15,"discounted_cash":35.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.83,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24385-0379-26","type":"NDC"}],"standard_charges":[{"minimum":2,"maximum":2.69,"gross_charge":3.32,"discounted_cash":0.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24385-0379-26","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":2.69,"gross_charge":3.32,"discounted_cash":0.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50580-0534-08","type":"NDC"}],"standard_charges":[{"minimum":5.46,"maximum":7.38,"gross_charge":9.1,"discounted_cash":2.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50580-0534-08","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":7.38,"gross_charge":9.1,"discounted_cash":2.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50580-0535-01","type":"NDC"}],"standard_charges":[{"minimum":3.55,"maximum":4.79,"gross_charge":5.91,"discounted_cash":1.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50580-0535-01","type":"NDC"}],"standard_charges":[{"minimum":0.89,"maximum":4.79,"gross_charge":5.91,"discounted_cash":1.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0152-01","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":1.96,"gross_charge":2.41,"discounted_cash":0.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0152-01","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":1.96,"gross_charge":2.41,"discounted_cash":0.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.43,"maximum":1.92,"gross_charge":2.37,"discounted_cash":0.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.36,"maximum":1.92,"gross_charge":2.37,"discounted_cash":0.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71399-8028-01","type":"NDC"}],"standard_charges":[{"minimum":1.22,"maximum":1.65,"gross_charge":2.03,"discounted_cash":0.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71399-8028-01","type":"NDC"}],"standard_charges":[{"minimum":0.31,"maximum":1.65,"gross_charge":2.03,"discounted_cash":0.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.34,"maximum":1.81,"gross_charge":2.23,"discounted_cash":0.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.34,"maximum":1.81,"gross_charge":2.23,"discounted_cash":0.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.12,"maximum":2.86,"gross_charge":3.53,"discounted_cash":1.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.53,"maximum":2.86,"gross_charge":3.53,"discounted_cash":1.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1061-01","type":"NDC"}],"standard_charges":[{"minimum":17.07,"maximum":23.04,"gross_charge":28.44,"discounted_cash":8.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.07,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1061-01","type":"NDC"}],"standard_charges":[{"minimum":4.27,"maximum":23.04,"gross_charge":28.44,"discounted_cash":8.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1061-02","type":"NDC"}],"standard_charges":[{"minimum":225.13,"maximum":303.93,"gross_charge":375.21,"discounted_cash":111.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.13,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1061-02","type":"NDC"}],"standard_charges":[{"minimum":56.29,"maximum":303.93,"gross_charge":375.21,"discounted_cash":111.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":303.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.05,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0490-01","type":"NDC"}],"standard_charges":[{"minimum":22.05,"maximum":29.76,"gross_charge":36.74,"discounted_cash":10.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.05,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0490-01","type":"NDC"}],"standard_charges":[{"minimum":5.52,"maximum":29.76,"gross_charge":36.74,"discounted_cash":10.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0910-01","type":"NDC"}],"standard_charges":[{"minimum":27.99,"maximum":37.78,"gross_charge":46.64,"discounted_cash":13.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.99,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0910-01","type":"NDC"}],"standard_charges":[{"minimum":7,"maximum":37.78,"gross_charge":46.64,"discounted_cash":13.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0909-90","type":"NDC"}],"standard_charges":[{"minimum":8.67,"maximum":11.7,"gross_charge":14.44,"discounted_cash":4.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0909-90","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":11.7,"gross_charge":14.44,"discounted_cash":4.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.67,"maximum":48.15,"gross_charge":59.44,"discounted_cash":17.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.67,"methodology":"fee schedule"}]}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.92,"maximum":48.15,"gross_charge":59.44,"discounted_cash":17.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"}]}]},{"description":"DIPYRIDAMOLE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0133-01","type":"NDC"}],"standard_charges":[{"minimum":71.13,"maximum":96.03,"gross_charge":118.55,"discounted_cash":35.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.13,"methodology":"fee schedule"}]}]},{"description":"DIPYRIDAMOLE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0133-01","type":"NDC"}],"standard_charges":[{"minimum":17.79,"maximum":96.03,"gross_charge":118.55,"discounted_cash":35.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"}]}]},{"description":"DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":234.85,"maximum":317.05,"gross_charge":391.41,"discounted_cash":115.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":234.85,"methodology":"fee schedule"}]}]},{"description":"DISOPYRAMIDE PHOSPHATE ER 100 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.72,"maximum":317.05,"gross_charge":391.41,"discounted_cash":115.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":234.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.29,"methodology":"fee schedule"}]}]},{"description":"DISOPYRAMIDE PHOSPHATE ER 150 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":277.58,"maximum":374.74,"gross_charge":462.63,"discounted_cash":136.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.58,"methodology":"fee schedule"}]}]},{"description":"DISOPYRAMIDE PHOSPHATE ER 150 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":69.4,"maximum":374.74,"gross_charge":462.63,"discounted_cash":136.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.53,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 125 MG CAPSULEDELAYED RELEASE SPRINKLE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0995-10","type":"NDC"}],"standard_charges":[{"minimum":37.23,"maximum":50.26,"gross_charge":62.04,"discounted_cash":18.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.23,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 125 MG CAPSULEDELAYED RELEASE SPRINKLE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0995-10","type":"NDC"}],"standard_charges":[{"minimum":9.31,"maximum":50.26,"gross_charge":62.04,"discounted_cash":18.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 125 MG CAPSULEDELAYED RELEASE SPRINKLE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":32.31,"maximum":43.62,"gross_charge":53.84,"discounted_cash":15.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.31,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 125 MG CAPSULEDELAYED RELEASE SPRINKLE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.08,"maximum":43.62,"gross_charge":53.84,"discounted_cash":15.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 250 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0776-11","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":0.29,"gross_charge":0.35,"discounted_cash":0.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 250 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0776-11","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.29,"gross_charge":0.35,"discounted_cash":0.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 500 MG TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":0.35,"gross_charge":0.42,"discounted_cash":0.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX 500 MG TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.07,"maximum":0.35,"gross_charge":0.42,"discounted_cash":0.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX ER 250 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0259-15","type":"NDC"}],"standard_charges":[{"minimum":7.25,"maximum":9.79,"gross_charge":12.08,"discounted_cash":3.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX ER 250 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0259-15","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":9.79,"gross_charge":12.08,"discounted_cash":3.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX ER 250 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0310-01","type":"NDC"}],"standard_charges":[{"minimum":38.25,"maximum":51.63,"gross_charge":63.74,"discounted_cash":18.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.25,"methodology":"fee schedule"}]}]},{"description":"DIVALPROEX ER 250 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0310-01","type":"NDC"}],"standard_charges":[{"minimum":9.57,"maximum":51.63,"gross_charge":63.74,"discounted_cash":18.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61269-0981-35","type":"NDC"}],"standard_charges":[{"minimum":6.64,"maximum":8.96,"gross_charge":11.06,"discounted_cash":3.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61269-0981-35","type":"NDC"}],"standard_charges":[{"minimum":1.66,"maximum":8.96,"gross_charge":11.06,"discounted_cash":3.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.54,"maximum":10.18,"gross_charge":12.56,"discounted_cash":3.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.89,"maximum":10.18,"gross_charge":12.56,"discounted_cash":3.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.26,"maximum":12.5,"gross_charge":15.43,"discounted_cash":4.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.32,"maximum":12.5,"gross_charge":15.43,"discounted_cash":4.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.7,"maximum":14.45,"gross_charge":17.83,"discounted_cash":5.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.7,"methodology":"fee schedule"}]}]},{"description":"DOCOSANOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.68,"maximum":14.45,"gross_charge":17.83,"discounted_cash":5.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"}]}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":1.28,"gross_charge":1.58,"discounted_cash":0.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"}]}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.24,"maximum":1.28,"gross_charge":1.58,"discounted_cash":0.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"}]}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.76,"maximum":7.77,"gross_charge":9.59,"discounted_cash":2.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"}]}]},{"description":"DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.44,"maximum":7.77,"gross_charge":9.59,"discounted_cash":2.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0840-01","type":"NDC"}],"standard_charges":[{"minimum":8.79,"maximum":11.87,"gross_charge":14.65,"discounted_cash":4.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0840-01","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":11.87,"gross_charge":14.65,"discounted_cash":4.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0411-60","type":"NDC"}],"standard_charges":[{"minimum":9.55,"maximum":12.89,"gross_charge":15.91,"discounted_cash":4.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0411-60","type":"NDC"}],"standard_charges":[{"minimum":2.39,"maximum":12.89,"gross_charge":15.91,"discounted_cash":4.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0061-86","type":"NDC"}],"standard_charges":[{"minimum":53.45,"maximum":72.15,"gross_charge":89.07,"discounted_cash":26.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.45,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0061-86","type":"NDC"}],"standard_charges":[{"minimum":13.37,"maximum":72.15,"gross_charge":89.07,"discounted_cash":26.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0130-01","type":"NDC"}],"standard_charges":[{"minimum":0.54,"maximum":0.73,"gross_charge":0.89,"discounted_cash":0.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0130-01","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":0.73,"gross_charge":0.89,"discounted_cash":0.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":248.32,"maximum":335.23,"gross_charge":413.86,"discounted_cash":122.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":248.32,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 125 MCG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":62.08,"maximum":335.23,"gross_charge":413.86,"discounted_cash":122.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":248.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.78,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 250 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0412-60","type":"NDC"}],"standard_charges":[{"minimum":10.31,"maximum":13.91,"gross_charge":17.17,"discounted_cash":5.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.31,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 250 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0412-60","type":"NDC"}],"standard_charges":[{"minimum":2.58,"maximum":13.91,"gross_charge":17.17,"discounted_cash":5.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 250 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0131-01","type":"NDC"}],"standard_charges":[{"minimum":54.31,"maximum":73.32,"gross_charge":90.51,"discounted_cash":26.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.31,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 250 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0131-01","type":"NDC"}],"standard_charges":[{"minimum":13.58,"maximum":73.32,"gross_charge":90.51,"discounted_cash":26.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.11,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0842-01","type":"NDC"}],"standard_charges":[{"minimum":8.97,"maximum":12.11,"gross_charge":14.95,"discounted_cash":4.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0842-01","type":"NDC"}],"standard_charges":[{"minimum":2.25,"maximum":12.11,"gross_charge":14.95,"discounted_cash":4.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0046-10","type":"NDC"}],"standard_charges":[{"minimum":105.08,"maximum":141.86,"gross_charge":175.13,"discounted_cash":51.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.08,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0046-10","type":"NDC"}],"standard_charges":[{"minimum":26.27,"maximum":141.86,"gross_charge":175.13,"discounted_cash":51.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0041-60","type":"NDC"}],"standard_charges":[{"minimum":6.13,"maximum":8.28,"gross_charge":10.21,"discounted_cash":3.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0041-60","type":"NDC"}],"standard_charges":[{"minimum":1.54,"maximum":8.28,"gross_charge":10.21,"discounted_cash":3.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0132-01","type":"NDC"}],"standard_charges":[{"minimum":55.1,"maximum":74.39,"gross_charge":91.83,"discounted_cash":27.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.1,"methodology":"fee schedule"}]}]},{"description":"DOFETILIDE 500 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0132-01","type":"NDC"}],"standard_charges":[{"minimum":13.78,"maximum":74.39,"gross_charge":91.83,"discounted_cash":27.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"}]}]},{"description":"DOLUTEGRAVIR 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49702-0228-13","type":"NDC"}],"standard_charges":[{"minimum":1314.18,"maximum":1774.14,"gross_charge":2190.29,"discounted_cash":648.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1774.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1774.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1774.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1314.18,"methodology":"fee schedule"}]}]},{"description":"DOLUTEGRAVIR 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49702-0228-13","type":"NDC"}],"standard_charges":[{"minimum":328.55,"maximum":1774.14,"gross_charge":2190.29,"discounted_cash":648.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1774.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1774.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1774.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1314.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.06,"methodology":"fee schedule"}]}]},{"description":"DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50242-0100-40","type":"NDC"}],"standard_charges":[{"minimum":75.69,"maximum":102.18,"gross_charge":126.14,"discounted_cash":37.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.69,"methodology":"fee schedule"}]}]},{"description":"DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50242-0100-40","type":"NDC"}],"standard_charges":[{"minimum":18.93,"maximum":102.18,"gross_charge":126.14,"discounted_cash":37.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"}]}]},{"description":"DOXAZOSIN 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0414-01","type":"NDC"}],"standard_charges":[{"minimum":12.92,"maximum":17.44,"gross_charge":21.53,"discounted_cash":6.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"}]}]},{"description":"DOXAZOSIN 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0414-01","type":"NDC"}],"standard_charges":[{"minimum":3.23,"maximum":17.44,"gross_charge":21.53,"discounted_cash":6.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0217-01","type":"NDC"}],"standard_charges":[{"minimum":26.31,"maximum":35.52,"gross_charge":43.84,"discounted_cash":12.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.31,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0217-01","type":"NDC"}],"standard_charges":[{"minimum":6.58,"maximum":35.52,"gross_charge":43.84,"discounted_cash":12.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0436-01","type":"NDC"}],"standard_charges":[{"minimum":0.39,"maximum":0.52,"gross_charge":0.64,"discounted_cash":0.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0436-01","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":0.52,"gross_charge":0.64,"discounted_cash":0.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.25,"maximum":31.38,"gross_charge":38.74,"discounted_cash":11.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.82,"maximum":31.38,"gross_charge":38.74,"discounted_cash":11.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.75,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":31.35,"maximum":42.32,"gross_charge":52.24,"discounted_cash":15.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.84,"maximum":42.32,"gross_charge":52.24,"discounted_cash":15.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0133-01","type":"NDC"}],"standard_charges":[{"minimum":35.13,"maximum":47.42,"gross_charge":58.54,"discounted_cash":17.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.13,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0133-01","type":"NDC"}],"standard_charges":[{"minimum":8.79,"maximum":47.42,"gross_charge":58.54,"discounted_cash":17.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0218-01","type":"NDC"}],"standard_charges":[{"minimum":34.59,"maximum":46.69,"gross_charge":57.64,"discounted_cash":17.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.59,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0218-01","type":"NDC"}],"standard_charges":[{"minimum":8.65,"maximum":46.69,"gross_charge":57.64,"discounted_cash":17.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.25,"maximum":55.68,"gross_charge":68.74,"discounted_cash":20.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"}]}]},{"description":"DOXEPIN 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.32,"maximum":55.68,"gross_charge":68.74,"discounted_cash":20.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0616-50","type":"NDC"}],"standard_charges":[{"minimum":6.53,"maximum":8.82,"gross_charge":10.88,"discounted_cash":3.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"}]}]},{"description":"DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0616-50","type":"NDC"}],"standard_charges":[{"minimum":1.64,"maximum":8.82,"gross_charge":10.88,"discounted_cash":3.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"}]}]},{"description":"DRONEDARONE 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":601.05,"maximum":811.41,"gross_charge":1001.74,"discounted_cash":296.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":811.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":811.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":811.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":601.05,"methodology":"fee schedule"}]}]},{"description":"DRONEDARONE 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":150.27,"maximum":811.41,"gross_charge":1001.74,"discounted_cash":296.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":811.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":811.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":811.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":601.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.35,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0014-90","type":"NDC"}],"standard_charges":[{"minimum":47.18,"maximum":63.7,"gross_charge":78.63,"discounted_cash":23.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0014-90","type":"NDC"}],"standard_charges":[{"minimum":11.8,"maximum":63.7,"gross_charge":78.63,"discounted_cash":23.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0820-19","type":"NDC"}],"standard_charges":[{"minimum":2193.54,"maximum":2961.28,"gross_charge":3655.89,"discounted_cash":1082.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2961.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2961.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2961.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2193.54,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0820-19","type":"NDC"}],"standard_charges":[{"minimum":548.39,"maximum":2961.28,"gross_charge":3655.89,"discounted_cash":1082.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2961.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2961.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2961.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2193.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.18,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0072-90","type":"NDC"}],"standard_charges":[{"minimum":17.31,"maximum":23.37,"gross_charge":28.85,"discounted_cash":8.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0072-90","type":"NDC"}],"standard_charges":[{"minimum":4.33,"maximum":23.37,"gross_charge":28.85,"discounted_cash":8.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0821-19","type":"NDC"}],"standard_charges":[{"minimum":4386.94,"maximum":5922.37,"gross_charge":7311.56,"discounted_cash":2164.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5922.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5922.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5922.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4386.94,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0821-19","type":"NDC"}],"standard_charges":[{"minimum":1096.74,"maximum":5922.37,"gross_charge":7311.56,"discounted_cash":2164.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5922.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5922.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5922.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4386.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1389.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1462.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1096.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1462.32,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0822-19","type":"NDC"}],"standard_charges":[{"minimum":6580.39,"maximum":8883.53,"gross_charge":10967.31,"discounted_cash":3246.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8883.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8883.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8883.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6580.39,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67386-0822-19","type":"NDC"}],"standard_charges":[{"minimum":1645.1,"maximum":8883.53,"gross_charge":10967.31,"discounted_cash":3246.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8883.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8883.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8883.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6580.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2083.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2193.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1645.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2193.47,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1391-09","type":"NDC"}],"standard_charges":[{"minimum":231.84,"maximum":312.99,"gross_charge":386.4,"discounted_cash":114.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231.84,"methodology":"fee schedule"}]}]},{"description":"DROXIDOPA 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1391-09","type":"NDC"}],"standard_charges":[{"minimum":57.96,"maximum":312.99,"gross_charge":386.4,"discounted_cash":114.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.28,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0097-06","type":"NDC"}],"standard_charges":[{"minimum":2.13,"maximum":2.88,"gross_charge":3.55,"discounted_cash":1.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0097-06","type":"NDC"}],"standard_charges":[{"minimum":0.54,"maximum":2.88,"gross_charge":3.55,"discounted_cash":1.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0263-60","type":"NDC"}],"standard_charges":[{"minimum":2.31,"maximum":3.12,"gross_charge":3.85,"discounted_cash":1.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0263-60","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":3.12,"gross_charge":3.85,"discounted_cash":1.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0255-06","type":"NDC"}],"standard_charges":[{"minimum":15.86,"maximum":21.41,"gross_charge":26.42,"discounted_cash":7.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0255-06","type":"NDC"}],"standard_charges":[{"minimum":3.97,"maximum":21.41,"gross_charge":26.42,"discounted_cash":7.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0413-06","type":"NDC"}],"standard_charges":[{"minimum":6.49,"maximum":8.76,"gross_charge":10.81,"discounted_cash":3.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0413-06","type":"NDC"}],"standard_charges":[{"minimum":1.63,"maximum":8.76,"gross_charge":10.81,"discounted_cash":3.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0675-11","type":"NDC"}],"standard_charges":[{"minimum":0.7,"maximum":0.94,"gross_charge":1.16,"discounted_cash":0.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 20 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0675-11","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.94,"gross_charge":1.16,"discounted_cash":0.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0380-03","type":"NDC"}],"standard_charges":[{"minimum":1.61,"maximum":2.18,"gross_charge":2.68,"discounted_cash":0.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0380-03","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":2.18,"gross_charge":2.68,"discounted_cash":0.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0256-05","type":"NDC"}],"standard_charges":[{"minimum":14.23,"maximum":19.21,"gross_charge":23.71,"discounted_cash":7.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0256-05","type":"NDC"}],"standard_charges":[{"minimum":3.56,"maximum":19.21,"gross_charge":23.71,"discounted_cash":7.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0414-04","type":"NDC"}],"standard_charges":[{"minimum":3.3,"maximum":4.46,"gross_charge":5.5,"discounted_cash":1.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0414-04","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":4.46,"gross_charge":5.5,"discounted_cash":1.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0295-06","type":"NDC"}],"standard_charges":[{"minimum":3.83,"maximum":5.16,"gross_charge":6.37,"discounted_cash":1.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 30 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0295-06","type":"NDC"}],"standard_charges":[{"minimum":0.96,"maximum":5.16,"gross_charge":6.37,"discounted_cash":1.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0099-03","type":"NDC"}],"standard_charges":[{"minimum":2.03,"maximum":2.73,"gross_charge":3.37,"discounted_cash":1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0099-03","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":2.73,"gross_charge":3.37,"discounted_cash":1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0099-90","type":"NDC"}],"standard_charges":[{"minimum":67.29,"maximum":90.85,"gross_charge":112.15,"discounted_cash":33.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.29,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0099-90","type":"NDC"}],"standard_charges":[{"minimum":16.83,"maximum":90.85,"gross_charge":112.15,"discounted_cash":33.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0019-30","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":2.93,"gross_charge":3.61,"discounted_cash":1.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0019-30","type":"NDC"}],"standard_charges":[{"minimum":0.55,"maximum":2.93,"gross_charge":3.61,"discounted_cash":1.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0257-04","type":"NDC"}],"standard_charges":[{"minimum":2.76,"maximum":3.73,"gross_charge":4.6,"discounted_cash":1.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"}]}]},{"description":"DULOXETINE 60 MG CAPSULEDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0257-04","type":"NDC"}],"standard_charges":[{"minimum":0.69,"maximum":3.73,"gross_charge":4.6,"discounted_cash":1.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0131-90","type":"NDC"}],"standard_charges":[{"minimum":19.91,"maximum":26.87,"gross_charge":33.17,"discounted_cash":9.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.91,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0131-90","type":"NDC"}],"standard_charges":[{"minimum":4.98,"maximum":26.87,"gross_charge":33.17,"discounted_cash":9.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0549-09","type":"NDC"}],"standard_charges":[{"minimum":8.78,"maximum":11.85,"gross_charge":14.62,"discounted_cash":4.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0549-09","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":11.85,"gross_charge":14.62,"discounted_cash":4.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0282-11","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0282-11","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":1,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":109.94,"maximum":148.42,"gross_charge":183.23,"discounted_cash":54.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.94,"methodology":"fee schedule"}]}]},{"description":"DUTASTERIDE 0.5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.49,"maximum":148.42,"gross_charge":183.23,"discounted_cash":54.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.65,"methodology":"fee schedule"}]}]},{"description":"EFAVIRENZ 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0407-09","type":"NDC"}],"standard_charges":[{"minimum":439.14,"maximum":592.84,"gross_charge":731.89,"discounted_cash":216.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":592.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":592.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":439.14,"methodology":"fee schedule"}]}]},{"description":"EFAVIRENZ 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0407-09","type":"NDC"}],"standard_charges":[{"minimum":109.79,"maximum":592.84,"gross_charge":731.89,"discounted_cash":216.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":592.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":592.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":592.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":439.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.38,"methodology":"fee schedule"}]}]},{"description":"EFAVIRENZ 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0889-04","type":"NDC"}],"standard_charges":[{"minimum":34.45,"maximum":46.51,"gross_charge":57.41,"discounted_cash":17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"}]}]},{"description":"EFAVIRENZ 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0889-04","type":"NDC"}],"standard_charges":[{"minimum":8.62,"maximum":46.51,"gross_charge":57.41,"discounted_cash":17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"}]}]},{"description":"EFAVIRENZ 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0049-30","type":"NDC"}],"standard_charges":[{"minimum":47.38,"maximum":63.96,"gross_charge":78.96,"discounted_cash":23.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"}]}]},{"description":"EFAVIRENZ 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0049-30","type":"NDC"}],"standard_charges":[{"minimum":11.85,"maximum":63.96,"gross_charge":78.96,"discounted_cash":23.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"}]}]},{"description":"ELTROMBOPAG OLAMINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3384.97,"maximum":4569.71,"gross_charge":5641.61,"discounted_cash":1669.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4569.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4569.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4569.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3384.97,"methodology":"fee schedule"}]}]},{"description":"ELTROMBOPAG OLAMINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":846.25,"maximum":4569.71,"gross_charge":5641.61,"discounted_cash":1669.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4569.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4569.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4569.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3384.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1071.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":846.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1128.33,"methodology":"fee schedule"}]}]},{"description":"ELTROMBOPAG OLAMINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6125.67,"maximum":8269.65,"gross_charge":10209.44,"discounted_cash":3022,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8269.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8269.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8269.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6125.67,"methodology":"fee schedule"}]}]},{"description":"ELTROMBOPAG OLAMINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1531.42,"maximum":8269.65,"gross_charge":10209.44,"discounted_cash":3022,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8269.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8269.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8269.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6125.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1939.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2041.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1531.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2041.89,"methodology":"fee schedule"}]}]},{"description":"ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFENAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1901-01","type":"NDC"}],"standard_charges":[{"minimum":2317.64,"maximum":3128.81,"gross_charge":3862.72,"discounted_cash":1143.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3128.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3128.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3128.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2317.64,"methodology":"fee schedule"}]}]},{"description":"ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFENAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1901-01","type":"NDC"}],"standard_charges":[{"minimum":579.41,"maximum":3128.81,"gross_charge":3862.72,"discounted_cash":1143.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3128.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3128.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3128.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2317.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.55,"methodology":"fee schedule"}]}]},{"description":"ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO DISOPRO 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1201-01","type":"NDC"}],"standard_charges":[{"minimum":2431.19,"maximum":3282.1,"gross_charge":4051.97,"discounted_cash":1199.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3282.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3282.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3282.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2431.19,"methodology":"fee schedule"}]}]},{"description":"ELVITEG 150 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO DISOPRO 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1201-01","type":"NDC"}],"standard_charges":[{"minimum":607.8,"maximum":3282.1,"gross_charge":4051.97,"discounted_cash":1199.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3282.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3282.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3282.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2431.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":769.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":607.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.4,"methodology":"fee schedule"}]}]},{"description":"EMPAGLIFLOZIN 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":237.39,"maximum":320.47,"gross_charge":395.64,"discounted_cash":117.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":320.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":320.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.39,"methodology":"fee schedule"}]}]},{"description":"EMPAGLIFLOZIN 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":59.35,"maximum":320.47,"gross_charge":395.64,"discounted_cash":117.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":320.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":320.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":320.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":237.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.13,"methodology":"fee schedule"}]}]},{"description":"EMTRICITABINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0601-01","type":"NDC"}],"standard_charges":[{"minimum":312.39,"maximum":421.73,"gross_charge":520.65,"discounted_cash":154.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.39,"methodology":"fee schedule"}]}]},{"description":"EMTRICITABINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0601-01","type":"NDC"}],"standard_charges":[{"minimum":78.1,"maximum":421.73,"gross_charge":520.65,"discounted_cash":154.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.13,"methodology":"fee schedule"}]}]},{"description":"EMTRICITABINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0301-30","type":"NDC"}],"standard_charges":[{"minimum":289.35,"maximum":390.62,"gross_charge":482.24,"discounted_cash":142.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":390.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.35,"methodology":"fee schedule"}]}]},{"description":"EMTRICITABINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0301-30","type":"NDC"}],"standard_charges":[{"minimum":72.34,"maximum":390.62,"gross_charge":482.24,"discounted_cash":142.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":390.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":289.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.45,"methodology":"fee schedule"}]}]},{"description":"EMTRICITABINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0642-02","type":"NDC"}],"standard_charges":[{"minimum":254.6,"maximum":343.71,"gross_charge":424.33,"discounted_cash":125.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":343.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":343.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":343.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.6,"methodology":"fee schedule"}]}]},{"description":"EMTRICITABINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0642-02","type":"NDC"}],"standard_charges":[{"minimum":63.65,"maximum":343.71,"gross_charge":424.33,"discounted_cash":125.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":343.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":343.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":343.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":254.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.87,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0444-01","type":"NDC"}],"standard_charges":[{"minimum":21.33,"maximum":28.79,"gross_charge":35.54,"discounted_cash":10.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0444-01","type":"NDC"}],"standard_charges":[{"minimum":5.34,"maximum":28.79,"gross_charge":35.54,"discounted_cash":10.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0391-01","type":"NDC"}],"standard_charges":[{"minimum":19.05,"maximum":25.71,"gross_charge":31.74,"discounted_cash":9.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0391-01","type":"NDC"}],"standard_charges":[{"minimum":4.77,"maximum":25.71,"gross_charge":31.74,"discounted_cash":9.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0712-01","type":"NDC"}],"standard_charges":[{"minimum":15.93,"maximum":21.5,"gross_charge":26.54,"discounted_cash":7.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.93,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0712-01","type":"NDC"}],"standard_charges":[{"minimum":3.99,"maximum":21.5,"gross_charge":26.54,"discounted_cash":7.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.55,"maximum":39.89,"gross_charge":49.24,"discounted_cash":14.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":39.89,"gross_charge":49.24,"discounted_cash":14.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0710-01","type":"NDC"}],"standard_charges":[{"minimum":11.48,"maximum":15.5,"gross_charge":19.13,"discounted_cash":5.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0710-01","type":"NDC"}],"standard_charges":[{"minimum":2.87,"maximum":15.5,"gross_charge":19.13,"discounted_cash":5.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0443-01","type":"NDC"}],"standard_charges":[{"minimum":21.99,"maximum":29.68,"gross_charge":36.64,"discounted_cash":10.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0443-01","type":"NDC"}],"standard_charges":[{"minimum":5.5,"maximum":29.68,"gross_charge":36.64,"discounted_cash":10.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4038-01","type":"NDC"}],"standard_charges":[{"minimum":3.14,"maximum":4.24,"gross_charge":5.23,"discounted_cash":1.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4038-01","type":"NDC"}],"standard_charges":[{"minimum":0.79,"maximum":4.24,"gross_charge":5.23,"discounted_cash":1.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64679-0924-02","type":"NDC"}],"standard_charges":[{"minimum":28.41,"maximum":38.35,"gross_charge":47.34,"discounted_cash":14.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.41,"methodology":"fee schedule"}]}]},{"description":"ENALAPRIL MALEATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64679-0924-02","type":"NDC"}],"standard_charges":[{"minimum":7.11,"maximum":38.35,"gross_charge":47.34,"discounted_cash":14.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"}]}]},{"description":"ENTACAPONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0049-10","type":"NDC"}],"standard_charges":[{"minimum":32.01,"maximum":43.21,"gross_charge":53.34,"discounted_cash":15.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.01,"methodology":"fee schedule"}]}]},{"description":"ENTACAPONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0049-10","type":"NDC"}],"standard_charges":[{"minimum":8.01,"maximum":43.21,"gross_charge":53.34,"discounted_cash":15.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"}]}]},{"description":"ENTACAPONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0188-11","type":"NDC"}],"standard_charges":[{"minimum":2.04,"maximum":2.75,"gross_charge":3.39,"discounted_cash":1.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"}]}]},{"description":"ENTACAPONE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0188-11","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":2.75,"gross_charge":3.39,"discounted_cash":1.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"}]}]},{"description":"ENTECAVIR 0.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":68.27,"maximum":92.17,"gross_charge":113.78,"discounted_cash":33.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.27,"methodology":"fee schedule"}]}]},{"description":"ENTECAVIR 0.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.07,"maximum":92.17,"gross_charge":113.78,"discounted_cash":33.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.76,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0877-33","type":"NDC"}],"standard_charges":[{"minimum":12.56,"maximum":16.95,"gross_charge":20.92,"discounted_cash":6.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0877-33","type":"NDC"}],"standard_charges":[{"minimum":3.14,"maximum":16.95,"gross_charge":20.92,"discounted_cash":6.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0863-30","type":"NDC"}],"standard_charges":[{"minimum":4.85,"maximum":6.55,"gross_charge":8.08,"discounted_cash":2.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0863-30","type":"NDC"}],"standard_charges":[{"minimum":1.22,"maximum":6.55,"gross_charge":8.08,"discounted_cash":2.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.29,"maximum":38.2,"gross_charge":47.15,"discounted_cash":13.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.29,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.08,"maximum":38.2,"gross_charge":47.15,"discounted_cash":13.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.29,"maximum":78.69,"gross_charge":97.14,"discounted_cash":28.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"}]}]},{"description":"EPLERENONE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.58,"maximum":78.69,"gross_charge":97.14,"discounted_cash":28.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"}]}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1250 MCG (50000 UNIT) CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0500-01","type":"NDC"}],"standard_charges":[{"minimum":66.87,"maximum":90.28,"gross_charge":111.45,"discounted_cash":32.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"}]}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1250 MCG (50000 UNIT) CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0500-01","type":"NDC"}],"standard_charges":[{"minimum":16.72,"maximum":90.28,"gross_charge":111.45,"discounted_cash":32.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.29,"methodology":"fee schedule"}]}]},{"description":"ERLOTINIB 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50242-0063-01","type":"NDC"}],"standard_charges":[{"minimum":4103.09,"maximum":5539.17,"gross_charge":6838.48,"discounted_cash":2024.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5539.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5539.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5539.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4103.09,"methodology":"fee schedule"}]}]},{"description":"ERLOTINIB 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50242-0063-01","type":"NDC"}],"standard_charges":[{"minimum":1025.78,"maximum":5539.17,"gross_charge":6838.48,"discounted_cash":2024.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5539.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5539.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5539.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4103.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1299.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1367.7,"methodology":"fee schedule"}]}]},{"description":"ERLOTINIB 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50242-0064-01","type":"NDC"}],"standard_charges":[{"minimum":4640.88,"maximum":6265.18,"gross_charge":7734.79,"discounted_cash":2289.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6265.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6265.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4640.88,"methodology":"fee schedule"}]}]},{"description":"ERLOTINIB 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50242-0064-01","type":"NDC"}],"standard_charges":[{"minimum":1160.22,"maximum":6265.18,"gross_charge":7734.79,"discounted_cash":2289.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6265.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6265.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6265.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4640.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1469.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1546.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1160.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1546.96,"methodology":"fee schedule"}]}]},{"description":"ESCITALOPRAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0617-01","type":"NDC"}],"standard_charges":[{"minimum":13.1,"maximum":17.69,"gross_charge":21.83,"discounted_cash":6.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"}]}]},{"description":"ESCITALOPRAM 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0617-01","type":"NDC"}],"standard_charges":[{"minimum":3.28,"maximum":17.69,"gross_charge":21.83,"discounted_cash":6.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"}]}]},{"description":"ESCITALOPRAM 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0282-10","type":"NDC"}],"standard_charges":[{"minimum":5.96,"maximum":8.05,"gross_charge":9.93,"discounted_cash":2.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"}]}]},{"description":"ESCITALOPRAM 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0282-10","type":"NDC"}],"standard_charges":[{"minimum":1.49,"maximum":8.05,"gross_charge":9.93,"discounted_cash":2.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"15310-0010-01","type":"NDC"}],"standard_charges":[{"minimum":155.45,"maximum":209.86,"gross_charge":259.08,"discounted_cash":76.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.45,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"15310-0010-01","type":"NDC"}],"standard_charges":[{"minimum":38.87,"maximum":209.86,"gross_charge":259.08,"discounted_cash":76.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.82,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51293-0640-01","type":"NDC"}],"standard_charges":[{"minimum":164.4,"maximum":221.94,"gross_charge":273.99,"discounted_cash":81.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.4,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51293-0640-01","type":"NDC"}],"standard_charges":[{"minimum":41.1,"maximum":221.94,"gross_charge":273.99,"discounted_cash":81.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.8,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58657-0405-01","type":"NDC"}],"standard_charges":[{"minimum":179.76,"maximum":242.67,"gross_charge":299.59,"discounted_cash":88.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":242.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.76,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58657-0405-01","type":"NDC"}],"standard_charges":[{"minimum":44.94,"maximum":242.67,"gross_charge":299.59,"discounted_cash":88.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":242.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.92,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0149-01","type":"NDC"}],"standard_charges":[{"minimum":161.7,"maximum":218.29,"gross_charge":269.49,"discounted_cash":79.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":218.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":218.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.7,"methodology":"fee schedule"}]}]},{"description":"ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0149-01","type":"NDC"}],"standard_charges":[{"minimum":40.43,"maximum":218.29,"gross_charge":269.49,"discounted_cash":79.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":218.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":218.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":161.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.9,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0097-35","type":"NDC"}],"standard_charges":[{"minimum":58.62,"maximum":79.13,"gross_charge":97.69,"discounted_cash":28.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0097-35","type":"NDC"}],"standard_charges":[{"minimum":14.66,"maximum":79.13,"gross_charge":97.69,"discounted_cash":28.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0104-44","type":"NDC"}],"standard_charges":[{"minimum":33.54,"maximum":45.28,"gross_charge":55.9,"discounted_cash":16.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.54,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0104-44","type":"NDC"}],"standard_charges":[{"minimum":8.39,"maximum":45.28,"gross_charge":55.9,"discounted_cash":16.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8713-01","type":"NDC"}],"standard_charges":[{"minimum":50.18,"maximum":67.74,"gross_charge":83.62,"discounted_cash":24.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8713-01","type":"NDC"}],"standard_charges":[{"minimum":12.55,"maximum":67.74,"gross_charge":83.62,"discounted_cash":24.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0002-10","type":"NDC"}],"standard_charges":[{"minimum":60.09,"maximum":81.13,"gross_charge":100.15,"discounted_cash":29.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.09,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0002-10","type":"NDC"}],"standard_charges":[{"minimum":15.03,"maximum":81.13,"gross_charge":100.15,"discounted_cash":29.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72162-1389-02","type":"NDC"}],"standard_charges":[{"minimum":12.05,"maximum":16.26,"gross_charge":20.07,"discounted_cash":5.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72162-1389-02","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":16.26,"gross_charge":20.07,"discounted_cash":5.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":56.85,"maximum":76.75,"gross_charge":94.75,"discounted_cash":28.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.85,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.22,"maximum":76.75,"gross_charge":94.75,"discounted_cash":28.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":94.89,"maximum":128.1,"gross_charge":158.14,"discounted_cash":46.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.89,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.73,"maximum":128.1,"gross_charge":158.14,"discounted_cash":46.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.42,"maximum":7.31,"gross_charge":9.02,"discounted_cash":2.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.36,"maximum":7.31,"gross_charge":9.02,"discounted_cash":2.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.51,"maximum":7.44,"gross_charge":9.18,"discounted_cash":2.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.38,"maximum":7.44,"gross_charge":9.18,"discounted_cash":2.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":43.53,"maximum":58.77,"gross_charge":72.55,"discounted_cash":21.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.53,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.89,"maximum":58.77,"gross_charge":72.55,"discounted_cash":21.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.51,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.22,"maximum":15.15,"gross_charge":18.7,"discounted_cash":5.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.81,"maximum":15.15,"gross_charge":18.7,"discounted_cash":5.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.65,"maximum":60.28,"gross_charge":74.41,"discounted_cash":22.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.025 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.17,"maximum":60.28,"gross_charge":74.41,"discounted_cash":22.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.6,"maximum":7.55,"gross_charge":9.32,"discounted_cash":2.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.4,"maximum":7.55,"gross_charge":9.32,"discounted_cash":2.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":42.74,"maximum":57.69,"gross_charge":71.22,"discounted_cash":21.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.69,"maximum":57.69,"gross_charge":71.22,"discounted_cash":21.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.25,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.21,"maximum":59.68,"gross_charge":73.67,"discounted_cash":21.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.21,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.06,"maximum":59.68,"gross_charge":73.67,"discounted_cash":21.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0993-04","type":"NDC"}],"standard_charges":[{"minimum":4.99,"maximum":6.74,"gross_charge":8.31,"discounted_cash":2.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0993-04","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":6.74,"gross_charge":8.31,"discounted_cash":2.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0993-08","type":"NDC"}],"standard_charges":[{"minimum":39.33,"maximum":53.09,"gross_charge":65.54,"discounted_cash":19.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0993-08","type":"NDC"}],"standard_charges":[{"minimum":9.84,"maximum":53.09,"gross_charge":65.54,"discounted_cash":19.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.24,"maximum":7.08,"gross_charge":8.73,"discounted_cash":2.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.31,"maximum":7.08,"gross_charge":8.73,"discounted_cash":2.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.85,"maximum":53.8,"gross_charge":66.41,"discounted_cash":19.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.97,"maximum":53.8,"gross_charge":66.41,"discounted_cash":19.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.35,"maximum":55.82,"gross_charge":68.91,"discounted_cash":20.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.34,"maximum":55.82,"gross_charge":68.91,"discounted_cash":20.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.04,"maximum":13.55,"gross_charge":16.72,"discounted_cash":4.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.51,"maximum":13.55,"gross_charge":16.72,"discounted_cash":4.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.9,"maximum":53.87,"gross_charge":66.5,"discounted_cash":19.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.98,"maximum":53.87,"gross_charge":66.5,"discounted_cash":19.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0997-04","type":"NDC"}],"standard_charges":[{"minimum":2.71,"maximum":3.66,"gross_charge":4.51,"discounted_cash":1.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0997-04","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":3.66,"gross_charge":4.51,"discounted_cash":1.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0997-08","type":"NDC"}],"standard_charges":[{"minimum":21.09,"maximum":28.48,"gross_charge":35.15,"discounted_cash":10.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0997-08","type":"NDC"}],"standard_charges":[{"minimum":5.28,"maximum":28.48,"gross_charge":35.15,"discounted_cash":10.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.4,"maximum":7.29,"gross_charge":8.99,"discounted_cash":2.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.35,"maximum":7.29,"gross_charge":8.99,"discounted_cash":2.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.45,"maximum":8.71,"gross_charge":10.75,"discounted_cash":3.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.62,"maximum":8.71,"gross_charge":10.75,"discounted_cash":3.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.66,"maximum":14.39,"gross_charge":17.76,"discounted_cash":5.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.67,"maximum":14.39,"gross_charge":17.76,"discounted_cash":5.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":43.03,"maximum":58.09,"gross_charge":71.71,"discounted_cash":21.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.76,"maximum":58.09,"gross_charge":71.71,"discounted_cash":21.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":51.59,"maximum":69.64,"gross_charge":85.97,"discounted_cash":25.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.9,"maximum":69.64,"gross_charge":85.97,"discounted_cash":25.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":84.7,"maximum":114.34,"gross_charge":141.16,"discounted_cash":41.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.7,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.18,"maximum":114.34,"gross_charge":141.16,"discounted_cash":41.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.24,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.01,"maximum":13.52,"gross_charge":16.68,"discounted_cash":4.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.51,"maximum":13.52,"gross_charge":16.68,"discounted_cash":4.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.8,"maximum":53.72,"gross_charge":66.32,"discounted_cash":19.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.95,"maximum":53.72,"gross_charge":66.32,"discounted_cash":19.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"}]}]},{"description":"ESTRAMUSTINE 140 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":920.49,"maximum":1242.67,"gross_charge":1534.15,"discounted_cash":454.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1242.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":920.49,"methodology":"fee schedule"}]}]},{"description":"ESTRAMUSTINE 140 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":230.13,"maximum":1242.67,"gross_charge":1534.15,"discounted_cash":454.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1242.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1242.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":920.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":230.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.83,"methodology":"fee schedule"}]}]},{"description":"ESZOPICLONE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0299-07","type":"NDC"}],"standard_charges":[{"minimum":6.22,"maximum":8.4,"gross_charge":10.36,"discounted_cash":3.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"}]}]},{"description":"ESZOPICLONE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0299-07","type":"NDC"}],"standard_charges":[{"minimum":1.56,"maximum":8.4,"gross_charge":10.36,"discounted_cash":3.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"}]}]},{"description":"ESZOPICLONE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0619-01","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":5.62,"gross_charge":6.93,"discounted_cash":2.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"}]}]},{"description":"ESZOPICLONE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0619-01","type":"NDC"}],"standard_charges":[{"minimum":1.04,"maximum":5.62,"gross_charge":6.93,"discounted_cash":2.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"}]}]},{"description":"ETHACRYNIC ACID 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0405-01","type":"NDC"}],"standard_charges":[{"minimum":137.87,"maximum":186.13,"gross_charge":229.78,"discounted_cash":68.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"}]}]},{"description":"ETHACRYNIC ACID 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0405-01","type":"NDC"}],"standard_charges":[{"minimum":34.47,"maximum":186.13,"gross_charge":229.78,"discounted_cash":68.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.96,"methodology":"fee schedule"}]}]},{"description":"ETHACRYNIC ACID 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1126-01","type":"NDC"}],"standard_charges":[{"minimum":71.37,"maximum":96.35,"gross_charge":118.95,"discounted_cash":35.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.37,"methodology":"fee schedule"}]}]},{"description":"ETHACRYNIC ACID 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1126-01","type":"NDC"}],"standard_charges":[{"minimum":17.85,"maximum":96.35,"gross_charge":118.95,"discounted_cash":35.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.79,"methodology":"fee schedule"}]}]},{"description":"ETHACRYNIC ACID 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":150.11,"maximum":202.65,"gross_charge":250.18,"discounted_cash":74.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.11,"methodology":"fee schedule"}]}]},{"description":"ETHACRYNIC ACID 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":37.53,"maximum":202.65,"gross_charge":250.18,"discounted_cash":74.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":202.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":202.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":202.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"}]}]},{"description":"ETHAMBUTOL 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0280-11","type":"NDC"}],"standard_charges":[{"minimum":42.81,"maximum":57.79,"gross_charge":71.34,"discounted_cash":21.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.81,"methodology":"fee schedule"}]}]},{"description":"ETHAMBUTOL 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0280-11","type":"NDC"}],"standard_charges":[{"minimum":10.71,"maximum":57.79,"gross_charge":71.34,"discounted_cash":21.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"}]}]},{"description":"ETHAMBUTOL 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68850-0012-02","type":"NDC"}],"standard_charges":[{"minimum":42.93,"maximum":57.95,"gross_charge":71.54,"discounted_cash":21.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"}]}]},{"description":"ETHAMBUTOL 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68850-0012-02","type":"NDC"}],"standard_charges":[{"minimum":10.74,"maximum":57.95,"gross_charge":71.54,"discounted_cash":21.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"}]}]},{"description":"ETHOSUXIMIDE 250 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61748-0025-01","type":"NDC"}],"standard_charges":[{"minimum":99.82,"maximum":134.76,"gross_charge":166.36,"discounted_cash":49.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.82,"methodology":"fee schedule"}]}]},{"description":"ETHOSUXIMIDE 250 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61748-0025-01","type":"NDC"}],"standard_charges":[{"minimum":24.96,"maximum":134.76,"gross_charge":166.36,"discounted_cash":49.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.28,"methodology":"fee schedule"}]}]},{"description":"EZETIMIBE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0787-90","type":"NDC"}],"standard_charges":[{"minimum":2.51,"maximum":3.39,"gross_charge":4.18,"discounted_cash":1.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"}]}]},{"description":"EZETIMIBE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0787-90","type":"NDC"}],"standard_charges":[{"minimum":0.63,"maximum":3.39,"gross_charge":4.18,"discounted_cash":1.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"}]}]},{"description":"EZETIMIBE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0490-30","type":"NDC"}],"standard_charges":[{"minimum":5.16,"maximum":6.96,"gross_charge":8.59,"discounted_cash":2.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"EZETIMIBE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0490-30","type":"NDC"}],"standard_charges":[{"minimum":1.29,"maximum":6.96,"gross_charge":8.59,"discounted_cash":2.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"}]}]},{"description":"FAMCICLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0708-30","type":"NDC"}],"standard_charges":[{"minimum":21.06,"maximum":28.43,"gross_charge":35.09,"discounted_cash":10.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"}]}]},{"description":"FAMCICLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0708-30","type":"NDC"}],"standard_charges":[{"minimum":5.27,"maximum":28.43,"gross_charge":35.09,"discounted_cash":10.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"}]}]},{"description":"FAMCICLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0026-07","type":"NDC"}],"standard_charges":[{"minimum":19.28,"maximum":26.02,"gross_charge":32.12,"discounted_cash":9.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.28,"methodology":"fee schedule"}]}]},{"description":"FAMCICLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0026-07","type":"NDC"}],"standard_charges":[{"minimum":4.82,"maximum":26.02,"gross_charge":32.12,"discounted_cash":9.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16837-0855-14","type":"NDC"}],"standard_charges":[{"minimum":6.44,"maximum":8.7,"gross_charge":10.73,"discounted_cash":3.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16837-0855-14","type":"NDC"}],"standard_charges":[{"minimum":1.61,"maximum":8.7,"gross_charge":10.73,"discounted_cash":3.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0595-01","type":"NDC"}],"standard_charges":[{"minimum":11.36,"maximum":15.34,"gross_charge":18.93,"discounted_cash":5.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0595-01","type":"NDC"}],"standard_charges":[{"minimum":2.84,"maximum":15.34,"gross_charge":18.93,"discounted_cash":5.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0001-91","type":"NDC"}],"standard_charges":[{"minimum":55.29,"maximum":74.65,"gross_charge":92.15,"discounted_cash":27.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.29,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0001-91","type":"NDC"}],"standard_charges":[{"minimum":13.83,"maximum":74.65,"gross_charge":92.15,"discounted_cash":27.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0397-00","type":"NDC"}],"standard_charges":[{"minimum":2.9,"maximum":3.92,"gross_charge":4.83,"discounted_cash":1.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0397-00","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":3.92,"gross_charge":4.83,"discounted_cash":1.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.57,"maximum":3.47,"gross_charge":4.28,"discounted_cash":1.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"}]}]},{"description":"FAMOTIDINE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":3.47,"gross_charge":4.28,"discounted_cash":1.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0059-01","type":"NDC"}],"standard_charges":[{"minimum":67.86,"maximum":91.62,"gross_charge":113.1,"discounted_cash":33.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.86,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0059-01","type":"NDC"}],"standard_charges":[{"minimum":16.97,"maximum":91.62,"gross_charge":113.1,"discounted_cash":33.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0796-30","type":"NDC"}],"standard_charges":[{"minimum":18.21,"maximum":24.59,"gross_charge":30.35,"discounted_cash":8.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0796-30","type":"NDC"}],"standard_charges":[{"minimum":4.56,"maximum":24.59,"gross_charge":30.35,"discounted_cash":8.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":45.63,"maximum":61.61,"gross_charge":76.05,"discounted_cash":22.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.63,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.41,"maximum":61.61,"gross_charge":76.05,"discounted_cash":22.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0797-30","type":"NDC"}],"standard_charges":[{"minimum":19.89,"maximum":26.85,"gross_charge":33.14,"discounted_cash":9.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0797-30","type":"NDC"}],"standard_charges":[{"minimum":4.98,"maximum":26.85,"gross_charge":33.14,"discounted_cash":9.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64764-0677-30","type":"NDC"}],"standard_charges":[{"minimum":181.31,"maximum":244.76,"gross_charge":302.17,"discounted_cash":89.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":244.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":244.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":244.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64764-0677-30","type":"NDC"}],"standard_charges":[{"minimum":45.33,"maximum":244.76,"gross_charge":302.17,"discounted_cash":89.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":244.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":244.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":244.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.44,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72578-0137-06","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":0.66,"gross_charge":0.81,"discounted_cash":0.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"FEBUXOSTAT 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72578-0137-06","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.66,"gross_charge":0.81,"discounted_cash":0.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0660-45","type":"NDC"}],"standard_charges":[{"minimum":7.86,"maximum":10.61,"gross_charge":13.09,"discounted_cash":3.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0660-45","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":10.61,"gross_charge":13.09,"discounted_cash":3.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60219-5522-09","type":"NDC"}],"standard_charges":[{"minimum":7.37,"maximum":9.95,"gross_charge":12.28,"discounted_cash":3.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60219-5522-09","type":"NDC"}],"standard_charges":[{"minimum":1.85,"maximum":9.95,"gross_charge":12.28,"discounted_cash":3.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0666-11","type":"NDC"}],"standard_charges":[{"minimum":1.33,"maximum":1.8,"gross_charge":2.21,"discounted_cash":0.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0666-11","type":"NDC"}],"standard_charges":[{"minimum":0.34,"maximum":1.8,"gross_charge":2.21,"discounted_cash":0.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0666-21","type":"NDC"}],"standard_charges":[{"minimum":37.53,"maximum":50.66,"gross_charge":62.54,"discounted_cash":18.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.53,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0666-21","type":"NDC"}],"standard_charges":[{"minimum":9.39,"maximum":50.66,"gross_charge":62.54,"discounted_cash":18.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0539-90","type":"NDC"}],"standard_charges":[{"minimum":32.76,"maximum":44.22,"gross_charge":54.59,"discounted_cash":16.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0539-90","type":"NDC"}],"standard_charges":[{"minimum":8.19,"maximum":44.22,"gross_charge":54.59,"discounted_cash":16.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0901-90","type":"NDC"}],"standard_charges":[{"minimum":5.27,"maximum":7.11,"gross_charge":8.77,"discounted_cash":2.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0901-90","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":7.11,"gross_charge":8.77,"discounted_cash":2.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0328-11","type":"NDC"}],"standard_charges":[{"minimum":51.23,"maximum":69.16,"gross_charge":85.38,"discounted_cash":25.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0328-11","type":"NDC"}],"standard_charges":[{"minimum":12.81,"maximum":69.16,"gross_charge":85.38,"discounted_cash":25.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0949-60","type":"NDC"}],"standard_charges":[{"minimum":7.17,"maximum":9.68,"gross_charge":11.95,"discounted_cash":3.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0949-60","type":"NDC"}],"standard_charges":[{"minimum":1.8,"maximum":9.68,"gross_charge":11.95,"discounted_cash":3.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":46.97,"maximum":63.4,"gross_charge":78.27,"discounted_cash":23.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.97,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE 160 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.75,"maximum":63.4,"gross_charge":78.27,"discounted_cash":23.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE MICRONIZED 67 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0084-31","type":"NDC"}],"standard_charges":[{"minimum":13.4,"maximum":18.09,"gross_charge":22.33,"discounted_cash":6.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"FENOFIBRATE MICRONIZED 67 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0084-31","type":"NDC"}],"standard_charges":[{"minimum":3.35,"maximum":18.09,"gross_charge":22.33,"discounted_cash":6.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0428-11","type":"NDC"}],"standard_charges":[{"minimum":7.32,"maximum":9.89,"gross_charge":12.2,"discounted_cash":3.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0428-11","type":"NDC"}],"standard_charges":[{"minimum":1.83,"maximum":9.89,"gross_charge":12.2,"discounted_cash":3.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0428-47","type":"NDC"}],"standard_charges":[{"minimum":36.3,"maximum":49.01,"gross_charge":60.5,"discounted_cash":17.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0428-47","type":"NDC"}],"standard_charges":[{"minimum":9.08,"maximum":49.01,"gross_charge":60.5,"discounted_cash":17.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7009-00","type":"NDC"}],"standard_charges":[{"minimum":2.46,"maximum":3.32,"gross_charge":4.09,"discounted_cash":1.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7009-00","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":3.32,"gross_charge":4.09,"discounted_cash":1.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7009-02","type":"NDC"}],"standard_charges":[{"minimum":11.96,"maximum":16.14,"gross_charge":19.92,"discounted_cash":5.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7009-02","type":"NDC"}],"standard_charges":[{"minimum":2.99,"maximum":16.14,"gross_charge":19.92,"discounted_cash":5.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7084-00","type":"NDC"}],"standard_charges":[{"minimum":7.98,"maximum":10.77,"gross_charge":13.29,"discounted_cash":3.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7084-00","type":"NDC"}],"standard_charges":[{"minimum":2,"maximum":10.77,"gross_charge":13.29,"discounted_cash":3.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7084-02","type":"NDC"}],"standard_charges":[{"minimum":39.57,"maximum":53.42,"gross_charge":65.95,"discounted_cash":19.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.57,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7084-02","type":"NDC"}],"standard_charges":[{"minimum":9.9,"maximum":53.42,"gross_charge":65.95,"discounted_cash":19.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.21,"maximum":21.88,"gross_charge":27.01,"discounted_cash":8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.06,"maximum":21.88,"gross_charge":27.01,"discounted_cash":8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.63,"maximum":33.26,"gross_charge":41.05,"discounted_cash":12.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.63,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.16,"maximum":33.26,"gross_charge":41.05,"discounted_cash":12.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.12,"maximum":39.31,"gross_charge":48.53,"discounted_cash":14.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.28,"maximum":39.31,"gross_charge":48.53,"discounted_cash":14.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":81.53,"maximum":110.07,"gross_charge":135.88,"discounted_cash":40.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.53,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 100 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.39,"maximum":110.07,"gross_charge":135.88,"discounted_cash":40.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.18,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0423-11","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":3.6,"gross_charge":4.44,"discounted_cash":1.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0423-11","type":"NDC"}],"standard_charges":[{"minimum":0.67,"maximum":3.6,"gross_charge":4.44,"discounted_cash":1.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0423-47","type":"NDC"}],"standard_charges":[{"minimum":13.02,"maximum":17.57,"gross_charge":21.69,"discounted_cash":6.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0423-47","type":"NDC"}],"standard_charges":[{"minimum":3.26,"maximum":17.57,"gross_charge":21.69,"discounted_cash":6.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7010-00","type":"NDC"}],"standard_charges":[{"minimum":1.92,"maximum":2.6,"gross_charge":3.2,"discounted_cash":0.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7010-00","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":2.6,"gross_charge":3.2,"discounted_cash":0.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7010-02","type":"NDC"}],"standard_charges":[{"minimum":9.29,"maximum":12.54,"gross_charge":15.47,"discounted_cash":4.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7010-02","type":"NDC"}],"standard_charges":[{"minimum":2.33,"maximum":12.54,"gross_charge":15.47,"discounted_cash":4.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7080-00","type":"NDC"}],"standard_charges":[{"minimum":8.16,"maximum":11.01,"gross_charge":13.59,"discounted_cash":4.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7080-00","type":"NDC"}],"standard_charges":[{"minimum":2.04,"maximum":11.01,"gross_charge":13.59,"discounted_cash":4.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7080-02","type":"NDC"}],"standard_charges":[{"minimum":40.47,"maximum":54.64,"gross_charge":67.45,"discounted_cash":19.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7080-02","type":"NDC"}],"standard_charges":[{"minimum":10.12,"maximum":54.64,"gross_charge":67.45,"discounted_cash":19.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":9.72,"gross_charge":12,"discounted_cash":3.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.8,"maximum":9.72,"gross_charge":12,"discounted_cash":3.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.87,"maximum":11.97,"gross_charge":14.77,"discounted_cash":4.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.22,"maximum":11.97,"gross_charge":14.77,"discounted_cash":4.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.24,"maximum":20.58,"gross_charge":25.4,"discounted_cash":7.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.81,"maximum":20.58,"gross_charge":25.4,"discounted_cash":7.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.58,"maximum":35.89,"gross_charge":44.3,"discounted_cash":13.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.58,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.65,"maximum":35.89,"gross_charge":44.3,"discounted_cash":13.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.7,"maximum":48.19,"gross_charge":59.49,"discounted_cash":17.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.7,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 12 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.93,"maximum":48.19,"gross_charge":59.49,"discounted_cash":17.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0424-11","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":2.97,"gross_charge":3.66,"discounted_cash":1.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0424-11","type":"NDC"}],"standard_charges":[{"minimum":0.55,"maximum":2.97,"gross_charge":3.66,"discounted_cash":1.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0424-47","type":"NDC"}],"standard_charges":[{"minimum":10.67,"maximum":14.41,"gross_charge":17.78,"discounted_cash":5.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0424-47","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":14.41,"gross_charge":17.78,"discounted_cash":5.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7006-00","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":1.32,"gross_charge":1.62,"discounted_cash":0.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7006-00","type":"NDC"}],"standard_charges":[{"minimum":0.25,"maximum":1.32,"gross_charge":1.62,"discounted_cash":0.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7006-02","type":"NDC"}],"standard_charges":[{"minimum":4.55,"maximum":6.14,"gross_charge":7.57,"discounted_cash":2.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7006-02","type":"NDC"}],"standard_charges":[{"minimum":1.14,"maximum":6.14,"gross_charge":7.57,"discounted_cash":2.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7081-02","type":"NDC"}],"standard_charges":[{"minimum":8.47,"maximum":11.43,"gross_charge":14.11,"discounted_cash":4.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7081-02","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":11.43,"gross_charge":14.11,"discounted_cash":4.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.26,"maximum":5.75,"gross_charge":7.09,"discounted_cash":2.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":5.75,"gross_charge":7.09,"discounted_cash":2.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.83,"maximum":13.26,"gross_charge":16.37,"discounted_cash":4.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.46,"maximum":13.26,"gross_charge":16.37,"discounted_cash":4.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.01,"maximum":16.21,"gross_charge":20.01,"discounted_cash":5.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.01,"maximum":16.21,"gross_charge":20.01,"discounted_cash":5.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.16,"maximum":28.57,"gross_charge":35.26,"discounted_cash":10.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.16,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 25 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.29,"maximum":28.57,"gross_charge":35.26,"discounted_cash":10.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0426-47","type":"NDC"}],"standard_charges":[{"minimum":19.87,"maximum":26.82,"gross_charge":33.11,"discounted_cash":9.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0426-47","type":"NDC"}],"standard_charges":[{"minimum":4.97,"maximum":26.82,"gross_charge":33.11,"discounted_cash":9.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7007-02","type":"NDC"}],"standard_charges":[{"minimum":7.29,"maximum":9.85,"gross_charge":12.15,"discounted_cash":3.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7007-02","type":"NDC"}],"standard_charges":[{"minimum":1.83,"maximum":9.85,"gross_charge":12.15,"discounted_cash":3.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.49,"maximum":10.11,"gross_charge":12.48,"discounted_cash":3.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.88,"maximum":10.11,"gross_charge":12.48,"discounted_cash":3.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.1,"maximum":21.74,"gross_charge":26.83,"discounted_cash":7.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.03,"maximum":21.74,"gross_charge":26.83,"discounted_cash":7.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.66,"maximum":23.84,"gross_charge":29.43,"discounted_cash":8.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.66,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.42,"maximum":23.84,"gross_charge":29.43,"discounted_cash":8.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.89,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":37.52,"maximum":50.65,"gross_charge":62.52,"discounted_cash":18.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.52,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 50 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.38,"maximum":50.65,"gross_charge":62.52,"discounted_cash":18.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0427-11","type":"NDC"}],"standard_charges":[{"minimum":7.69,"maximum":10.38,"gross_charge":12.81,"discounted_cash":3.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0427-11","type":"NDC"}],"standard_charges":[{"minimum":1.93,"maximum":10.38,"gross_charge":12.81,"discounted_cash":3.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0427-47","type":"NDC"}],"standard_charges":[{"minimum":38.13,"maximum":51.48,"gross_charge":63.55,"discounted_cash":18.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.13,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0427-47","type":"NDC"}],"standard_charges":[{"minimum":9.54,"maximum":51.48,"gross_charge":63.55,"discounted_cash":18.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7008-02","type":"NDC"}],"standard_charges":[{"minimum":9.67,"maximum":13.05,"gross_charge":16.11,"discounted_cash":4.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7008-02","type":"NDC"}],"standard_charges":[{"minimum":2.42,"maximum":13.05,"gross_charge":16.11,"discounted_cash":4.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7083-02","type":"NDC"}],"standard_charges":[{"minimum":35.8,"maximum":48.33,"gross_charge":59.66,"discounted_cash":17.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7083-02","type":"NDC"}],"standard_charges":[{"minimum":8.95,"maximum":48.33,"gross_charge":59.66,"discounted_cash":17.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.87,"maximum":36.28,"gross_charge":44.78,"discounted_cash":13.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.72,"maximum":36.28,"gross_charge":44.78,"discounted_cash":13.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.66,"maximum":79.19,"gross_charge":97.76,"discounted_cash":28.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.67,"maximum":79.19,"gross_charge":97.76,"discounted_cash":28.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":59.25,"maximum":79.99,"gross_charge":98.75,"discounted_cash":29.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.25,"methodology":"fee schedule"}]}]},{"description":"FENTANYL 75 MCG/HR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.82,"maximum":79.99,"gross_charge":98.75,"discounted_cash":29.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"}]}]},{"description":"FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.91,"maximum":2.57,"gross_charge":3.17,"discounted_cash":0.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.48,"maximum":2.57,"gross_charge":3.17,"discounted_cash":0.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"}]}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"20555-0021-01","type":"NDC"}],"standard_charges":[{"minimum":0.92,"maximum":1.24,"gross_charge":1.53,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"}]}]},{"description":"FERROUS SULFATE 325 MG (65 MG IRON) TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"20555-0021-01","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":1.24,"gross_charge":1.53,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"}]}]},{"description":"FEXOFENADINE 180 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0899-01","type":"NDC"}],"standard_charges":[{"minimum":4.53,"maximum":6.11,"gross_charge":7.54,"discounted_cash":2.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"}]}]},{"description":"FEXOFENADINE 180 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0899-01","type":"NDC"}],"standard_charges":[{"minimum":1.14,"maximum":6.11,"gross_charge":7.54,"discounted_cash":2.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"}]}]},{"description":"FEXOFENADINE 180 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.77,"maximum":22.64,"gross_charge":27.95,"discounted_cash":8.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"}]}]},{"description":"FEXOFENADINE 180 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":22.64,"gross_charge":27.95,"discounted_cash":8.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.59,"methodology":"fee schedule"}]}]},{"description":"FIDAXOMICIN 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52015-0080-01","type":"NDC"}],"standard_charges":[{"minimum":1340.25,"maximum":1809.33,"gross_charge":2233.74,"discounted_cash":661.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1809.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1809.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1809.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1340.25,"methodology":"fee schedule"}]}]},{"description":"FIDAXOMICIN 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52015-0080-01","type":"NDC"}],"standard_charges":[{"minimum":335.07,"maximum":1809.33,"gross_charge":2233.74,"discounted_cash":661.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1809.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1809.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1809.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1340.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":424.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":335.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":446.75,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0090-15","type":"NDC"}],"standard_charges":[{"minimum":3.81,"maximum":5.14,"gross_charge":6.34,"discounted_cash":1.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0090-15","type":"NDC"}],"standard_charges":[{"minimum":0.96,"maximum":5.14,"gross_charge":6.34,"discounted_cash":1.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0525-30","type":"NDC"}],"standard_charges":[{"minimum":6.89,"maximum":9.3,"gross_charge":11.47,"discounted_cash":3.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0525-30","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":9.3,"gross_charge":11.47,"discounted_cash":3.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0525-90","type":"NDC"}],"standard_charges":[{"minimum":20.77,"maximum":28.04,"gross_charge":34.61,"discounted_cash":10.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0525-90","type":"NDC"}],"standard_charges":[{"minimum":5.2,"maximum":28.04,"gross_charge":34.61,"discounted_cash":10.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0314-11","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":0.39,"gross_charge":0.48,"discounted_cash":0.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0314-11","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.39,"gross_charge":0.48,"discounted_cash":0.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0428-65","type":"NDC"}],"standard_charges":[{"minimum":23.64,"maximum":31.91,"gross_charge":39.39,"discounted_cash":11.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0428-65","type":"NDC"}],"standard_charges":[{"minimum":5.91,"maximum":31.91,"gross_charge":39.39,"discounted_cash":11.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.95,"maximum":13.43,"gross_charge":16.58,"discounted_cash":4.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.49,"maximum":13.43,"gross_charge":16.58,"discounted_cash":4.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.07,"maximum":35.19,"gross_charge":43.44,"discounted_cash":12.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"}]}]},{"description":"FINASTERIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.52,"maximum":35.19,"gross_charge":43.44,"discounted_cash":12.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.69,"methodology":"fee schedule"}]}]},{"description":"FLAVOXATE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0058-01","type":"NDC"}],"standard_charges":[{"minimum":96.1,"maximum":129.73,"gross_charge":160.16,"discounted_cash":47.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.1,"methodology":"fee schedule"}]}]},{"description":"FLAVOXATE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0058-01","type":"NDC"}],"standard_charges":[{"minimum":24.03,"maximum":129.73,"gross_charge":160.16,"discounted_cash":47.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.04,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0642-01","type":"NDC"}],"standard_charges":[{"minimum":8.66,"maximum":11.69,"gross_charge":14.43,"discounted_cash":4.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0642-01","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":11.69,"gross_charge":14.43,"discounted_cash":4.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0642-10","type":"NDC"}],"standard_charges":[{"minimum":51.57,"maximum":69.62,"gross_charge":85.95,"discounted_cash":25.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.57,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0642-10","type":"NDC"}],"standard_charges":[{"minimum":12.9,"maximum":69.62,"gross_charge":85.95,"discounted_cash":25.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0622-01","type":"NDC"}],"standard_charges":[{"minimum":42.27,"maximum":57.06,"gross_charge":70.44,"discounted_cash":20.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.27,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0622-01","type":"NDC"}],"standard_charges":[{"minimum":10.57,"maximum":57.06,"gross_charge":70.44,"discounted_cash":20.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.04,"maximum":40.55,"gross_charge":50.06,"discounted_cash":14.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.51,"maximum":40.55,"gross_charge":50.06,"discounted_cash":14.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0641-10","type":"NDC"}],"standard_charges":[{"minimum":31.59,"maximum":42.64,"gross_charge":52.64,"discounted_cash":15.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"}]}]},{"description":"FLECAINIDE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0641-10","type":"NDC"}],"standard_charges":[{"minimum":7.9,"maximum":42.64,"gross_charge":52.64,"discounted_cash":15.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0728-01","type":"NDC"}],"standard_charges":[{"minimum":65.07,"maximum":87.85,"gross_charge":108.45,"discounted_cash":32.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.07,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0728-01","type":"NDC"}],"standard_charges":[{"minimum":16.27,"maximum":87.85,"gross_charge":108.45,"discounted_cash":32.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0728-11","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":0.99,"gross_charge":1.21,"discounted_cash":0.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0728-11","type":"NDC"}],"standard_charges":[{"minimum":0.19,"maximum":0.99,"gross_charge":1.21,"discounted_cash":0.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":25.38,"maximum":34.26,"gross_charge":42.29,"discounted_cash":12.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.35,"maximum":34.26,"gross_charge":42.29,"discounted_cash":12.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0692-11","type":"NDC"}],"standard_charges":[{"minimum":0.52,"maximum":0.7,"gross_charge":0.86,"discounted_cash":0.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0692-11","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.7,"gross_charge":0.86,"discounted_cash":0.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0253-20","type":"NDC"}],"standard_charges":[{"minimum":8.76,"maximum":11.82,"gross_charge":14.59,"discounted_cash":4.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0253-20","type":"NDC"}],"standard_charges":[{"minimum":2.19,"maximum":11.82,"gross_charge":14.59,"discounted_cash":4.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0693-01","type":"NDC"}],"standard_charges":[{"minimum":12.11,"maximum":16.34,"gross_charge":20.17,"discounted_cash":5.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0693-01","type":"NDC"}],"standard_charges":[{"minimum":3.03,"maximum":16.34,"gross_charge":20.17,"discounted_cash":5.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0993-30","type":"NDC"}],"standard_charges":[{"minimum":10.74,"maximum":14.5,"gross_charge":17.89,"discounted_cash":5.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0993-30","type":"NDC"}],"standard_charges":[{"minimum":2.69,"maximum":14.5,"gross_charge":17.89,"discounted_cash":5.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0735-01","type":"NDC"}],"standard_charges":[{"minimum":117.71,"maximum":158.9,"gross_charge":196.17,"discounted_cash":58.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":158.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":158.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.71,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0735-01","type":"NDC"}],"standard_charges":[{"minimum":29.43,"maximum":158.9,"gross_charge":196.17,"discounted_cash":58.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":158.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":158.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.24,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0104-30","type":"NDC"}],"standard_charges":[{"minimum":18.52,"maximum":25,"gross_charge":30.86,"discounted_cash":9.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0104-30","type":"NDC"}],"standard_charges":[{"minimum":4.63,"maximum":25,"gross_charge":30.86,"discounted_cash":9.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.08,"maximum":37.9,"gross_charge":46.79,"discounted_cash":13.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.08,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.02,"maximum":37.9,"gross_charge":46.79,"discounted_cash":13.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 40 MG/ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0150-35","type":"NDC"}],"standard_charges":[{"minimum":6.41,"maximum":8.65,"gross_charge":10.67,"discounted_cash":3.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 40 MG/ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0150-35","type":"NDC"}],"standard_charges":[{"minimum":1.61,"maximum":8.65,"gross_charge":10.67,"discounted_cash":3.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 40 MG/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.8,"maximum":38.88,"gross_charge":47.99,"discounted_cash":14.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 40 MG/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.2,"maximum":38.88,"gross_charge":47.99,"discounted_cash":14.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0010-08","type":"NDC"}],"standard_charges":[{"minimum":933.58,"maximum":1260.33,"gross_charge":1555.96,"discounted_cash":460.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1260.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1260.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1260.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":933.58,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0010-08","type":"NDC"}],"standard_charges":[{"minimum":233.4,"maximum":1260.33,"gross_charge":1555.96,"discounted_cash":460.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1260.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1260.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1260.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":933.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.2,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0770-01","type":"NDC"}],"standard_charges":[{"minimum":687.41,"maximum":928,"gross_charge":1145.67,"discounted_cash":339.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":928,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":928,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":928,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":687.41,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0770-01","type":"NDC"}],"standard_charges":[{"minimum":171.86,"maximum":928,"gross_charge":1145.67,"discounted_cash":339.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":928,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":928,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":928,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":687.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":217.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.14,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0332-01","type":"NDC"}],"standard_charges":[{"minimum":654.7,"maximum":883.84,"gross_charge":1091.16,"discounted_cash":322.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":883.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":883.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":883.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":654.7,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0332-01","type":"NDC"}],"standard_charges":[{"minimum":163.68,"maximum":883.84,"gross_charge":1091.16,"discounted_cash":322.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":883.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":883.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":883.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":654.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.24,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0180-01","type":"NDC"}],"standard_charges":[{"minimum":6840.98,"maximum":9235.32,"gross_charge":11401.62,"discounted_cash":3374.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9235.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9235.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9235.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6840.98,"methodology":"fee schedule"}]}]},{"description":"FLUCYTOSINE 500 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0180-01","type":"NDC"}],"standard_charges":[{"minimum":1710.25,"maximum":9235.32,"gross_charge":11401.62,"discounted_cash":3374.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9235.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9235.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9235.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6840.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2166.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1710.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2280.33,"methodology":"fee schedule"}]}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.85,"maximum":32.19,"gross_charge":39.74,"discounted_cash":11.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"}]}]},{"description":"FLUDROCORTISONE 0.1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.97,"maximum":32.19,"gross_charge":39.74,"discounted_cash":11.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"}]}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17238-0900-11","type":"NDC"}],"standard_charges":[{"minimum":69.67,"maximum":94.05,"gross_charge":116.11,"discounted_cash":34.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.67,"methodology":"fee schedule"}]}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17238-0900-11","type":"NDC"}],"standard_charges":[{"minimum":17.42,"maximum":94.05,"gross_charge":116.11,"discounted_cash":34.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.23,"methodology":"fee schedule"}]}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17238-0900-30","type":"NDC"}],"standard_charges":[{"minimum":119.18,"maximum":160.89,"gross_charge":198.62,"discounted_cash":58.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.18,"methodology":"fee schedule"}]}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17238-0900-30","type":"NDC"}],"standard_charges":[{"minimum":29.8,"maximum":160.89,"gross_charge":198.62,"discounted_cash":58.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"}]}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17238-0900-99","type":"NDC"}],"standard_charges":[{"minimum":33.16,"maximum":44.77,"gross_charge":55.26,"discounted_cash":16.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.16,"methodology":"fee schedule"}]}]},{"description":"FLUORESCEIN 1 MG EYE STRIPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17238-0900-99","type":"NDC"}],"standard_charges":[{"minimum":8.29,"maximum":44.77,"gross_charge":55.26,"discounted_cash":16.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":68.43,"maximum":92.39,"gross_charge":114.05,"discounted_cash":33.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.11,"maximum":92.39,"gross_charge":114.05,"discounted_cash":33.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.81,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0244-40","type":"NDC"}],"standard_charges":[{"minimum":3.17,"maximum":4.28,"gross_charge":5.28,"discounted_cash":1.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0244-40","type":"NDC"}],"standard_charges":[{"minimum":0.8,"maximum":4.28,"gross_charge":5.28,"discounted_cash":1.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0244-77","type":"NDC"}],"standard_charges":[{"minimum":2.13,"maximum":2.87,"gross_charge":3.54,"discounted_cash":1.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0244-77","type":"NDC"}],"standard_charges":[{"minimum":0.54,"maximum":2.87,"gross_charge":3.54,"discounted_cash":1.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.64,"maximum":2.21,"gross_charge":2.72,"discounted_cash":0.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.41,"maximum":2.21,"gross_charge":2.72,"discounted_cash":0.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.39,"maximum":27.53,"gross_charge":33.98,"discounted_cash":10.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.39,"methodology":"fee schedule"}]}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.1,"maximum":27.53,"gross_charge":33.98,"discounted_cash":10.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0672-01","type":"NDC"}],"standard_charges":[{"minimum":50.19,"maximum":67.76,"gross_charge":83.65,"discounted_cash":24.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0672-01","type":"NDC"}],"standard_charges":[{"minimum":12.55,"maximum":67.76,"gross_charge":83.65,"discounted_cash":24.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1678-01","type":"NDC"}],"standard_charges":[{"minimum":41.49,"maximum":56.01,"gross_charge":69.14,"discounted_cash":20.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1678-01","type":"NDC"}],"standard_charges":[{"minimum":10.38,"maximum":56.01,"gross_charge":69.14,"discounted_cash":20.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0273-10","type":"NDC"}],"standard_charges":[{"minimum":35.55,"maximum":47.99,"gross_charge":59.24,"discounted_cash":17.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.55,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0273-10","type":"NDC"}],"standard_charges":[{"minimum":8.89,"maximum":47.99,"gross_charge":59.24,"discounted_cash":17.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":88.96,"maximum":120.1,"gross_charge":148.26,"discounted_cash":43.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.96,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.24,"maximum":120.1,"gross_charge":148.26,"discounted_cash":43.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.66,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0726-01","type":"NDC"}],"standard_charges":[{"minimum":84.76,"maximum":114.43,"gross_charge":141.26,"discounted_cash":41.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.76,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0726-01","type":"NDC"}],"standard_charges":[{"minimum":21.19,"maximum":114.43,"gross_charge":141.26,"discounted_cash":41.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.26,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0673-01","type":"NDC"}],"standard_charges":[{"minimum":100.06,"maximum":135.08,"gross_charge":166.76,"discounted_cash":49.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.06,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0673-01","type":"NDC"}],"standard_charges":[{"minimum":25.02,"maximum":135.08,"gross_charge":166.76,"discounted_cash":49.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.36,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0336-01","type":"NDC"}],"standard_charges":[{"minimum":14.12,"maximum":19.06,"gross_charge":23.53,"discounted_cash":6.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0336-01","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":19.06,"gross_charge":23.53,"discounted_cash":6.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.71,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1679-01","type":"NDC"}],"standard_charges":[{"minimum":64.35,"maximum":86.88,"gross_charge":107.25,"discounted_cash":31.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.35,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1679-01","type":"NDC"}],"standard_charges":[{"minimum":16.09,"maximum":86.88,"gross_charge":107.25,"discounted_cash":31.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":60.51,"maximum":81.69,"gross_charge":100.85,"discounted_cash":29.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.51,"methodology":"fee schedule"}]}]},{"description":"FLUPHENAZINE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.13,"maximum":81.69,"gross_charge":100.85,"discounted_cash":29.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"}]}]},{"description":"FLUTAMIDE 125 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":155.63,"maximum":210.1,"gross_charge":259.38,"discounted_cash":76.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.63,"methodology":"fee schedule"}]}]},{"description":"FLUTAMIDE 125 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":38.91,"maximum":210.1,"gross_charge":259.38,"discounted_cash":76.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0700-16","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":2.48,"gross_charge":3.06,"discounted_cash":0.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0700-16","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":2.48,"gross_charge":3.06,"discounted_cash":0.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0829-01","type":"NDC"}],"standard_charges":[{"minimum":3.57,"maximum":4.82,"gross_charge":5.94,"discounted_cash":1.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0829-01","type":"NDC"}],"standard_charges":[{"minimum":0.9,"maximum":4.82,"gross_charge":5.94,"discounted_cash":1.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.86,"maximum":6.57,"gross_charge":8.1,"discounted_cash":2.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"}]}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAYSUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.22,"maximum":6.57,"gross_charge":8.1,"discounted_cash":2.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.04,"maximum":13.56,"gross_charge":16.73,"discounted_cash":4.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"}]}]},{"description":"FOLIC ACID 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.51,"maximum":13.56,"gross_charge":16.73,"discounted_cash":4.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0749-57","type":"NDC"}],"standard_charges":[{"minimum":40.24,"maximum":54.32,"gross_charge":67.06,"discounted_cash":19.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0749-57","type":"NDC"}],"standard_charges":[{"minimum":10.06,"maximum":54.32,"gross_charge":67.06,"discounted_cash":19.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0579-67","type":"NDC"}],"standard_charges":[{"minimum":27.14,"maximum":36.64,"gross_charge":45.23,"discounted_cash":13.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.14,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0579-67","type":"NDC"}],"standard_charges":[{"minimum":6.79,"maximum":36.64,"gross_charge":45.23,"discounted_cash":13.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70700-0268-99","type":"NDC"}],"standard_charges":[{"minimum":29.15,"maximum":39.35,"gross_charge":48.58,"discounted_cash":14.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70700-0268-99","type":"NDC"}],"standard_charges":[{"minimum":7.29,"maximum":39.35,"gross_charge":48.58,"discounted_cash":14.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":38.68,"maximum":52.22,"gross_charge":64.46,"discounted_cash":19.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"}]}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.67,"maximum":52.22,"gross_charge":64.46,"discounted_cash":19.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 80 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.13,"maximum":31.22,"gross_charge":38.54,"discounted_cash":11.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.13,"methodology":"fee schedule"}]}]},{"description":"FUROSEMIDE 80 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.79,"maximum":31.22,"gross_charge":38.54,"discounted_cash":11.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0902-10","type":"NDC"}],"standard_charges":[{"minimum":3.74,"maximum":5.05,"gross_charge":6.23,"discounted_cash":1.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0902-10","type":"NDC"}],"standard_charges":[{"minimum":0.94,"maximum":5.05,"gross_charge":6.23,"discounted_cash":1.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0101-50","type":"NDC"}],"standard_charges":[{"minimum":15.09,"maximum":20.37,"gross_charge":25.14,"discounted_cash":7.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0101-50","type":"NDC"}],"standard_charges":[{"minimum":3.78,"maximum":20.37,"gross_charge":25.14,"discounted_cash":7.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0591-01","type":"NDC"}],"standard_charges":[{"minimum":7.1,"maximum":9.59,"gross_charge":11.83,"discounted_cash":3.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0591-01","type":"NDC"}],"standard_charges":[{"minimum":1.78,"maximum":9.59,"gross_charge":11.83,"discounted_cash":3.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0102-10","type":"NDC"}],"standard_charges":[{"minimum":5.3,"maximum":7.16,"gross_charge":8.83,"discounted_cash":2.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0102-10","type":"NDC"}],"standard_charges":[{"minimum":1.33,"maximum":7.16,"gross_charge":8.83,"discounted_cash":2.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0102-50","type":"NDC"}],"standard_charges":[{"minimum":26.19,"maximum":35.35,"gross_charge":43.64,"discounted_cash":12.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.19,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0102-50","type":"NDC"}],"standard_charges":[{"minimum":6.55,"maximum":35.35,"gross_charge":43.64,"discounted_cash":12.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.58,"maximum":10.24,"gross_charge":12.63,"discounted_cash":3.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.58,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.9,"maximum":10.24,"gross_charge":12.63,"discounted_cash":3.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 400 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0904-10","type":"NDC"}],"standard_charges":[{"minimum":5.66,"maximum":7.64,"gross_charge":9.43,"discounted_cash":2.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"}]}]},{"description":"GABAPENTIN 400 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0904-10","type":"NDC"}],"standard_charges":[{"minimum":1.42,"maximum":7.64,"gross_charge":9.43,"discounted_cash":2.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0458-60","type":"NDC"}],"standard_charges":[{"minimum":23.2,"maximum":31.32,"gross_charge":38.66,"discounted_cash":11.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.2,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0458-60","type":"NDC"}],"standard_charges":[{"minimum":5.8,"maximum":31.32,"gross_charge":38.66,"discounted_cash":11.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70436-0004-06","type":"NDC"}],"standard_charges":[{"minimum":21.65,"maximum":29.23,"gross_charge":36.08,"discounted_cash":10.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.65,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70436-0004-06","type":"NDC"}],"standard_charges":[{"minimum":5.42,"maximum":29.23,"gross_charge":36.08,"discounted_cash":10.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.4,"maximum":28.89,"gross_charge":35.66,"discounted_cash":10.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.4,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.35,"maximum":28.89,"gross_charge":35.66,"discounted_cash":10.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":85.2,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.2,"methodology":"fee schedule"}]}]},{"description":"GALANTAMINE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.3,"maximum":115.02,"gross_charge":142,"discounted_cash":42.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"}]}]},{"description":"GELATIN ABSORBABLE EYE FILM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4046.62,"maximum":5462.94,"gross_charge":6744.36,"discounted_cash":1996.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5462.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5462.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5462.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4046.62,"methodology":"fee schedule"}]}]},{"description":"GELATIN ABSORBABLE EYE FILM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1011.66,"maximum":5462.94,"gross_charge":6744.36,"discounted_cash":1996.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5462.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5462.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5462.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4046.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1281.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1011.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1348.88,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0056-35","type":"NDC"}],"standard_charges":[{"minimum":20.32,"maximum":27.43,"gross_charge":33.86,"discounted_cash":10.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.32,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0056-35","type":"NDC"}],"standard_charges":[{"minimum":5.08,"maximum":27.43,"gross_charge":33.86,"discounted_cash":10.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.75,"maximum":15.86,"gross_charge":19.57,"discounted_cash":5.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.94,"maximum":15.86,"gross_charge":19.57,"discounted_cash":5.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0283-10","type":"NDC"}],"standard_charges":[{"minimum":8.68,"maximum":11.72,"gross_charge":14.46,"discounted_cash":4.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0283-10","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":11.72,"gross_charge":14.46,"discounted_cash":4.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0580-60","type":"NDC"}],"standard_charges":[{"minimum":8.11,"maximum":10.95,"gross_charge":13.51,"discounted_cash":4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0580-60","type":"NDC"}],"standard_charges":[{"minimum":2.03,"maximum":10.95,"gross_charge":13.51,"discounted_cash":4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0633-05","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":4.08,"gross_charge":5.03,"discounted_cash":1.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0633-05","type":"NDC"}],"standard_charges":[{"minimum":0.76,"maximum":4.08,"gross_charge":5.03,"discounted_cash":1.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0788-25","type":"NDC"}],"standard_charges":[{"minimum":12.41,"maximum":16.76,"gross_charge":20.68,"discounted_cash":6.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0788-25","type":"NDC"}],"standard_charges":[{"minimum":3.11,"maximum":16.76,"gross_charge":20.68,"discounted_cash":6.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.14,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0788-95","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":0.67,"gross_charge":0.82,"discounted_cash":0.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0788-95","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.67,"gross_charge":0.82,"discounted_cash":0.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0326-01","type":"NDC"}],"standard_charges":[{"minimum":24.75,"maximum":33.41,"gross_charge":41.24,"discounted_cash":12.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.75,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0326-01","type":"NDC"}],"standard_charges":[{"minimum":6.19,"maximum":33.41,"gross_charge":41.24,"discounted_cash":12.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0179-00","type":"NDC"}],"standard_charges":[{"minimum":20.67,"maximum":27.9,"gross_charge":34.44,"discounted_cash":10.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0179-00","type":"NDC"}],"standard_charges":[{"minimum":5.17,"maximum":27.9,"gross_charge":34.44,"discounted_cash":10.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0327-11","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":0.55,"gross_charge":0.67,"discounted_cash":0.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"GLIMEPIRIDE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0327-11","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":0.55,"gross_charge":0.67,"discounted_cash":0.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0362-15","type":"NDC"}],"standard_charges":[{"minimum":10.49,"maximum":14.16,"gross_charge":17.48,"discounted_cash":5.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0362-15","type":"NDC"}],"standard_charges":[{"minimum":2.63,"maximum":14.16,"gross_charge":17.48,"discounted_cash":5.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.15,"maximum":20.45,"gross_charge":25.24,"discounted_cash":7.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.79,"maximum":20.45,"gross_charge":25.24,"discounted_cash":7.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 10 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0890-01","type":"NDC"}],"standard_charges":[{"minimum":12.38,"maximum":16.72,"gross_charge":20.63,"discounted_cash":6.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 10 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0890-01","type":"NDC"}],"standard_charges":[{"minimum":3.1,"maximum":16.72,"gross_charge":20.63,"discounted_cash":6.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0480-11","type":"NDC"}],"standard_charges":[{"minimum":0.64,"maximum":0.86,"gross_charge":1.06,"discounted_cash":0.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0480-11","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":0.86,"gross_charge":1.06,"discounted_cash":0.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0480-21","type":"NDC"}],"standard_charges":[{"minimum":16.9,"maximum":22.81,"gross_charge":28.16,"discounted_cash":8.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.9,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0480-21","type":"NDC"}],"standard_charges":[{"minimum":4.23,"maximum":22.81,"gross_charge":28.16,"discounted_cash":8.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0279-03","type":"NDC"}],"standard_charges":[{"minimum":1.54,"maximum":2.08,"gross_charge":2.56,"discounted_cash":0.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0279-03","type":"NDC"}],"standard_charges":[{"minimum":0.39,"maximum":2.08,"gross_charge":2.56,"discounted_cash":0.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0888-30","type":"NDC"}],"standard_charges":[{"minimum":3.65,"maximum":4.92,"gross_charge":6.07,"discounted_cash":1.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0888-30","type":"NDC"}],"standard_charges":[{"minimum":0.92,"maximum":4.92,"gross_charge":6.07,"discounted_cash":1.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0295-21","type":"NDC"}],"standard_charges":[{"minimum":17.75,"maximum":23.96,"gross_charge":29.57,"discounted_cash":8.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.75,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0295-21","type":"NDC"}],"standard_charges":[{"minimum":4.44,"maximum":23.96,"gross_charge":29.57,"discounted_cash":8.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.1,"maximum":5.53,"gross_charge":6.82,"discounted_cash":2.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"}]}]},{"description":"GLIPIZIDE ER 2.5 MG TABLET EXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.03,"maximum":5.53,"gross_charge":6.82,"discounted_cash":2.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"GLUCOSAMINE-CHONDROITIN 500 MG-400 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57896-0859-06","type":"NDC"}],"standard_charges":[{"minimum":3.29,"maximum":4.44,"gross_charge":5.47,"discounted_cash":1.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"}]}]},{"description":"GLUCOSAMINE-CHONDROITIN 500 MG-400 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57896-0859-06","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":4.44,"gross_charge":5.47,"discounted_cash":1.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"}]}]},{"description":"GLUCOSAMINE-CHONDROITIN 500 MG-400 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"80681-0117-01","type":"NDC"}],"standard_charges":[{"minimum":11.03,"maximum":14.88,"gross_charge":18.37,"discounted_cash":5.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"GLUCOSAMINE-CHONDROITIN 500 MG-400 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"80681-0117-01","type":"NDC"}],"standard_charges":[{"minimum":2.76,"maximum":14.88,"gross_charge":18.37,"discounted_cash":5.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"GLYBURIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.74,"maximum":9.1,"gross_charge":11.23,"discounted_cash":3.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.74,"methodology":"fee schedule"}]}]},{"description":"GLYBURIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.69,"maximum":9.1,"gross_charge":11.23,"discounted_cash":3.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"}]}]},{"description":"GLYCERIN 99.5 % TOPICAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.59,"maximum":4.84,"gross_charge":5.97,"discounted_cash":1.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"}]}]},{"description":"GLYCERIN 99.5 % TOPICAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.9,"maximum":4.84,"gross_charge":5.97,"discounted_cash":1.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"}]}]},{"description":"GLYCERIN 99.5 % TOPICAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.02,"maximum":13.52,"gross_charge":16.69,"discounted_cash":4.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"}]}]},{"description":"GLYCERIN 99.5 % TOPICAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.51,"maximum":13.52,"gross_charge":16.69,"discounted_cash":4.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"}]}]},{"description":"GLYCERIN TOPICAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0104-04","type":"NDC"}],"standard_charges":[{"minimum":62.37,"maximum":84.2,"gross_charge":103.95,"discounted_cash":30.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"}]}]},{"description":"GLYCERIN TOPICAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0104-04","type":"NDC"}],"standard_charges":[{"minimum":15.6,"maximum":84.2,"gross_charge":103.95,"discounted_cash":30.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0014-01","type":"NDC"}],"standard_charges":[{"minimum":26.13,"maximum":35.27,"gross_charge":43.54,"discounted_cash":12.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.13,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0014-01","type":"NDC"}],"standard_charges":[{"minimum":6.54,"maximum":35.27,"gross_charge":43.54,"discounted_cash":12.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0063-10","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":0.33,"gross_charge":0.4,"discounted_cash":0.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0063-10","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.33,"gross_charge":0.4,"discounted_cash":0.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.02,"maximum":1.38,"gross_charge":1.7,"discounted_cash":0.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":1.38,"gross_charge":1.7,"discounted_cash":0.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN ER 600 MG TABLET EXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0572-01","type":"NDC"}],"standard_charges":[{"minimum":42.57,"maximum":57.47,"gross_charge":70.94,"discounted_cash":21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN ER 600 MG TABLET EXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0572-01","type":"NDC"}],"standard_charges":[{"minimum":10.65,"maximum":57.47,"gross_charge":70.94,"discounted_cash":21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN ER 600 MG TABLET EXTENDED RELEASE 12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":38.07,"maximum":51.39,"gross_charge":63.44,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN ER 600 MG TABLET EXTENDED RELEASE 12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.52,"maximum":51.39,"gross_charge":63.44,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN ER 600 MG TABLET EXTENDED RELEASE 12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":63.39,"maximum":85.58,"gross_charge":105.65,"discounted_cash":31.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.39,"methodology":"fee schedule"}]}]},{"description":"GUAIFENESIN ER 600 MG TABLET EXTENDED RELEASE 12 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.85,"maximum":85.58,"gross_charge":105.65,"discounted_cash":31.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.13,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0458-01","type":"NDC"}],"standard_charges":[{"minimum":30.57,"maximum":41.27,"gross_charge":50.94,"discounted_cash":15.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0458-01","type":"NDC"}],"standard_charges":[{"minimum":7.65,"maximum":41.27,"gross_charge":50.94,"discounted_cash":15.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0310-01","type":"NDC"}],"standard_charges":[{"minimum":22.11,"maximum":29.85,"gross_charge":36.84,"discounted_cash":10.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.11,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0310-01","type":"NDC"}],"standard_charges":[{"minimum":5.53,"maximum":29.85,"gross_charge":36.84,"discounted_cash":10.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0711-01","type":"NDC"}],"standard_charges":[{"minimum":27.75,"maximum":37.46,"gross_charge":46.24,"discounted_cash":13.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0711-01","type":"NDC"}],"standard_charges":[{"minimum":6.94,"maximum":37.46,"gross_charge":46.24,"discounted_cash":13.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0710-11","type":"NDC"}],"standard_charges":[{"minimum":1.19,"maximum":1.6,"gross_charge":1.97,"discounted_cash":0.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0710-11","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":1.6,"gross_charge":1.97,"discounted_cash":0.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0710-21","type":"NDC"}],"standard_charges":[{"minimum":33.23,"maximum":44.85,"gross_charge":55.37,"discounted_cash":16.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.23,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0710-21","type":"NDC"}],"standard_charges":[{"minimum":8.31,"maximum":44.85,"gross_charge":55.37,"discounted_cash":16.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0065-59","type":"NDC"}],"standard_charges":[{"minimum":1.27,"maximum":1.71,"gross_charge":2.11,"discounted_cash":0.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0065-59","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":1.71,"gross_charge":2.11,"discounted_cash":0.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0065-62","type":"NDC"}],"standard_charges":[{"minimum":35.71,"maximum":48.21,"gross_charge":59.51,"discounted_cash":17.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.71,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0065-62","type":"NDC"}],"standard_charges":[{"minimum":8.93,"maximum":48.21,"gross_charge":59.51,"discounted_cash":17.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.01,"maximum":39.17,"gross_charge":48.35,"discounted_cash":14.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.01,"methodology":"fee schedule"}]}]},{"description":"GUANFACINE 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.26,"maximum":39.17,"gross_charge":48.35,"discounted_cash":14.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"}]}]},{"description":"GUM MASTIC-STORAX-METHYLSALICYLATE-ALCOHOL DROPSDROPPERETTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":47.3,"maximum":63.85,"gross_charge":78.82,"discounted_cash":23.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"}]}]},{"description":"GUM MASTIC-STORAX-METHYLSALICYLATE-ALCOHOL DROPSDROPPERETTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.83,"maximum":63.85,"gross_charge":78.82,"discounted_cash":23.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 0.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.43,"maximum":19.48,"gross_charge":24.04,"discounted_cash":7.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 0.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.61,"maximum":19.48,"gross_charge":24.04,"discounted_cash":7.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0161-11","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":0.79,"gross_charge":0.97,"discounted_cash":0.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0161-11","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.79,"gross_charge":0.97,"discounted_cash":0.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0079-01","type":"NDC"}],"standard_charges":[{"minimum":35.01,"maximum":47.26,"gross_charge":58.34,"discounted_cash":17.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0079-01","type":"NDC"}],"standard_charges":[{"minimum":8.76,"maximum":47.26,"gross_charge":58.34,"discounted_cash":17.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.49,"maximum":60.07,"gross_charge":74.15,"discounted_cash":21.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.49,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.13,"maximum":60.07,"gross_charge":74.15,"discounted_cash":21.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"}]}]},{"description":"HONEY 100 % TOPICAL PASTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.96,"maximum":12.09,"gross_charge":14.92,"discounted_cash":4.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"}]}]},{"description":"HONEY 100 % TOPICAL PASTE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.24,"maximum":12.09,"gross_charge":14.92,"discounted_cash":4.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0822-01","type":"NDC"}],"standard_charges":[{"minimum":9.68,"maximum":13.07,"gross_charge":16.13,"discounted_cash":4.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0822-01","type":"NDC"}],"standard_charges":[{"minimum":2.42,"maximum":13.07,"gross_charge":16.13,"discounted_cash":4.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0833-11","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":0.35,"gross_charge":0.43,"discounted_cash":0.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0833-11","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.35,"gross_charge":0.43,"discounted_cash":0.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0328-10","type":"NDC"}],"standard_charges":[{"minimum":5.72,"maximum":7.72,"gross_charge":9.53,"discounted_cash":2.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0328-10","type":"NDC"}],"standard_charges":[{"minimum":1.43,"maximum":7.72,"gross_charge":9.53,"discounted_cash":2.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0404-15","type":"NDC"}],"standard_charges":[{"minimum":4.82,"maximum":6.51,"gross_charge":8.03,"discounted_cash":2.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"}]}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0404-15","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":6.51,"gross_charge":8.03,"discounted_cash":2.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"}]}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.88,"maximum":6.59,"gross_charge":8.13,"discounted_cash":2.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"}]}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.22,"maximum":6.59,"gross_charge":8.13,"discounted_cash":2.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"}]}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0593-01","type":"NDC"}],"standard_charges":[{"minimum":12.26,"maximum":16.55,"gross_charge":20.43,"discounted_cash":6.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"}]}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0593-01","type":"NDC"}],"standard_charges":[{"minimum":3.07,"maximum":16.55,"gross_charge":20.43,"discounted_cash":6.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0402-15","type":"NDC"}],"standard_charges":[{"minimum":6.89,"maximum":9.3,"gross_charge":11.48,"discounted_cash":3.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0402-15","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":9.3,"gross_charge":11.48,"discounted_cash":3.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0779-20","type":"NDC"}],"standard_charges":[{"minimum":18.51,"maximum":24.99,"gross_charge":30.84,"discounted_cash":9.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0779-20","type":"NDC"}],"standard_charges":[{"minimum":4.63,"maximum":24.99,"gross_charge":30.84,"discounted_cash":9.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0110-05","type":"NDC"}],"standard_charges":[{"minimum":60.39,"maximum":81.53,"gross_charge":100.65,"discounted_cash":29.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.39,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0110-05","type":"NDC"}],"standard_charges":[{"minimum":15.1,"maximum":81.53,"gross_charge":100.65,"discounted_cash":29.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0176-88","type":"NDC"}],"standard_charges":[{"minimum":12.14,"maximum":16.39,"gross_charge":20.23,"discounted_cash":5.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0176-88","type":"NDC"}],"standard_charges":[{"minimum":3.04,"maximum":16.39,"gross_charge":20.23,"discounted_cash":5.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0884-11","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":0.32,"gross_charge":0.39,"discounted_cash":0.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0884-11","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.32,"gross_charge":0.39,"discounted_cash":0.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8,"maximum":10.8,"gross_charge":13.33,"discounted_cash":3.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2,"maximum":10.8,"gross_charge":13.33,"discounted_cash":3.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.27,"maximum":36.81,"gross_charge":45.44,"discounted_cash":13.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.82,"maximum":36.81,"gross_charge":45.44,"discounted_cash":13.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":103.91,"maximum":140.27,"gross_charge":173.17,"discounted_cash":51.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.91,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":25.98,"maximum":140.27,"gross_charge":173.17,"discounted_cash":51.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.64,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0401-15","type":"NDC"}],"standard_charges":[{"minimum":5.21,"maximum":7.04,"gross_charge":8.68,"discounted_cash":2.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0401-15","type":"NDC"}],"standard_charges":[{"minimum":1.31,"maximum":7.04,"gross_charge":8.68,"discounted_cash":2.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0777-01","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.24,"gross_charge":0.29,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0777-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.24,"gross_charge":0.29,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0895-09","type":"NDC"}],"standard_charges":[{"minimum":18.86,"maximum":25.46,"gross_charge":31.42,"discounted_cash":9.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0895-09","type":"NDC"}],"standard_charges":[{"minimum":4.72,"maximum":25.46,"gross_charge":31.42,"discounted_cash":9.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0400-15","type":"NDC"}],"standard_charges":[{"minimum":6.35,"maximum":8.57,"gross_charge":10.58,"discounted_cash":3.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0400-15","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":8.57,"gross_charge":10.58,"discounted_cash":3.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0778-01","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":0.39,"gross_charge":0.47,"discounted_cash":0.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0778-01","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.39,"gross_charge":0.47,"discounted_cash":0.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0170-88","type":"NDC"}],"standard_charges":[{"minimum":9.74,"maximum":13.15,"gross_charge":16.23,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0170-88","type":"NDC"}],"standard_charges":[{"minimum":2.44,"maximum":13.15,"gross_charge":16.23,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0407-01","type":"NDC"}],"standard_charges":[{"minimum":21.63,"maximum":29.2,"gross_charge":36.04,"discounted_cash":10.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0407-01","type":"NDC"}],"standard_charges":[{"minimum":5.41,"maximum":29.2,"gross_charge":36.04,"discounted_cash":10.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0407-11","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":0.4,"gross_charge":0.49,"discounted_cash":0.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0407-11","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.4,"gross_charge":0.49,"discounted_cash":0.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0863-01","type":"NDC"}],"standard_charges":[{"minimum":17.97,"maximum":24.26,"gross_charge":29.94,"discounted_cash":8.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0863-01","type":"NDC"}],"standard_charges":[{"minimum":4.5,"maximum":24.26,"gross_charge":29.94,"discounted_cash":8.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.11,"maximum":25.8,"gross_charge":31.84,"discounted_cash":9.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.78,"maximum":25.8,"gross_charge":31.84,"discounted_cash":9.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.37,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0417-71","type":"NDC"}],"standard_charges":[{"minimum":1.48,"maximum":2,"gross_charge":2.46,"discounted_cash":0.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0417-71","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":2,"gross_charge":2.46,"discounted_cash":0.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64376-0640-16","type":"NDC"}],"standard_charges":[{"minimum":10.87,"maximum":14.67,"gross_charge":18.11,"discounted_cash":5.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64376-0640-16","type":"NDC"}],"standard_charges":[{"minimum":2.72,"maximum":14.67,"gross_charge":18.11,"discounted_cash":5.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0714-59","type":"NDC"}],"standard_charges":[{"minimum":1.43,"maximum":1.93,"gross_charge":2.38,"discounted_cash":0.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0714-59","type":"NDC"}],"standard_charges":[{"minimum":0.36,"maximum":1.93,"gross_charge":2.38,"discounted_cash":0.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.33,"maximum":3.15,"gross_charge":3.88,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.59,"maximum":3.15,"gross_charge":3.88,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.79,"maximum":3.77,"gross_charge":4.65,"discounted_cash":1.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.7,"maximum":3.77,"gross_charge":4.65,"discounted_cash":1.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.18,"maximum":5.64,"gross_charge":6.96,"discounted_cash":2.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"}]}]},{"description":"HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.05,"maximum":5.64,"gross_charge":6.96,"discounted_cash":2.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42543-0141-01","type":"NDC"}],"standard_charges":[{"minimum":12.2,"maximum":16.47,"gross_charge":20.33,"discounted_cash":6.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42543-0141-01","type":"NDC"}],"standard_charges":[{"minimum":3.05,"maximum":16.47,"gross_charge":20.33,"discounted_cash":6.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0414-01","type":"NDC"}],"standard_charges":[{"minimum":15.81,"maximum":21.34,"gross_charge":26.34,"discounted_cash":7.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0414-01","type":"NDC"}],"standard_charges":[{"minimum":3.96,"maximum":21.34,"gross_charge":26.34,"discounted_cash":7.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0511-01","type":"NDC"}],"standard_charges":[{"minimum":76.84,"maximum":103.73,"gross_charge":128.06,"discounted_cash":37.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.84,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0511-01","type":"NDC"}],"standard_charges":[{"minimum":19.21,"maximum":103.73,"gross_charge":128.06,"discounted_cash":37.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.62,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0971-06","type":"NDC"}],"standard_charges":[{"minimum":32.55,"maximum":43.94,"gross_charge":54.24,"discounted_cash":16.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0971-06","type":"NDC"}],"standard_charges":[{"minimum":8.14,"maximum":43.94,"gross_charge":54.24,"discounted_cash":16.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 100 MG/60 ML ENEMA","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0138-07","type":"NDC"}],"standard_charges":[{"minimum":11.85,"maximum":16,"gross_charge":19.75,"discounted_cash":5.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 100 MG/60 ML ENEMA","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0138-07","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":16,"gross_charge":19.75,"discounted_cash":5.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 100 MG/60 ML ENEMA","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-1110-07","type":"NDC"}],"standard_charges":[{"minimum":4.11,"maximum":5.55,"gross_charge":6.85,"discounted_cash":2.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 100 MG/60 ML ENEMA","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-1110-07","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":5.55,"gross_charge":6.85,"discounted_cash":2.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0004-03","type":"NDC"}],"standard_charges":[{"minimum":1.7,"maximum":2.29,"gross_charge":2.82,"discounted_cash":0.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0004-03","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":2.29,"gross_charge":2.82,"discounted_cash":0.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.65,"maximum":2.22,"gross_charge":2.74,"discounted_cash":0.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 2.5 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.42,"maximum":2.22,"gross_charge":2.74,"discounted_cash":0.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0415-01","type":"NDC"}],"standard_charges":[{"minimum":28.29,"maximum":38.19,"gross_charge":47.14,"discounted_cash":13.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.29,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0415-01","type":"NDC"}],"standard_charges":[{"minimum":7.08,"maximum":38.19,"gross_charge":47.14,"discounted_cash":13.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.03,"maximum":36.49,"gross_charge":45.04,"discounted_cash":13.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.76,"maximum":36.49,"gross_charge":45.04,"discounted_cash":13.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0970-25","type":"NDC"}],"standard_charges":[{"minimum":10.37,"maximum":14,"gross_charge":17.28,"discounted_cash":5.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0970-25","type":"NDC"}],"standard_charges":[{"minimum":2.6,"maximum":14,"gross_charge":17.28,"discounted_cash":5.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.19,"maximum":9.71,"gross_charge":11.98,"discounted_cash":3.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.8,"maximum":9.71,"gross_charge":11.98,"discounted_cash":3.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"39328-0029-12","type":"NDC"}],"standard_charges":[{"minimum":8.32,"maximum":11.23,"gross_charge":13.86,"discounted_cash":4.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.32,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"39328-0029-12","type":"NDC"}],"standard_charges":[{"minimum":2.08,"maximum":11.23,"gross_charge":13.86,"discounted_cash":4.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42494-0301-12","type":"NDC"}],"standard_charges":[{"minimum":12.16,"maximum":16.42,"gross_charge":20.26,"discounted_cash":6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42494-0301-12","type":"NDC"}],"standard_charges":[{"minimum":3.04,"maximum":16.42,"gross_charge":20.26,"discounted_cash":6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42494-0302-00","type":"NDC"}],"standard_charges":[{"minimum":14.96,"maximum":20.2,"gross_charge":24.93,"discounted_cash":7.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42494-0302-00","type":"NDC"}],"standard_charges":[{"minimum":3.74,"maximum":20.2,"gross_charge":24.93,"discounted_cash":7.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69367-0243-12","type":"NDC"}],"standard_charges":[{"minimum":83.14,"maximum":112.24,"gross_charge":138.56,"discounted_cash":41.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.14,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69367-0243-12","type":"NDC"}],"standard_charges":[{"minimum":20.79,"maximum":112.24,"gross_charge":138.56,"discounted_cash":41.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.97,"maximum":18.86,"gross_charge":23.28,"discounted_cash":6.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.5,"maximum":18.86,"gross_charge":23.28,"discounted_cash":6.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":81.94,"maximum":110.62,"gross_charge":136.56,"discounted_cash":40.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.94,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.49,"maximum":110.62,"gross_charge":136.56,"discounted_cash":40.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.32,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0472-64","type":"NDC"}],"standard_charges":[{"minimum":47.94,"maximum":64.72,"gross_charge":79.89,"discounted_cash":23.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0472-64","type":"NDC"}],"standard_charges":[{"minimum":11.99,"maximum":64.72,"gross_charge":79.89,"discounted_cash":23.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52817-0817-01","type":"NDC"}],"standard_charges":[{"minimum":42.69,"maximum":57.64,"gross_charge":71.15,"discounted_cash":21.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.69,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE-PRAMOXINE 2.5 %-1 % RECTAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52817-0817-01","type":"NDC"}],"standard_charges":[{"minimum":10.68,"maximum":57.64,"gross_charge":71.15,"discounted_cash":21.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0423-01","type":"NDC"}],"standard_charges":[{"minimum":8.6,"maximum":11.61,"gross_charge":14.33,"discounted_cash":4.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0423-01","type":"NDC"}],"standard_charges":[{"minimum":2.15,"maximum":11.61,"gross_charge":14.33,"discounted_cash":4.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0302-25","type":"NDC"}],"standard_charges":[{"minimum":10.88,"maximum":14.69,"gross_charge":18.13,"discounted_cash":5.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0302-25","type":"NDC"}],"standard_charges":[{"minimum":2.72,"maximum":14.69,"gross_charge":18.13,"discounted_cash":5.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.44,"maximum":12.75,"gross_charge":15.73,"discounted_cash":4.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.36,"maximum":12.75,"gross_charge":15.73,"discounted_cash":4.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.21,"maximum":20.53,"gross_charge":25.34,"discounted_cash":7.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.81,"maximum":20.53,"gross_charge":25.34,"discounted_cash":7.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0269-11","type":"NDC"}],"standard_charges":[{"minimum":114.23,"maximum":154.2,"gross_charge":190.37,"discounted_cash":56.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.23,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0269-11","type":"NDC"}],"standard_charges":[{"minimum":28.56,"maximum":154.2,"gross_charge":190.37,"discounted_cash":56.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":154.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":154.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":154.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0096-01","type":"NDC"}],"standard_charges":[{"minimum":41.31,"maximum":55.77,"gross_charge":68.84,"discounted_cash":20.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0096-01","type":"NDC"}],"standard_charges":[{"minimum":10.33,"maximum":55.77,"gross_charge":68.84,"discounted_cash":20.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.73,"maximum":48.23,"gross_charge":59.54,"discounted_cash":17.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.73,"methodology":"fee schedule"}]}]},{"description":"HYDROXYCHLOROQUINE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.94,"maximum":48.23,"gross_charge":59.54,"discounted_cash":17.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"}]}]},{"description":"HYDROXYUREA 500 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.55,"maximum":56.09,"gross_charge":69.24,"discounted_cash":20.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"}]}]},{"description":"HYDROXYUREA 500 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.39,"maximum":56.09,"gross_charge":69.24,"discounted_cash":20.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0253-11","type":"NDC"}],"standard_charges":[{"minimum":14.3,"maximum":19.31,"gross_charge":23.83,"discounted_cash":7.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0253-11","type":"NDC"}],"standard_charges":[{"minimum":3.58,"maximum":19.31,"gross_charge":23.83,"discounted_cash":7.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0675-11","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.22,"gross_charge":0.27,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0675-11","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.22,"gross_charge":0.27,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0254-01","type":"NDC"}],"standard_charges":[{"minimum":13.76,"maximum":18.58,"gross_charge":22.93,"discounted_cash":6.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0254-01","type":"NDC"}],"standard_charges":[{"minimum":3.44,"maximum":18.58,"gross_charge":22.93,"discounted_cash":6.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0254-11","type":"NDC"}],"standard_charges":[{"minimum":0.22,"maximum":0.3,"gross_charge":0.36,"discounted_cash":0.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0254-11","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.3,"gross_charge":0.36,"discounted_cash":0.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0707-65","type":"NDC"}],"standard_charges":[{"minimum":11.9,"maximum":16.07,"gross_charge":19.83,"discounted_cash":5.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0707-65","type":"NDC"}],"standard_charges":[{"minimum":2.98,"maximum":16.07,"gross_charge":19.83,"discounted_cash":5.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 50 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.86,"maximum":13.31,"gross_charge":16.43,"discounted_cash":4.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.86,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE PAMOATE 50 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.47,"maximum":13.31,"gross_charge":16.43,"discounted_cash":4.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43199-0011-01","type":"NDC"}],"standard_charges":[{"minimum":30.21,"maximum":40.78,"gross_charge":50.34,"discounted_cash":14.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43199-0011-01","type":"NDC"}],"standard_charges":[{"minimum":7.56,"maximum":40.78,"gross_charge":50.34,"discounted_cash":14.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0011-01","type":"NDC"}],"standard_charges":[{"minimum":25.89,"maximum":34.95,"gross_charge":43.14,"discounted_cash":12.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.89,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0011-01","type":"NDC"}],"standard_charges":[{"minimum":6.48,"maximum":34.95,"gross_charge":43.14,"discounted_cash":12.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-1031-01","type":"NDC"}],"standard_charges":[{"minimum":7.04,"maximum":9.51,"gross_charge":11.73,"discounted_cash":3.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-1031-01","type":"NDC"}],"standard_charges":[{"minimum":1.76,"maximum":9.51,"gross_charge":11.73,"discounted_cash":3.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70156-0105-01","type":"NDC"}],"standard_charges":[{"minimum":12.74,"maximum":17.2,"gross_charge":21.23,"discounted_cash":6.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70156-0105-01","type":"NDC"}],"standard_charges":[{"minimum":3.19,"maximum":17.2,"gross_charge":21.23,"discounted_cash":6.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE ER 0.375 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43199-0014-01","type":"NDC"}],"standard_charges":[{"minimum":14,"maximum":18.9,"gross_charge":23.33,"discounted_cash":6.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14,"methodology":"fee schedule"}]}]},{"description":"HYOSCYAMINE ER 0.375 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43199-0014-01","type":"NDC"}],"standard_charges":[{"minimum":3.5,"maximum":18.9,"gross_charge":23.33,"discounted_cash":6.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"}]}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0494-59","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":0.65,"gross_charge":0.8,"discounted_cash":0.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0494-59","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.65,"gross_charge":0.8,"discounted_cash":0.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"}]}]},{"description":"IBUPROFEN 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.26,"maximum":4.4,"gross_charge":5.43,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"}]}]},{"description":"IBUPROFEN 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.82,"maximum":4.4,"gross_charge":5.43,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"}]}]},{"description":"IMATINIB 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":64.62,"maximum":87.24,"gross_charge":107.7,"discounted_cash":31.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.62,"methodology":"fee schedule"}]}]},{"description":"IMATINIB 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.16,"maximum":87.24,"gross_charge":107.7,"discounted_cash":31.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"}]}]},{"description":"IMATINIB 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4399.81,"maximum":5939.74,"gross_charge":7333.01,"discounted_cash":2170.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5939.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5939.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5939.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4399.81,"methodology":"fee schedule"}]}]},{"description":"IMATINIB 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1099.96,"maximum":5939.74,"gross_charge":7333.01,"discounted_cash":2170.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5939.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5939.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5939.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4399.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1466.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1466.61,"methodology":"fee schedule"}]}]},{"description":"IMIPRAMINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0134-01","type":"NDC"}],"standard_charges":[{"minimum":12.32,"maximum":16.63,"gross_charge":20.53,"discounted_cash":6.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"}]}]},{"description":"IMIPRAMINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0134-01","type":"NDC"}],"standard_charges":[{"minimum":3.08,"maximum":16.63,"gross_charge":20.53,"discounted_cash":6.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"}]}]},{"description":"IMIPRAMINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.41,"maximum":22.15,"gross_charge":27.34,"discounted_cash":8.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"}]}]},{"description":"IMIPRAMINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.11,"maximum":22.15,"gross_charge":27.34,"discounted_cash":8.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.47,"methodology":"fee schedule"}]}]},{"description":"INDOMETHACIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0430-15","type":"NDC"}],"standard_charges":[{"minimum":6.95,"maximum":9.38,"gross_charge":11.58,"discounted_cash":3.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"}]}]},{"description":"INDOMETHACIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0430-15","type":"NDC"}],"standard_charges":[{"minimum":1.74,"maximum":9.38,"gross_charge":11.58,"discounted_cash":3.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"}]}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42211-0102-43","type":"NDC"}],"standard_charges":[{"minimum":2844.61,"maximum":3840.22,"gross_charge":4741.01,"discounted_cash":1403.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3840.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3840.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3840.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2844.61,"methodology":"fee schedule"}]}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42211-0102-43","type":"NDC"}],"standard_charges":[{"minimum":711.16,"maximum":3840.22,"gross_charge":4741.01,"discounted_cash":1403.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3840.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3840.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3840.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2844.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":711.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":948.21,"methodology":"fee schedule"}]}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69344-0102-33","type":"NDC"}],"standard_charges":[{"minimum":5684.61,"maximum":7674.22,"gross_charge":9474.34,"discounted_cash":2804.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7674.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7674.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7674.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5684.61,"methodology":"fee schedule"}]}]},{"description":"INDOMETHACIN 50 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69344-0102-33","type":"NDC"}],"standard_charges":[{"minimum":1421.16,"maximum":7674.22,"gross_charge":9474.34,"discounted_cash":2804.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7674.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7674.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7674.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5684.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1800.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1421.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1894.87,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":228.48,"maximum":308.45,"gross_charge":380.8,"discounted_cash":112.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":228.48,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":57.12,"maximum":308.45,"gross_charge":380.8,"discounted_cash":112.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":308.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":228.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.16,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":259.29,"maximum":350.05,"gross_charge":432.15,"discounted_cash":127.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":259.29,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":64.83,"maximum":350.05,"gross_charge":432.15,"discounted_cash":127.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":259.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.43,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0526-01","type":"NDC"}],"standard_charges":[{"minimum":19.82,"maximum":26.75,"gross_charge":33.02,"discounted_cash":9.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.82,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0526-01","type":"NDC"}],"standard_charges":[{"minimum":4.96,"maximum":26.75,"gross_charge":33.02,"discounted_cash":9.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0826-01","type":"NDC"}],"standard_charges":[{"minimum":20.5,"maximum":27.67,"gross_charge":34.16,"discounted_cash":10.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.5,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0826-01","type":"NDC"}],"standard_charges":[{"minimum":5.13,"maximum":27.67,"gross_charge":34.16,"discounted_cash":10.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0399-15","type":"NDC"}],"standard_charges":[{"minimum":21.24,"maximum":28.68,"gross_charge":35.4,"discounted_cash":10.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.24,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0399-15","type":"NDC"}],"standard_charges":[{"minimum":5.31,"maximum":28.68,"gross_charge":35.4,"discounted_cash":10.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.08,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0827-01","type":"NDC"}],"standard_charges":[{"minimum":16.47,"maximum":22.24,"gross_charge":27.45,"discounted_cash":8.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0827-01","type":"NDC"}],"standard_charges":[{"minimum":4.12,"maximum":22.24,"gross_charge":27.45,"discounted_cash":8.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.85,"maximum":26.8,"gross_charge":33.08,"discounted_cash":9.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.85,"methodology":"fee schedule"}]}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.97,"maximum":26.8,"gross_charge":33.08,"discounted_cash":9.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"}]}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":776,"maximum":1047.6,"gross_charge":1293.33,"discounted_cash":382.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1047.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1047.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1047.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":776,"methodology":"fee schedule"}]}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":194,"maximum":1047.6,"gross_charge":1293.33,"discounted_cash":382.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1047.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1047.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1047.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":776,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":194,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":258.67,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0569-10","type":"NDC"}],"standard_charges":[{"minimum":35.97,"maximum":48.56,"gross_charge":59.94,"discounted_cash":17.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE DINITRATE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0569-10","type":"NDC"}],"standard_charges":[{"minimum":9,"maximum":48.56,"gross_charge":59.94,"discounted_cash":17.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":42.21,"maximum":56.98,"gross_charge":70.34,"discounted_cash":20.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.21,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE DINITRATE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.56,"maximum":56.98,"gross_charge":70.34,"discounted_cash":20.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE DINITRATE ER 40 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0600-88","type":"NDC"}],"standard_charges":[{"minimum":66.27,"maximum":89.47,"gross_charge":110.45,"discounted_cash":32.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.27,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE DINITRATE ER 40 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0600-88","type":"NDC"}],"standard_charges":[{"minimum":16.57,"maximum":89.47,"gross_charge":110.45,"discounted_cash":32.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.09,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.93,"maximum":25.55,"gross_charge":31.54,"discounted_cash":9.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":25.55,"gross_charge":31.54,"discounted_cash":9.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0452-15","type":"NDC"}],"standard_charges":[{"minimum":17.52,"maximum":23.65,"gross_charge":29.19,"discounted_cash":8.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0452-15","type":"NDC"}],"standard_charges":[{"minimum":4.38,"maximum":23.65,"gross_charge":29.19,"discounted_cash":8.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.27,"maximum":32.76,"gross_charge":40.44,"discounted_cash":11.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"}]}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.07,"maximum":32.76,"gross_charge":40.44,"discounted_cash":11.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0006-31","type":"NDC"}],"standard_charges":[{"minimum":147.89,"maximum":199.65,"gross_charge":246.48,"discounted_cash":72.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":199.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":199.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":199.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.89,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0006-31","type":"NDC"}],"standard_charges":[{"minimum":36.98,"maximum":199.65,"gross_charge":246.48,"discounted_cash":72.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":199.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":199.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":199.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":147.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.3,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0295-10","type":"NDC"}],"standard_charges":[{"minimum":13.45,"maximum":18.16,"gross_charge":22.41,"discounted_cash":6.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0295-10","type":"NDC"}],"standard_charges":[{"minimum":3.37,"maximum":18.16,"gross_charge":22.41,"discounted_cash":6.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0295-15","type":"NDC"}],"standard_charges":[{"minimum":188.31,"maximum":254.22,"gross_charge":313.85,"discounted_cash":92.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.31,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0295-15","type":"NDC"}],"standard_charges":[{"minimum":47.08,"maximum":254.22,"gross_charge":313.85,"discounted_cash":92.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0743-02","type":"NDC"}],"standard_charges":[{"minimum":19.62,"maximum":26.48,"gross_charge":32.69,"discounted_cash":9.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.62,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0743-02","type":"NDC"}],"standard_charges":[{"minimum":4.91,"maximum":26.48,"gross_charge":32.69,"discounted_cash":9.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0299-95","type":"NDC"}],"standard_charges":[{"minimum":1.9,"maximum":2.56,"gross_charge":3.16,"discounted_cash":0.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"}]}]},{"description":"ITRACONAZOLE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0299-95","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":2.56,"gross_charge":3.16,"discounted_cash":0.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"}]}]},{"description":"IVABRADINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0053-60","type":"NDC"}],"standard_charges":[{"minimum":227.51,"maximum":307.13,"gross_charge":379.17,"discounted_cash":112.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.51,"methodology":"fee schedule"}]}]},{"description":"IVABRADINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0053-60","type":"NDC"}],"standard_charges":[{"minimum":56.88,"maximum":307.13,"gross_charge":379.17,"discounted_cash":112.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":307.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":307.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":307.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.84,"methodology":"fee schedule"}]}]},{"description":"IVABRADINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55513-0800-60","type":"NDC"}],"standard_charges":[{"minimum":324.15,"maximum":437.6,"gross_charge":540.24,"discounted_cash":159.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":437.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":437.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":437.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.15,"methodology":"fee schedule"}]}]},{"description":"IVABRADINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55513-0800-60","type":"NDC"}],"standard_charges":[{"minimum":81.04,"maximum":437.6,"gross_charge":540.24,"discounted_cash":159.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":437.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":437.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":437.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.05,"methodology":"fee schedule"}]}]},{"description":"IVERMECTIN 3 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0806-01","type":"NDC"}],"standard_charges":[{"minimum":42.16,"maximum":56.92,"gross_charge":70.26,"discounted_cash":20.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.16,"methodology":"fee schedule"}]}]},{"description":"IVERMECTIN 3 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42799-0806-01","type":"NDC"}],"standard_charges":[{"minimum":10.54,"maximum":56.92,"gross_charge":70.26,"discounted_cash":20.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"}]}]},{"description":"IVERMECTIN 3 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":51.18,"maximum":69.09,"gross_charge":85.29,"discounted_cash":25.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.18,"methodology":"fee schedule"}]}]},{"description":"IVERMECTIN 3 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.8,"maximum":69.09,"gross_charge":85.29,"discounted_cash":25.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 2 % SHAMPOO","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0465-64","type":"NDC"}],"standard_charges":[{"minimum":8.29,"maximum":11.19,"gross_charge":13.81,"discounted_cash":4.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 2 % SHAMPOO","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0465-64","type":"NDC"}],"standard_charges":[{"minimum":2.08,"maximum":11.19,"gross_charge":13.81,"discounted_cash":4.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 2 % SHAMPOO","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63646-0010-04","type":"NDC"}],"standard_charges":[{"minimum":8.22,"maximum":11.09,"gross_charge":13.69,"discounted_cash":4.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 2 % SHAMPOO","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63646-0010-04","type":"NDC"}],"standard_charges":[{"minimum":2.06,"maximum":11.09,"gross_charge":13.69,"discounted_cash":4.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"35573-0433-02","type":"NDC"}],"standard_charges":[{"minimum":42.33,"maximum":57.14,"gross_charge":70.54,"discounted_cash":20.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"35573-0433-02","type":"NDC"}],"standard_charges":[{"minimum":10.59,"maximum":57.14,"gross_charge":70.54,"discounted_cash":20.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0827-06","type":"NDC"}],"standard_charges":[{"minimum":47.01,"maximum":63.47,"gross_charge":78.35,"discounted_cash":23.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0827-06","type":"NDC"}],"standard_charges":[{"minimum":11.76,"maximum":63.47,"gross_charge":78.35,"discounted_cash":23.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.83,"maximum":79.43,"gross_charge":98.05,"discounted_cash":29.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"}]}]},{"description":"KETOCONAZOLE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.71,"maximum":79.43,"gross_charge":98.05,"discounted_cash":29.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.61,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0388-10","type":"NDC"}],"standard_charges":[{"minimum":64.77,"maximum":87.44,"gross_charge":107.95,"discounted_cash":31.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.77,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0388-10","type":"NDC"}],"standard_charges":[{"minimum":16.2,"maximum":87.44,"gross_charge":107.95,"discounted_cash":31.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.59,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1710-01","type":"NDC"}],"standard_charges":[{"minimum":37.41,"maximum":50.5,"gross_charge":62.34,"discounted_cash":18.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1710-01","type":"NDC"}],"standard_charges":[{"minimum":9.36,"maximum":50.5,"gross_charge":62.34,"discounted_cash":18.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.41,"maximum":78.86,"gross_charge":97.35,"discounted_cash":28.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.41,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.61,"maximum":78.86,"gross_charge":97.35,"discounted_cash":28.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0717-10","type":"NDC"}],"standard_charges":[{"minimum":4.05,"maximum":5.47,"gross_charge":6.75,"discounted_cash":2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0717-10","type":"NDC"}],"standard_charges":[{"minimum":1.02,"maximum":5.47,"gross_charge":6.75,"discounted_cash":2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":4.23,"gross_charge":5.21,"discounted_cash":1.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.79,"maximum":4.23,"gross_charge":5.21,"discounted_cash":1.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.29,"maximum":8.49,"gross_charge":10.47,"discounted_cash":3.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.49,"gross_charge":10.47,"discounted_cash":3.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.32,"maximum":8.53,"gross_charge":10.53,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.32,"methodology":"fee schedule"}]}]},{"description":"KETOTIFEN 0.025 % (0.035 %) EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.53,"gross_charge":10.53,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0122-01","type":"NDC"}],"standard_charges":[{"minimum":16.53,"maximum":22.31,"gross_charge":27.54,"discounted_cash":8.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0122-01","type":"NDC"}],"standard_charges":[{"minimum":4.14,"maximum":22.31,"gross_charge":27.54,"discounted_cash":8.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.51,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.33,"maximum":32.84,"gross_charge":40.54,"discounted_cash":12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.33,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.09,"maximum":32.84,"gross_charge":40.54,"discounted_cash":12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0799-01","type":"NDC"}],"standard_charges":[{"minimum":16.95,"maximum":22.88,"gross_charge":28.24,"discounted_cash":8.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0799-01","type":"NDC"}],"standard_charges":[{"minimum":4.24,"maximum":22.88,"gross_charge":28.24,"discounted_cash":8.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0124-01","type":"NDC"}],"standard_charges":[{"minimum":36.45,"maximum":49.2,"gross_charge":60.74,"discounted_cash":17.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0124-01","type":"NDC"}],"standard_charges":[{"minimum":9.12,"maximum":49.2,"gross_charge":60.74,"discounted_cash":17.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71247-0130-01","type":"NDC"}],"standard_charges":[{"minimum":42.63,"maximum":57.55,"gross_charge":71.04,"discounted_cash":21.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.63,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71247-0130-01","type":"NDC"}],"standard_charges":[{"minimum":10.66,"maximum":57.55,"gross_charge":71.04,"discounted_cash":21.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 300 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.85,"maximum":48.39,"gross_charge":59.74,"discounted_cash":17.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.85,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 300 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.97,"maximum":48.39,"gross_charge":59.74,"discounted_cash":17.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0627-26","type":"NDC"}],"standard_charges":[{"minimum":67.05,"maximum":90.52,"gross_charge":111.75,"discounted_cash":33.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0627-26","type":"NDC"}],"standard_charges":[{"minimum":16.77,"maximum":90.52,"gross_charge":111.75,"discounted_cash":33.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":205.92,"maximum":278,"gross_charge":343.2,"discounted_cash":101.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":205.92,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":51.48,"maximum":278,"gross_charge":343.2,"discounted_cash":101.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":205.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.64,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":251.06,"maximum":338.93,"gross_charge":418.42,"discounted_cash":123.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":338.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":338.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.06,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":62.77,"maximum":338.93,"gross_charge":418.42,"discounted_cash":123.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":338.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":338.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.69,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":411.69,"maximum":555.79,"gross_charge":686.15,"discounted_cash":203.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":555.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":555.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":555.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":411.69,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":102.93,"maximum":555.79,"gross_charge":686.15,"discounted_cash":203.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":555.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":555.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":555.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":411.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.23,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0349-06","type":"NDC"}],"standard_charges":[{"minimum":12.47,"maximum":16.83,"gross_charge":20.77,"discounted_cash":6.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0349-06","type":"NDC"}],"standard_charges":[{"minimum":3.12,"maximum":16.83,"gross_charge":20.77,"discounted_cash":6.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":606.74,"maximum":819.09,"gross_charge":1011.22,"discounted_cash":299.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":819.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":819.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":819.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":606.74,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":151.69,"maximum":819.09,"gross_charge":1011.22,"discounted_cash":299.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":819.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":819.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":819.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":606.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.25,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":667.44,"maximum":901.05,"gross_charge":1112.4,"discounted_cash":329.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":901.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":667.44,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":901.05,"gross_charge":1112.4,"discounted_cash":329.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":901.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":667.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.48,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0552-01","type":"NDC"}],"standard_charges":[{"minimum":12.25,"maximum":16.54,"gross_charge":20.41,"discounted_cash":6.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0552-01","type":"NDC"}],"standard_charges":[{"minimum":3.07,"maximum":16.54,"gross_charge":20.41,"discounted_cash":6.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0681-60","type":"NDC"}],"standard_charges":[{"minimum":8.69,"maximum":11.73,"gross_charge":14.47,"discounted_cash":4.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.69,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0681-60","type":"NDC"}],"standard_charges":[{"minimum":2.18,"maximum":11.73,"gross_charge":14.47,"discounted_cash":4.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":642.74,"maximum":867.7,"gross_charge":1071.23,"discounted_cash":317.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":867.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":867.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":642.74,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":160.69,"maximum":867.7,"gross_charge":1071.23,"discounted_cash":317.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":867.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":867.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":867.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":642.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.25,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":707.09,"maximum":954.57,"gross_charge":1178.48,"discounted_cash":348.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":954.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":954.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":954.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":707.09,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":176.78,"maximum":954.57,"gross_charge":1178.48,"discounted_cash":348.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":954.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":954.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":954.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":707.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.7,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":426.95,"maximum":576.38,"gross_charge":711.58,"discounted_cash":210.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":576.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":576.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":576.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":426.95,"methodology":"fee schedule"}]}]},{"description":"LACOSAMIDE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":106.74,"maximum":576.38,"gross_charge":711.58,"discounted_cash":210.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":576.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":576.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":576.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":426.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.32,"methodology":"fee schedule"}]}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0795-16","type":"NDC"}],"standard_charges":[{"minimum":4.62,"maximum":6.24,"gross_charge":7.7,"discounted_cash":2.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"}]}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0795-16","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":6.24,"gross_charge":7.7,"discounted_cash":2.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"}]}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.49,"maximum":4.71,"gross_charge":5.81,"discounted_cash":1.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"}]}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":4.71,"gross_charge":5.81,"discounted_cash":1.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54838-0566-25","type":"NDC"}],"standard_charges":[{"minimum":0.54,"maximum":0.73,"gross_charge":0.9,"discounted_cash":0.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54838-0566-25","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":0.73,"gross_charge":0.9,"discounted_cash":0.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54838-0566-70","type":"NDC"}],"standard_charges":[{"minimum":30.47,"maximum":41.14,"gross_charge":50.78,"discounted_cash":15.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.47,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54838-0566-70","type":"NDC"}],"standard_charges":[{"minimum":7.62,"maximum":41.14,"gross_charge":50.78,"discounted_cash":15.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0752-60","type":"NDC"}],"standard_charges":[{"minimum":105.01,"maximum":141.76,"gross_charge":175.01,"discounted_cash":51.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.01,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0752-60","type":"NDC"}],"standard_charges":[{"minimum":26.26,"maximum":141.76,"gross_charge":175.01,"discounted_cash":51.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-3250-06","type":"NDC"}],"standard_charges":[{"minimum":269.42,"maximum":363.71,"gross_charge":449.02,"discounted_cash":132.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":363.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.42,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-3250-06","type":"NDC"}],"standard_charges":[{"minimum":67.36,"maximum":363.71,"gross_charge":449.02,"discounted_cash":132.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":363.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.81,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0362-11","type":"NDC"}],"standard_charges":[{"minimum":2.72,"maximum":3.67,"gross_charge":4.52,"discounted_cash":1.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0362-11","type":"NDC"}],"standard_charges":[{"minimum":0.68,"maximum":3.67,"gross_charge":4.52,"discounted_cash":1.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0362-21","type":"NDC"}],"standard_charges":[{"minimum":79.17,"maximum":106.88,"gross_charge":131.95,"discounted_cash":39.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.17,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0362-21","type":"NDC"}],"standard_charges":[{"minimum":19.8,"maximum":106.88,"gross_charge":131.95,"discounted_cash":39.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.39,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0710-03","type":"NDC"}],"standard_charges":[{"minimum":23.74,"maximum":32.05,"gross_charge":39.56,"discounted_cash":11.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.74,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0710-03","type":"NDC"}],"standard_charges":[{"minimum":5.94,"maximum":32.05,"gross_charge":39.56,"discounted_cash":11.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0578-11","type":"NDC"}],"standard_charges":[{"minimum":93.21,"maximum":125.84,"gross_charge":155.35,"discounted_cash":45.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.21,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0578-11","type":"NDC"}],"standard_charges":[{"minimum":23.31,"maximum":125.84,"gross_charge":155.35,"discounted_cash":45.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.07,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0602-07","type":"NDC"}],"standard_charges":[{"minimum":188.87,"maximum":254.98,"gross_charge":314.78,"discounted_cash":93.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.87,"methodology":"fee schedule"}]}]},{"description":"LAMIVUDINE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0602-07","type":"NDC"}],"standard_charges":[{"minimum":47.22,"maximum":254.98,"gross_charge":314.78,"discounted_cash":93.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.96,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0319-01","type":"NDC"}],"standard_charges":[{"minimum":10.1,"maximum":13.64,"gross_charge":16.83,"discounted_cash":4.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0319-01","type":"NDC"}],"standard_charges":[{"minimum":2.53,"maximum":13.64,"gross_charge":16.83,"discounted_cash":4.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4130-01","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":2.05,"gross_charge":2.53,"discounted_cash":0.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"LAMOTRIGINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4130-01","type":"NDC"}],"standard_charges":[{"minimum":0.38,"maximum":2.05,"gross_charge":2.53,"discounted_cash":0.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0422-47","type":"NDC"}],"standard_charges":[{"minimum":193.01,"maximum":260.57,"gross_charge":321.68,"discounted_cash":95.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.01,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0422-47","type":"NDC"}],"standard_charges":[{"minimum":48.26,"maximum":260.57,"gross_charge":321.68,"discounted_cash":95.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":193.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.34,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0422-85","type":"NDC"}],"standard_charges":[{"minimum":385.94,"maximum":521.02,"gross_charge":643.23,"discounted_cash":190.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":385.94,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0422-85","type":"NDC"}],"standard_charges":[{"minimum":96.49,"maximum":521.02,"gross_charge":643.23,"discounted_cash":190.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":385.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.65,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0819-42","type":"NDC"}],"standard_charges":[{"minimum":373.62,"maximum":504.39,"gross_charge":622.7,"discounted_cash":184.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.62,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0819-42","type":"NDC"}],"standard_charges":[{"minimum":93.41,"maximum":504.39,"gross_charge":622.7,"discounted_cash":184.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.54,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0819-52","type":"NDC"}],"standard_charges":[{"minimum":146.4,"maximum":197.64,"gross_charge":243.99,"discounted_cash":72.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0819-52","type":"NDC"}],"standard_charges":[{"minimum":36.6,"maximum":197.64,"gross_charge":243.99,"discounted_cash":72.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0934-57","type":"NDC"}],"standard_charges":[{"minimum":137.35,"maximum":185.42,"gross_charge":228.91,"discounted_cash":67.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":185.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":185.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":185.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0934-57","type":"NDC"}],"standard_charges":[{"minimum":34.34,"maximum":185.42,"gross_charge":228.91,"discounted_cash":67.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":185.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":185.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":185.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":137.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.79,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0934-98","type":"NDC"}],"standard_charges":[{"minimum":274.62,"maximum":370.74,"gross_charge":457.7,"discounted_cash":135.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.62,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0934-98","type":"NDC"}],"standard_charges":[{"minimum":68.66,"maximum":370.74,"gross_charge":457.7,"discounted_cash":135.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.54,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0476-45","type":"NDC"}],"standard_charges":[{"minimum":81.72,"maximum":110.32,"gross_charge":136.19,"discounted_cash":40.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.72,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0476-45","type":"NDC"}],"standard_charges":[{"minimum":20.43,"maximum":110.32,"gross_charge":136.19,"discounted_cash":40.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0476-90","type":"NDC"}],"standard_charges":[{"minimum":163.36,"maximum":220.54,"gross_charge":272.26,"discounted_cash":80.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.36,"methodology":"fee schedule"}]}]},{"description":"LANTHANUM 500 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0476-90","type":"NDC"}],"standard_charges":[{"minimum":40.84,"maximum":220.54,"gross_charge":272.26,"discounted_cash":80.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"}]}]},{"description":"LAPATINIB 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5013.14,"maximum":6767.74,"gross_charge":8355.23,"discounted_cash":2473.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6767.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6767.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6767.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5013.14,"methodology":"fee schedule"}]}]},{"description":"LAPATINIB 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1253.29,"maximum":6767.74,"gross_charge":8355.23,"discounted_cash":2473.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6767.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6767.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6767.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5013.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1587.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1671.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1253.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1671.05,"methodology":"fee schedule"}]}]},{"description":"LEDIPASVIR 90 MG-SOFOSBUVIR 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1801-01","type":"NDC"}],"standard_charges":[{"minimum":132255.81,"maximum":178545.35,"gross_charge":220426.35,"discounted_cash":65246.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178545.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":178545.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":178545.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":132255.81,"methodology":"fee schedule"}]}]},{"description":"LEDIPASVIR 90 MG-SOFOSBUVIR 400 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1801-01","type":"NDC"}],"standard_charges":[{"minimum":33063.96,"maximum":178545.35,"gross_charge":220426.35,"discounted_cash":65246.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":178545.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":178545.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":178545.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":132255.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41881.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44085.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33063.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44085.27,"methodology":"fee schedule"}]}]},{"description":"LEFLUNOMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0477-11","type":"NDC"}],"standard_charges":[{"minimum":0.99,"maximum":1.33,"gross_charge":1.64,"discounted_cash":0.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"}]}]},{"description":"LEFLUNOMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0477-11","type":"NDC"}],"standard_charges":[{"minimum":0.25,"maximum":1.33,"gross_charge":1.64,"discounted_cash":0.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"LEFLUNOMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0477-15","type":"NDC"}],"standard_charges":[{"minimum":45.27,"maximum":61.12,"gross_charge":75.45,"discounted_cash":22.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"}]}]},{"description":"LEFLUNOMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0477-15","type":"NDC"}],"standard_charges":[{"minimum":11.32,"maximum":61.12,"gross_charge":75.45,"discounted_cash":22.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"}]}]},{"description":"LETROZOLE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0476-15","type":"NDC"}],"standard_charges":[{"minimum":10.22,"maximum":13.8,"gross_charge":17.03,"discounted_cash":5.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"}]}]},{"description":"LETROZOLE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0476-15","type":"NDC"}],"standard_charges":[{"minimum":2.56,"maximum":13.8,"gross_charge":17.03,"discounted_cash":5.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":38.49,"maximum":51.96,"gross_charge":64.14,"discounted_cash":18.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.63,"maximum":51.96,"gross_charge":64.14,"discounted_cash":18.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.29,"maximum":78.7,"gross_charge":97.15,"discounted_cash":28.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.58,"maximum":78.7,"gross_charge":97.15,"discounted_cash":28.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"}]}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"35573-0444-25","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":0.75,"gross_charge":0.92,"discounted_cash":0.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"35573-0444-25","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":0.75,"gross_charge":0.92,"discounted_cash":0.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76204-0800-01","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":1.36,"gross_charge":1.67,"discounted_cash":0.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"}]}]},{"description":"LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76204-0800-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":1.36,"gross_charge":1.67,"discounted_cash":0.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0574-47","type":"NDC"}],"standard_charges":[{"minimum":8.88,"maximum":11.99,"gross_charge":14.8,"discounted_cash":4.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0574-47","type":"NDC"}],"standard_charges":[{"minimum":2.22,"maximum":11.99,"gross_charge":14.8,"discounted_cash":4.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50474-0001-05","type":"NDC"}],"standard_charges":[{"minimum":4.25,"maximum":5.74,"gross_charge":7.08,"discounted_cash":2.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50474-0001-05","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":5.74,"gross_charge":7.08,"discounted_cash":2.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0035-01","type":"NDC"}],"standard_charges":[{"minimum":6.06,"maximum":8.18,"gross_charge":10.09,"discounted_cash":2.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0035-01","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":8.18,"gross_charge":10.09,"discounted_cash":2.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0246-08","type":"NDC"}],"standard_charges":[{"minimum":17.51,"maximum":23.64,"gross_charge":29.18,"discounted_cash":8.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0246-08","type":"NDC"}],"standard_charges":[{"minimum":4.38,"maximum":23.64,"gross_charge":29.18,"discounted_cash":8.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.84,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69102-0104-01","type":"NDC"}],"standard_charges":[{"minimum":8.43,"maximum":11.39,"gross_charge":14.05,"discounted_cash":4.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69102-0104-01","type":"NDC"}],"standard_charges":[{"minimum":2.11,"maximum":11.39,"gross_charge":14.05,"discounted_cash":4.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0019-70","type":"NDC"}],"standard_charges":[{"minimum":1.35,"maximum":1.82,"gross_charge":2.24,"discounted_cash":0.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0019-70","type":"NDC"}],"standard_charges":[{"minimum":0.34,"maximum":1.82,"gross_charge":2.24,"discounted_cash":0.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0158-32","type":"NDC"}],"standard_charges":[{"minimum":1.41,"maximum":1.91,"gross_charge":2.35,"discounted_cash":0.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0158-32","type":"NDC"}],"standard_charges":[{"minimum":0.36,"maximum":1.91,"gross_charge":2.35,"discounted_cash":0.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0157-17","type":"NDC"}],"standard_charges":[{"minimum":1.71,"maximum":2.31,"gross_charge":2.84,"discounted_cash":0.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0157-17","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":2.31,"gross_charge":2.84,"discounted_cash":0.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.44,"maximum":1.94,"gross_charge":2.39,"discounted_cash":0.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.36,"maximum":1.94,"gross_charge":2.39,"discounted_cash":0.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0482-11","type":"NDC"}],"standard_charges":[{"minimum":11.54,"maximum":15.58,"gross_charge":19.23,"discounted_cash":5.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0482-11","type":"NDC"}],"standard_charges":[{"minimum":2.89,"maximum":15.58,"gross_charge":19.23,"discounted_cash":5.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0483-01","type":"NDC"}],"standard_charges":[{"minimum":19.53,"maximum":26.36,"gross_charge":32.54,"discounted_cash":9.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0483-01","type":"NDC"}],"standard_charges":[{"minimum":4.89,"maximum":26.36,"gross_charge":32.54,"discounted_cash":9.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"}]}]},{"description":"LEVONORGESTREL 1.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0809-01","type":"NDC"}],"standard_charges":[{"minimum":4.25,"maximum":5.73,"gross_charge":7.07,"discounted_cash":2.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"}]}]},{"description":"LEVONORGESTREL 1.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0809-01","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":5.73,"gross_charge":7.07,"discounted_cash":2.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"LEVONORGESTREL 1.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.72,"maximum":5.03,"gross_charge":6.2,"discounted_cash":1.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"}]}]},{"description":"LEVONORGESTREL 1.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.93,"maximum":5.03,"gross_charge":6.2,"discounted_cash":1.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0451-15","type":"NDC"}],"standard_charges":[{"minimum":5.7,"maximum":7.69,"gross_charge":9.49,"discounted_cash":2.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0451-15","type":"NDC"}],"standard_charges":[{"minimum":1.43,"maximum":7.69,"gross_charge":9.49,"discounted_cash":2.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0442-01","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":0.56,"gross_charge":0.68,"discounted_cash":0.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0442-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":0.56,"gross_charge":0.68,"discounted_cash":0.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0497-11","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":0.43,"gross_charge":0.52,"discounted_cash":0.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0497-11","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.43,"gross_charge":0.52,"discounted_cash":0.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.15,"maximum":36.65,"gross_charge":45.24,"discounted_cash":13.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.15,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.79,"maximum":36.65,"gross_charge":45.24,"discounted_cash":13.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0039-20","type":"NDC"}],"standard_charges":[{"minimum":34.89,"maximum":47.1,"gross_charge":58.14,"discounted_cash":17.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.89,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0039-20","type":"NDC"}],"standard_charges":[{"minimum":8.73,"maximum":47.1,"gross_charge":58.14,"discounted_cash":17.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1835-01","type":"NDC"}],"standard_charges":[{"minimum":19.23,"maximum":25.96,"gross_charge":32.04,"discounted_cash":9.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1835-01","type":"NDC"}],"standard_charges":[{"minimum":4.81,"maximum":25.96,"gross_charge":32.04,"discounted_cash":9.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.41,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.24,"maximum":8.42,"gross_charge":10.39,"discounted_cash":3.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.24,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.56,"maximum":8.42,"gross_charge":10.39,"discounted_cash":3.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.3,"maximum":36.86,"gross_charge":45.5,"discounted_cash":13.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 112 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.83,"maximum":36.86,"gross_charge":45.5,"discounted_cash":13.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 125 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.19,"maximum":39.4,"gross_charge":48.64,"discounted_cash":14.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.19,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 125 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.3,"maximum":39.4,"gross_charge":48.64,"discounted_cash":14.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 125 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.85,"maximum":40.29,"gross_charge":49.74,"discounted_cash":14.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 125 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.47,"maximum":40.29,"gross_charge":49.74,"discounted_cash":14.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 150 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.69,"maximum":41.43,"gross_charge":51.14,"discounted_cash":15.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.69,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 150 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.68,"maximum":41.43,"gross_charge":51.14,"discounted_cash":15.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 25 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0640-90","type":"NDC"}],"standard_charges":[{"minimum":4.89,"maximum":6.6,"gross_charge":8.14,"discounted_cash":2.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 25 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0640-90","type":"NDC"}],"standard_charges":[{"minimum":1.23,"maximum":6.6,"gross_charge":8.14,"discounted_cash":2.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 25 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.81,"maximum":25.39,"gross_charge":31.34,"discounted_cash":9.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.81,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 25 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.71,"maximum":25.39,"gross_charge":31.34,"discounted_cash":9.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.27,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 50 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.17,"maximum":29.93,"gross_charge":36.94,"discounted_cash":10.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 50 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.55,"maximum":29.93,"gross_charge":36.94,"discounted_cash":10.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0441-20","type":"NDC"}],"standard_charges":[{"minimum":32.61,"maximum":44.02,"gross_charge":54.34,"discounted_cash":16.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.61,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0441-20","type":"NDC"}],"standard_charges":[{"minimum":8.16,"maximum":44.02,"gross_charge":54.34,"discounted_cash":16.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0475-01","type":"NDC"}],"standard_charges":[{"minimum":29.31,"maximum":39.57,"gross_charge":48.84,"discounted_cash":14.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.31,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0475-01","type":"NDC"}],"standard_charges":[{"minimum":7.33,"maximum":39.57,"gross_charge":48.84,"discounted_cash":14.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.32,"maximum":7.18,"gross_charge":8.86,"discounted_cash":2.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.33,"maximum":7.18,"gross_charge":8.86,"discounted_cash":2.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.51,"maximum":37.14,"gross_charge":45.84,"discounted_cash":13.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.51,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 75 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.88,"maximum":37.14,"gross_charge":45.84,"discounted_cash":13.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 88 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0038-20","type":"NDC"}],"standard_charges":[{"minimum":29.97,"maximum":40.46,"gross_charge":49.94,"discounted_cash":14.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 88 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0038-20","type":"NDC"}],"standard_charges":[{"minimum":7.5,"maximum":40.46,"gross_charge":49.94,"discounted_cash":14.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE (LET) GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70092-1611-44","type":"NDC"}],"standard_charges":[{"minimum":7.62,"maximum":10.28,"gross_charge":12.69,"discounted_cash":3.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE (LET) GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70092-1611-44","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":10.28,"gross_charge":12.69,"discounted_cash":3.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"}]}]},{"description":"LINACLOTIDE 145 MCG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":296.96,"maximum":400.9,"gross_charge":494.93,"discounted_cash":146.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":296.96,"methodology":"fee schedule"}]}]},{"description":"LINACLOTIDE 145 MCG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":74.24,"maximum":400.9,"gross_charge":494.93,"discounted_cash":146.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":400.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":400.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":400.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":296.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.99,"methodology":"fee schedule"}]}]},{"description":"LINDANE 1 % SHAMPOO","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60432-0834-60","type":"NDC"}],"standard_charges":[{"minimum":60.21,"maximum":81.29,"gross_charge":100.35,"discounted_cash":29.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.21,"methodology":"fee schedule"}]}]},{"description":"LINDANE 1 % SHAMPOO","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60432-0834-60","type":"NDC"}],"standard_charges":[{"minimum":15.06,"maximum":81.29,"gross_charge":100.35,"discounted_cash":29.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.07,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1308-01","type":"NDC"}],"standard_charges":[{"minimum":268.97,"maximum":363.1,"gross_charge":448.27,"discounted_cash":132.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":363.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.97,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1308-01","type":"NDC"}],"standard_charges":[{"minimum":67.25,"maximum":363.1,"gross_charge":448.27,"discounted_cash":132.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":363.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.66,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1308-05","type":"NDC"}],"standard_charges":[{"minimum":6.88,"maximum":9.29,"gross_charge":11.46,"discounted_cash":3.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1308-05","type":"NDC"}],"standard_charges":[{"minimum":1.72,"maximum":9.29,"gross_charge":11.46,"discounted_cash":3.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0189-11","type":"NDC"}],"standard_charges":[{"minimum":2.02,"maximum":2.73,"gross_charge":3.36,"discounted_cash":1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0189-11","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":2.73,"gross_charge":3.36,"discounted_cash":1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0309-21","type":"NDC"}],"standard_charges":[{"minimum":31.1,"maximum":41.99,"gross_charge":51.83,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0309-21","type":"NDC"}],"standard_charges":[{"minimum":7.78,"maximum":41.99,"gross_charge":51.83,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0419-84","type":"NDC"}],"standard_charges":[{"minimum":32.11,"maximum":43.35,"gross_charge":53.51,"discounted_cash":15.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID 600 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0419-84","type":"NDC"}],"standard_charges":[{"minimum":8.03,"maximum":43.35,"gross_charge":53.51,"discounted_cash":15.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0166-01","type":"NDC"}],"standard_charges":[{"minimum":33.15,"maximum":44.75,"gross_charge":55.24,"discounted_cash":16.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0166-01","type":"NDC"}],"standard_charges":[{"minimum":8.29,"maximum":44.75,"gross_charge":55.24,"discounted_cash":16.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0417-90","type":"NDC"}],"standard_charges":[{"minimum":11.1,"maximum":14.98,"gross_charge":18.49,"discounted_cash":5.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0417-90","type":"NDC"}],"standard_charges":[{"minimum":2.78,"maximum":14.98,"gross_charge":18.49,"discounted_cash":5.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0018-02","type":"NDC"}],"standard_charges":[{"minimum":26.55,"maximum":35.84,"gross_charge":44.24,"discounted_cash":13.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.55,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0018-02","type":"NDC"}],"standard_charges":[{"minimum":6.64,"maximum":35.84,"gross_charge":44.24,"discounted_cash":13.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0018-12","type":"NDC"}],"standard_charges":[{"minimum":33.68,"maximum":45.46,"gross_charge":56.12,"discounted_cash":16.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.68,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42794-0018-12","type":"NDC"}],"standard_charges":[{"minimum":8.42,"maximum":45.46,"gross_charge":56.12,"discounted_cash":16.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1206-01","type":"NDC"}],"standard_charges":[{"minimum":36.63,"maximum":49.45,"gross_charge":61.04,"discounted_cash":18.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"}]}]},{"description":"LIOTHYRONINE 5 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1206-01","type":"NDC"}],"standard_charges":[{"minimum":9.16,"maximum":49.45,"gross_charge":61.04,"discounted_cash":18.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"}]}]},{"description":"LIPASE-PROTEASE-AMYLASE 24000-76000-120000 UNIT CAPSULEDELAYED REL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":452.16,"maximum":610.41,"gross_charge":753.59,"discounted_cash":223.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.16,"methodology":"fee schedule"}]}]},{"description":"LIPASE-PROTEASE-AMYLASE 24000-76000-120000 UNIT CAPSULEDELAYED REL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":113.04,"maximum":610.41,"gross_charge":753.59,"discounted_cash":223.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.72,"methodology":"fee schedule"}]}]},{"description":"LIPASE-PROTEASE-AMYLASE 5000-17000-24000 UNIT CAPSULE DELAYED REL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"73562-0115-01","type":"NDC"}],"standard_charges":[{"minimum":113.57,"maximum":153.31,"gross_charge":189.27,"discounted_cash":56.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"}]}]},{"description":"LIPASE-PROTEASE-AMYLASE 5000-17000-24000 UNIT CAPSULE DELAYED REL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"73562-0115-01","type":"NDC"}],"standard_charges":[{"minimum":28.4,"maximum":153.31,"gross_charge":189.27,"discounted_cash":56.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"}]}]},{"description":"LIPASE-PROTEASE-AMYLASE 5000-17000-24000 UNIT CAPSULE DELAYED REL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":101.39,"maximum":136.87,"gross_charge":168.97,"discounted_cash":50.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.39,"methodology":"fee schedule"}]}]},{"description":"LIPASE-PROTEASE-AMYLASE 5000-17000-24000 UNIT CAPSULE DELAYED REL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":25.35,"maximum":136.87,"gross_charge":168.97,"discounted_cash":50.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"}]}]},{"description":"LISINOPRIL 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0656-21","type":"NDC"}],"standard_charges":[{"minimum":9.12,"maximum":12.31,"gross_charge":15.19,"discounted_cash":4.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"}]}]},{"description":"LISINOPRIL 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0656-21","type":"NDC"}],"standard_charges":[{"minimum":2.28,"maximum":12.31,"gross_charge":15.19,"discounted_cash":4.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"}]}]},{"description":"LISINOPRIL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0335-00","type":"NDC"}],"standard_charges":[{"minimum":1.76,"maximum":2.38,"gross_charge":2.93,"discounted_cash":0.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"}]}]},{"description":"LISINOPRIL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0335-00","type":"NDC"}],"standard_charges":[{"minimum":0.44,"maximum":2.38,"gross_charge":2.93,"discounted_cash":0.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"LISINOPRIL 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.98,"maximum":5.38,"gross_charge":6.63,"discounted_cash":1.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"}]}]},{"description":"LISINOPRIL 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1,"maximum":5.38,"gross_charge":6.63,"discounted_cash":1.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"}]}]},{"description":"LOPINAVIR-RITONAVIR 100 MG-25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":149.12,"maximum":201.31,"gross_charge":248.52,"discounted_cash":73.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.12,"methodology":"fee schedule"}]}]},{"description":"LOPINAVIR-RITONAVIR 100 MG-25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":37.28,"maximum":201.31,"gross_charge":248.52,"discounted_cash":73.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"}]}]},{"description":"LOPINAVIR-RITONAVIR 200 MG-50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":596.3,"maximum":805,"gross_charge":993.82,"discounted_cash":294.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":596.3,"methodology":"fee schedule"}]}]},{"description":"LOPINAVIR-RITONAVIR 200 MG-50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":149.08,"maximum":805,"gross_charge":993.82,"discounted_cash":294.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":805,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":596.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.77,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0246-01","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.23,"gross_charge":0.28,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0246-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.23,"gross_charge":0.28,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58602-0702-04","type":"NDC"}],"standard_charges":[{"minimum":11.96,"maximum":16.15,"gross_charge":19.93,"discounted_cash":5.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58602-0702-04","type":"NDC"}],"standard_charges":[{"minimum":2.99,"maximum":16.15,"gross_charge":19.93,"discounted_cash":5.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58602-0702-83","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":0.69,"gross_charge":0.84,"discounted_cash":0.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58602-0702-83","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.69,"gross_charge":0.84,"discounted_cash":0.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0248-01","type":"NDC"}],"standard_charges":[{"minimum":10.28,"maximum":13.88,"gross_charge":17.13,"discounted_cash":5.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0248-01","type":"NDC"}],"standard_charges":[{"minimum":2.57,"maximum":13.88,"gross_charge":17.13,"discounted_cash":5.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.05,"maximum":4.12,"gross_charge":5.08,"discounted_cash":1.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"LORATADINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.77,"maximum":4.12,"gross_charge":5.08,"discounted_cash":1.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0736-01","type":"NDC"}],"standard_charges":[{"minimum":9.02,"maximum":12.18,"gross_charge":15.03,"discounted_cash":4.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0736-01","type":"NDC"}],"standard_charges":[{"minimum":2.26,"maximum":12.18,"gross_charge":15.03,"discounted_cash":4.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 0.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.72,"maximum":3.67,"gross_charge":4.53,"discounted_cash":1.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 0.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.68,"maximum":3.67,"gross_charge":4.53,"discounted_cash":1.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5,"maximum":6.75,"gross_charge":8.33,"discounted_cash":2.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":6.75,"gross_charge":8.33,"discounted_cash":2.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0424-09","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":6.38,"gross_charge":7.87,"discounted_cash":2.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0424-09","type":"NDC"}],"standard_charges":[{"minimum":1.19,"maximum":6.38,"gross_charge":7.87,"discounted_cash":2.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0515-11","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":0.37,"gross_charge":0.45,"discounted_cash":0.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0515-11","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.37,"gross_charge":0.45,"discounted_cash":0.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0339-90","type":"NDC"}],"standard_charges":[{"minimum":12.61,"maximum":17.02,"gross_charge":21.01,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.61,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0339-90","type":"NDC"}],"standard_charges":[{"minimum":3.16,"maximum":17.02,"gross_charge":21.01,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0470-30","type":"NDC"}],"standard_charges":[{"minimum":2.01,"maximum":2.71,"gross_charge":3.34,"discounted_cash":0.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0470-30","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":2.71,"gross_charge":3.34,"discounted_cash":0.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0470-90","type":"NDC"}],"standard_charges":[{"minimum":7.91,"maximum":10.68,"gross_charge":13.18,"discounted_cash":3.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0470-90","type":"NDC"}],"standard_charges":[{"minimum":1.98,"maximum":10.68,"gross_charge":13.18,"discounted_cash":3.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.81,"maximum":7.84,"gross_charge":9.67,"discounted_cash":2.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 100 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.46,"maximum":7.84,"gross_charge":9.67,"discounted_cash":2.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0700-90","type":"NDC"}],"standard_charges":[{"minimum":4.19,"maximum":5.65,"gross_charge":6.97,"discounted_cash":2.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0700-90","type":"NDC"}],"standard_charges":[{"minimum":1.05,"maximum":5.65,"gross_charge":6.97,"discounted_cash":2.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0027-90","type":"NDC"}],"standard_charges":[{"minimum":20.61,"maximum":27.82,"gross_charge":34.34,"discounted_cash":10.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0027-90","type":"NDC"}],"standard_charges":[{"minimum":5.16,"maximum":27.82,"gross_charge":34.34,"discounted_cash":10.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0201-90","type":"NDC"}],"standard_charges":[{"minimum":4.29,"maximum":5.8,"gross_charge":7.15,"discounted_cash":2.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0201-90","type":"NDC"}],"standard_charges":[{"minimum":1.08,"maximum":5.8,"gross_charge":7.15,"discounted_cash":2.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.47,"maximum":22.23,"gross_charge":27.44,"discounted_cash":8.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.12,"maximum":22.23,"gross_charge":27.44,"discounted_cash":8.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0409-10","type":"NDC"}],"standard_charges":[{"minimum":21.69,"maximum":29.28,"gross_charge":36.14,"discounted_cash":10.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0409-10","type":"NDC"}],"standard_charges":[{"minimum":5.43,"maximum":29.28,"gross_charge":36.14,"discounted_cash":10.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0505-11","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":0.28,"gross_charge":0.34,"discounted_cash":0.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0505-11","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.28,"gross_charge":0.34,"discounted_cash":0.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0686-10","type":"NDC"}],"standard_charges":[{"minimum":16.35,"maximum":22.07,"gross_charge":27.24,"discounted_cash":8.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0686-10","type":"NDC"}],"standard_charges":[{"minimum":4.09,"maximum":22.07,"gross_charge":27.24,"discounted_cash":8.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0347-01","type":"NDC"}],"standard_charges":[{"minimum":35.49,"maximum":47.91,"gross_charge":59.14,"discounted_cash":17.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.49,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0347-01","type":"NDC"}],"standard_charges":[{"minimum":8.88,"maximum":47.91,"gross_charge":59.14,"discounted_cash":17.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0377-03","type":"NDC"}],"standard_charges":[{"minimum":25.29,"maximum":34.14,"gross_charge":42.14,"discounted_cash":12.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0377-03","type":"NDC"}],"standard_charges":[{"minimum":6.33,"maximum":34.14,"gross_charge":42.14,"discounted_cash":12.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0337-90","type":"NDC"}],"standard_charges":[{"minimum":11.37,"maximum":15.35,"gross_charge":18.94,"discounted_cash":5.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0337-90","type":"NDC"}],"standard_charges":[{"minimum":2.85,"maximum":15.35,"gross_charge":18.94,"discounted_cash":5.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.16,"maximum":1.57,"gross_charge":1.93,"discounted_cash":0.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":1.57,"gross_charge":1.93,"discounted_cash":0.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.97,"maximum":5.36,"gross_charge":6.61,"discounted_cash":1.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"}]}]},{"description":"LOSARTAN 50 MG-HYDROCHLOROTHIAZIDE 12.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1,"maximum":5.36,"gross_charge":6.61,"discounted_cash":1.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0299-05","type":"NDC"}],"standard_charges":[{"minimum":174.76,"maximum":235.93,"gross_charge":291.26,"discounted_cash":86.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.76,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0299-05","type":"NDC"}],"standard_charges":[{"minimum":43.69,"maximum":235.93,"gross_charge":291.26,"discounted_cash":86.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.26,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0265-05","type":"NDC"}],"standard_charges":[{"minimum":80.29,"maximum":108.39,"gross_charge":133.81,"discounted_cash":39.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.29,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50383-0265-05","type":"NDC"}],"standard_charges":[{"minimum":20.08,"maximum":108.39,"gross_charge":133.81,"discounted_cash":39.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0232-90","type":"NDC"}],"standard_charges":[{"minimum":74.33,"maximum":100.34,"gross_charge":123.87,"discounted_cash":36.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.33,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0232-90","type":"NDC"}],"standard_charges":[{"minimum":18.59,"maximum":100.34,"gross_charge":123.87,"discounted_cash":36.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.78,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0299-05","type":"NDC"}],"standard_charges":[{"minimum":112.88,"maximum":152.38,"gross_charge":188.12,"discounted_cash":55.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.88,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0299-05","type":"NDC"}],"standard_charges":[{"minimum":28.22,"maximum":152.38,"gross_charge":188.12,"discounted_cash":55.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72485-0665-05","type":"NDC"}],"standard_charges":[{"minimum":9.47,"maximum":12.78,"gross_charge":15.77,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"}]}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72485-0665-05","type":"NDC"}],"standard_charges":[{"minimum":2.37,"maximum":12.78,"gross_charge":15.77,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"LUBIPROSTONE 24 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64764-0240-60","type":"NDC"}],"standard_charges":[{"minimum":201.87,"maximum":272.52,"gross_charge":336.44,"discounted_cash":99.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.87,"methodology":"fee schedule"}]}]},{"description":"LUBIPROSTONE 24 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64764-0240-60","type":"NDC"}],"standard_charges":[{"minimum":50.47,"maximum":272.52,"gross_charge":336.44,"discounted_cash":99.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.29,"methodology":"fee schedule"}]}]},{"description":"LUBIPROSTONE 24 MCG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.33,"maximum":47.7,"gross_charge":58.88,"discounted_cash":17.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"}]}]},{"description":"LUBIPROSTONE 24 MCG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.84,"maximum":47.7,"gross_charge":58.88,"discounted_cash":17.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"}]}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0351-60","type":"NDC"}],"standard_charges":[{"minimum":41.27,"maximum":55.72,"gross_charge":68.78,"discounted_cash":20.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"}]}]},{"description":"LUBIPROSTONE 8 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0351-60","type":"NDC"}],"standard_charges":[{"minimum":10.32,"maximum":55.72,"gross_charge":68.78,"discounted_cash":20.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0304-01","type":"NDC"}],"standard_charges":[{"minimum":21.03,"maximum":28.39,"gross_charge":35.04,"discounted_cash":10.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0304-01","type":"NDC"}],"standard_charges":[{"minimum":5.26,"maximum":28.39,"gross_charge":35.04,"discounted_cash":10.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.01,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0304-10","type":"NDC"}],"standard_charges":[{"minimum":2094.82,"maximum":2828.01,"gross_charge":3491.36,"discounted_cash":1033.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2828.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2828.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2828.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2094.82,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0304-10","type":"NDC"}],"standard_charges":[{"minimum":523.71,"maximum":2828.01,"gross_charge":3491.36,"discounted_cash":1033.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2828.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2828.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2828.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2094.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.28,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0304-30","type":"NDC"}],"standard_charges":[{"minimum":662.26,"maximum":894.05,"gross_charge":1103.76,"discounted_cash":326.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":894.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":894.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":894.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":662.26,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63402-0304-30","type":"NDC"}],"standard_charges":[{"minimum":165.57,"maximum":894.05,"gross_charge":1103.76,"discounted_cash":326.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":894.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":894.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":894.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":662.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.76,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0208-30","type":"NDC"}],"standard_charges":[{"minimum":7.41,"maximum":10,"gross_charge":12.34,"discounted_cash":3.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0208-30","type":"NDC"}],"standard_charges":[{"minimum":1.86,"maximum":10,"gross_charge":12.34,"discounted_cash":3.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0354-30","type":"NDC"}],"standard_charges":[{"minimum":7.88,"maximum":10.63,"gross_charge":13.12,"discounted_cash":3.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0354-30","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":10.63,"gross_charge":13.12,"discounted_cash":3.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0881-03","type":"NDC"}],"standard_charges":[{"minimum":7.25,"maximum":9.78,"gross_charge":12.07,"discounted_cash":3.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0881-03","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":9.78,"gross_charge":12.07,"discounted_cash":3.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0210-30","type":"NDC"}],"standard_charges":[{"minimum":0.36,"maximum":0.48,"gross_charge":0.59,"discounted_cash":0.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"}]}]},{"description":"LURASIDONE 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0210-30","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.48,"gross_charge":0.59,"discounted_cash":0.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"MACITENTAN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66215-0501-15","type":"NDC"}],"standard_charges":[{"minimum":3061.89,"maximum":4133.56,"gross_charge":5103.15,"discounted_cash":1510.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4133.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4133.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4133.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3061.89,"methodology":"fee schedule"}]}]},{"description":"MACITENTAN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66215-0501-15","type":"NDC"}],"standard_charges":[{"minimum":765.48,"maximum":4133.56,"gross_charge":5103.15,"discounted_cash":1510.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4133.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4133.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4133.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3061.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":969.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":765.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1020.63,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70677-1111-01","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":1.55,"gross_charge":1.91,"discounted_cash":0.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70677-1111-01","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":1.55,"gross_charge":1.91,"discounted_cash":0.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71399-7889-01","type":"NDC"}],"standard_charges":[{"minimum":1.86,"maximum":2.51,"gross_charge":3.09,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71399-7889-01","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":2.51,"gross_charge":3.09,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.44,"maximum":0.59,"gross_charge":0.72,"discounted_cash":0.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM CITRATE ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.11,"maximum":0.59,"gross_charge":0.72,"discounted_cash":0.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0153-01","type":"NDC"}],"standard_charges":[{"minimum":1.4,"maximum":1.88,"gross_charge":2.32,"discounted_cash":0.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0153-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":1.88,"gross_charge":2.32,"discounted_cash":0.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM-CALCIUM-FOLIC ACID 400 MG-200 MG-1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59528-0416-05","type":"NDC"}],"standard_charges":[{"minimum":17.9,"maximum":24.17,"gross_charge":29.83,"discounted_cash":8.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM-CALCIUM-FOLIC ACID 400 MG-200 MG-1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59528-0416-05","type":"NDC"}],"standard_charges":[{"minimum":4.48,"maximum":24.17,"gross_charge":29.83,"discounted_cash":8.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0523-11","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0523-11","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0523-15","type":"NDC"}],"standard_charges":[{"minimum":13.13,"maximum":17.73,"gross_charge":21.88,"discounted_cash":6.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0523-15","type":"NDC"}],"standard_charges":[{"minimum":3.29,"maximum":17.73,"gross_charge":21.88,"discounted_cash":6.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0730-65","type":"NDC"}],"standard_charges":[{"minimum":11.72,"maximum":15.82,"gross_charge":19.53,"discounted_cash":5.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0730-65","type":"NDC"}],"standard_charges":[{"minimum":2.93,"maximum":15.82,"gross_charge":19.53,"discounted_cash":5.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.37,"maximum":35.6,"gross_charge":43.94,"discounted_cash":13.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.6,"maximum":35.6,"gross_charge":43.94,"discounted_cash":13.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.39,"maximum":36.97,"gross_charge":45.64,"discounted_cash":13.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"}]}]},{"description":"MECLIZINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.85,"maximum":36.97,"gross_charge":45.64,"discounted_cash":13.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0165-10","type":"NDC"}],"standard_charges":[{"minimum":11.66,"maximum":15.74,"gross_charge":19.43,"discounted_cash":5.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0165-10","type":"NDC"}],"standard_charges":[{"minimum":2.92,"maximum":15.74,"gross_charge":19.43,"discounted_cash":5.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0160-01","type":"NDC"}],"standard_charges":[{"minimum":3.16,"maximum":4.27,"gross_charge":5.26,"discounted_cash":1.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69339-0160-01","type":"NDC"}],"standard_charges":[{"minimum":0.79,"maximum":4.27,"gross_charge":5.26,"discounted_cash":1.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.29,"maximum":1.74,"gross_charge":2.14,"discounted_cash":0.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.33,"maximum":1.74,"gross_charge":2.14,"discounted_cash":0.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.27,"maximum":3.07,"gross_charge":3.78,"discounted_cash":1.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.57,"maximum":3.07,"gross_charge":3.78,"discounted_cash":1.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.38,"maximum":3.21,"gross_charge":3.96,"discounted_cash":1.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"}]}]},{"description":"MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":3.21,"gross_charge":3.96,"discounted_cash":1.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"}]}]},{"description":"MELATONIN 3 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.28,"maximum":3.07,"gross_charge":3.79,"discounted_cash":1.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"}]}]},{"description":"MELATONIN 3 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.57,"maximum":3.07,"gross_charge":3.79,"discounted_cash":1.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"}]}]},{"description":"MELOXICAM 7.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0050-01","type":"NDC"}],"standard_charges":[{"minimum":1.04,"maximum":1.41,"gross_charge":1.73,"discounted_cash":0.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"}]}]},{"description":"MELOXICAM 7.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0050-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":1.41,"gross_charge":1.73,"discounted_cash":0.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.23,"maximum":5.72,"gross_charge":7.05,"discounted_cash":2.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.06,"maximum":5.72,"gross_charge":7.05,"discounted_cash":2.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0297-09","type":"NDC"}],"standard_charges":[{"minimum":11.93,"maximum":16.1,"gross_charge":19.87,"discounted_cash":5.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0297-09","type":"NDC"}],"standard_charges":[{"minimum":2.99,"maximum":16.1,"gross_charge":19.87,"discounted_cash":5.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.7,"maximum":10.4,"gross_charge":12.83,"discounted_cash":3.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.93,"maximum":10.4,"gross_charge":12.83,"discounted_cash":3.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.03,"maximum":32.44,"gross_charge":40.04,"discounted_cash":11.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"}]}]},{"description":"MEMANTINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.01,"maximum":32.44,"gross_charge":40.04,"discounted_cash":11.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0050-01","type":"NDC"}],"standard_charges":[{"minimum":22.76,"maximum":30.73,"gross_charge":37.93,"discounted_cash":11.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.76,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0050-01","type":"NDC"}],"standard_charges":[{"minimum":5.69,"maximum":30.73,"gross_charge":37.93,"discounted_cash":11.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0050-30","type":"NDC"}],"standard_charges":[{"minimum":558.48,"maximum":753.94,"gross_charge":930.79,"discounted_cash":275.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":753.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":753.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.48,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0050-30","type":"NDC"}],"standard_charges":[{"minimum":139.62,"maximum":753.94,"gross_charge":930.79,"discounted_cash":275.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":753.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":753.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.16,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":42.51,"maximum":57.39,"gross_charge":70.84,"discounted_cash":20.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.63,"maximum":57.39,"gross_charge":70.84,"discounted_cash":20.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":65.73,"maximum":88.73,"gross_charge":109.54,"discounted_cash":32.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.73,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.44,"maximum":88.73,"gross_charge":109.54,"discounted_cash":32.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.91,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":45.39,"maximum":61.28,"gross_charge":75.65,"discounted_cash":22.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE 50 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.35,"maximum":61.28,"gross_charge":75.65,"discounted_cash":22.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.13,"methodology":"fee schedule"}]}]},{"description":"MERCAPTOPURINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69076-0913-02","type":"NDC"}],"standard_charges":[{"minimum":47.64,"maximum":64.32,"gross_charge":79.4,"discounted_cash":23.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.64,"methodology":"fee schedule"}]}]},{"description":"MERCAPTOPURINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69076-0913-02","type":"NDC"}],"standard_charges":[{"minimum":11.91,"maximum":64.32,"gross_charge":79.4,"discounted_cash":23.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"}]}]},{"description":"MERCAPTOPURINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.14,"maximum":19.09,"gross_charge":23.56,"discounted_cash":6.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"}]}]},{"description":"MERCAPTOPURINE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.54,"maximum":19.09,"gross_charge":23.56,"discounted_cash":6.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0830-01","type":"NDC"}],"standard_charges":[{"minimum":200.28,"maximum":270.38,"gross_charge":333.8,"discounted_cash":98.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":270.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":270.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":270.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.28,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0830-01","type":"NDC"}],"standard_charges":[{"minimum":50.07,"maximum":270.38,"gross_charge":333.8,"discounted_cash":98.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":270.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":270.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":270.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":200.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.76,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54092-0100-01","type":"NDC"}],"standard_charges":[{"minimum":217.5,"maximum":293.62,"gross_charge":362.49,"discounted_cash":107.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.5,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54092-0100-01","type":"NDC"}],"standard_charges":[{"minimum":54.38,"maximum":293.62,"gross_charge":362.49,"discounted_cash":107.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0175-13","type":"NDC"}],"standard_charges":[{"minimum":98.09,"maximum":132.42,"gross_charge":163.48,"discounted_cash":48.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.09,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0175-13","type":"NDC"}],"standard_charges":[{"minimum":24.53,"maximum":132.42,"gross_charge":163.48,"discounted_cash":48.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.7,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0711-19","type":"NDC"}],"standard_charges":[{"minimum":190.42,"maximum":257.07,"gross_charge":317.36,"discounted_cash":93.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":257.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.42,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0711-19","type":"NDC"}],"standard_charges":[{"minimum":47.61,"maximum":257.07,"gross_charge":317.36,"discounted_cash":93.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":257.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":146.63,"maximum":197.95,"gross_charge":244.38,"discounted_cash":72.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.63,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1.2 GRAM TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":36.66,"maximum":197.95,"gross_charge":244.38,"discounted_cash":72.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.88,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0245-30","type":"NDC"}],"standard_charges":[{"minimum":27.72,"maximum":37.42,"gross_charge":46.19,"discounted_cash":13.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0245-30","type":"NDC"}],"standard_charges":[{"minimum":6.93,"maximum":37.42,"gross_charge":46.19,"discounted_cash":13.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58914-0501-01","type":"NDC"}],"standard_charges":[{"minimum":21.35,"maximum":28.82,"gross_charge":35.57,"discounted_cash":10.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.35,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58914-0501-01","type":"NDC"}],"standard_charges":[{"minimum":5.34,"maximum":28.82,"gross_charge":35.57,"discounted_cash":10.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.12,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58914-0501-56","type":"NDC"}],"standard_charges":[{"minimum":638.03,"maximum":861.33,"gross_charge":1063.37,"discounted_cash":314.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":861.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":861.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":861.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":638.03,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58914-0501-56","type":"NDC"}],"standard_charges":[{"minimum":159.51,"maximum":861.33,"gross_charge":1063.37,"discounted_cash":314.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":861.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":861.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":861.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":638.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.68,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69918-0560-30","type":"NDC"}],"standard_charges":[{"minimum":109.96,"maximum":148.45,"gross_charge":183.26,"discounted_cash":54.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.96,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69918-0560-30","type":"NDC"}],"standard_charges":[{"minimum":27.49,"maximum":148.45,"gross_charge":183.26,"discounted_cash":54.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":148.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.66,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":283.75,"maximum":383.06,"gross_charge":472.91,"discounted_cash":139.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.75,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 1000 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":70.94,"maximum":383.06,"gross_charge":472.91,"discounted_cash":139.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.59,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 4 GRAM/60 ML ENEMA","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0045-47","type":"NDC"}],"standard_charges":[{"minimum":4.47,"maximum":6.04,"gross_charge":7.45,"discounted_cash":2.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 4 GRAM/60 ML ENEMA","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0045-47","type":"NDC"}],"standard_charges":[{"minimum":1.12,"maximum":6.04,"gross_charge":7.45,"discounted_cash":2.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0117-01","type":"NDC"}],"standard_charges":[{"minimum":168.6,"maximum":227.61,"gross_charge":280.99,"discounted_cash":83.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.6,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0117-01","type":"NDC"}],"standard_charges":[{"minimum":42.15,"maximum":227.61,"gross_charge":280.99,"discounted_cash":83.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":227.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":168.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":235.89,"maximum":318.46,"gross_charge":393.15,"discounted_cash":116.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.89,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.98,"maximum":318.46,"gross_charge":393.15,"discounted_cash":116.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.63,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":383.67,"maximum":517.95,"gross_charge":639.44,"discounted_cash":189.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":517.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":517.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":517.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.67,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":95.92,"maximum":517.95,"gross_charge":639.44,"discounted_cash":189.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":517.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":517.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":517.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.89,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE ER 250 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54092-0189-81","type":"NDC"}],"standard_charges":[{"minimum":400.2,"maximum":540.27,"gross_charge":666.99,"discounted_cash":197.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":400.2,"methodology":"fee schedule"}]}]},{"description":"MESALAMINE ER 250 MG CAPSULEEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54092-0189-81","type":"NDC"}],"standard_charges":[{"minimum":100.05,"maximum":540.27,"gross_charge":666.99,"discounted_cash":197.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":540.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":400.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.4,"methodology":"fee schedule"}]}]},{"description":"METFORMIN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70010-0063-05","type":"NDC"}],"standard_charges":[{"minimum":6.08,"maximum":8.21,"gross_charge":10.13,"discounted_cash":3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"}]}]},{"description":"METFORMIN 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70010-0063-05","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":8.21,"gross_charge":10.13,"discounted_cash":3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"}]}]},{"description":"METHADONE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.71,"maximum":26.61,"gross_charge":32.84,"discounted_cash":9.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.71,"methodology":"fee schedule"}]}]},{"description":"METHADONE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.93,"maximum":26.61,"gross_charge":32.84,"discounted_cash":9.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"}]}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0712-16","type":"NDC"}],"standard_charges":[{"minimum":98.8,"maximum":133.38,"gross_charge":164.66,"discounted_cash":48.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"}]}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0712-16","type":"NDC"}],"standard_charges":[{"minimum":24.7,"maximum":133.38,"gross_charge":164.66,"discounted_cash":48.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"}]}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":31.29,"maximum":42.24,"gross_charge":52.14,"discounted_cash":15.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"}]}]},{"description":"METHADONE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.83,"maximum":42.24,"gross_charge":52.14,"discounted_cash":15.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.43,"methodology":"fee schedule"}]}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42571-0332-01","type":"NDC"}],"standard_charges":[{"minimum":104.69,"maximum":141.33,"gross_charge":174.47,"discounted_cash":51.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.69,"methodology":"fee schedule"}]}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42571-0332-01","type":"NDC"}],"standard_charges":[{"minimum":26.18,"maximum":141.33,"gross_charge":174.47,"discounted_cash":51.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.9,"methodology":"fee schedule"}]}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43199-0020-01","type":"NDC"}],"standard_charges":[{"minimum":69.93,"maximum":94.41,"gross_charge":116.55,"discounted_cash":34.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.93,"methodology":"fee schedule"}]}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43199-0020-01","type":"NDC"}],"standard_charges":[{"minimum":17.49,"maximum":94.41,"gross_charge":116.55,"discounted_cash":34.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"}]}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0142-01","type":"NDC"}],"standard_charges":[{"minimum":39.63,"maximum":53.5,"gross_charge":66.04,"discounted_cash":19.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"}]}]},{"description":"METHENAMINE HIPPURATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0142-01","type":"NDC"}],"standard_charges":[{"minimum":9.91,"maximum":53.5,"gross_charge":66.04,"discounted_cash":19.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"}]}]},{"description":"METHIMAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0357-01","type":"NDC"}],"standard_charges":[{"minimum":23.43,"maximum":31.63,"gross_charge":39.04,"discounted_cash":11.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"}]}]},{"description":"METHIMAZOLE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0357-01","type":"NDC"}],"standard_charges":[{"minimum":5.86,"maximum":31.63,"gross_charge":39.04,"discounted_cash":11.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"35573-0413-02","type":"NDC"}],"standard_charges":[{"minimum":4.34,"maximum":5.86,"gross_charge":7.23,"discounted_cash":2.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"35573-0413-02","type":"NDC"}],"standard_charges":[{"minimum":1.09,"maximum":5.86,"gross_charge":7.23,"discounted_cash":2.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0405-10","type":"NDC"}],"standard_charges":[{"minimum":2.66,"maximum":3.59,"gross_charge":4.43,"discounted_cash":1.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0405-10","type":"NDC"}],"standard_charges":[{"minimum":0.67,"maximum":3.59,"gross_charge":4.43,"discounted_cash":1.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0559-01","type":"NDC"}],"standard_charges":[{"minimum":14.79,"maximum":19.96,"gross_charge":24.64,"discounted_cash":7.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0559-01","type":"NDC"}],"standard_charges":[{"minimum":3.7,"maximum":19.96,"gross_charge":24.64,"discounted_cash":7.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0559-11","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":0.31,"gross_charge":0.38,"discounted_cash":0.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0559-11","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":0.31,"gross_charge":0.38,"discounted_cash":0.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0134-10","type":"NDC"}],"standard_charges":[{"minimum":39.21,"maximum":52.93,"gross_charge":65.34,"discounted_cash":19.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.21,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0134-10","type":"NDC"}],"standard_charges":[{"minimum":9.81,"maximum":52.93,"gross_charge":65.34,"discounted_cash":19.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70010-0754-01","type":"NDC"}],"standard_charges":[{"minimum":2.6,"maximum":3.51,"gross_charge":4.33,"discounted_cash":1.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70010-0754-01","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":3.51,"gross_charge":4.33,"discounted_cash":1.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.69,"maximum":21.18,"gross_charge":26.14,"discounted_cash":7.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.93,"maximum":21.18,"gross_charge":26.14,"discounted_cash":7.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 750 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0568-01","type":"NDC"}],"standard_charges":[{"minimum":16.23,"maximum":21.91,"gross_charge":27.04,"discounted_cash":8.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 750 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0568-01","type":"NDC"}],"standard_charges":[{"minimum":4.06,"maximum":21.91,"gross_charge":27.04,"discounted_cash":8.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 750 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0135-10","type":"NDC"}],"standard_charges":[{"minimum":58.77,"maximum":79.34,"gross_charge":97.95,"discounted_cash":29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.77,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 750 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0135-10","type":"NDC"}],"standard_charges":[{"minimum":14.7,"maximum":79.34,"gross_charge":97.95,"discounted_cash":29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"41167-0060-03","type":"NDC"}],"standard_charges":[{"minimum":1.51,"maximum":2.04,"gross_charge":2.51,"discounted_cash":0.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"41167-0060-03","type":"NDC"}],"standard_charges":[{"minimum":0.38,"maximum":2.04,"gross_charge":2.51,"discounted_cash":0.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0174-53","type":"NDC"}],"standard_charges":[{"minimum":1.71,"maximum":2.31,"gross_charge":2.85,"discounted_cash":0.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0174-53","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":2.31,"gross_charge":2.85,"discounted_cash":0.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57896-0116-03","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":2.45,"gross_charge":3.02,"discounted_cash":0.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57896-0116-03","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":2.45,"gross_charge":3.02,"discounted_cash":0.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.92,"maximum":2.59,"gross_charge":3.19,"discounted_cash":0.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"}]}]},{"description":"METHYL SALICYLATE 15 %-MENTHOL 10 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.48,"maximum":2.59,"gross_charge":3.19,"discounted_cash":0.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0821-01","type":"NDC"}],"standard_charges":[{"minimum":2.36,"maximum":3.19,"gross_charge":3.93,"discounted_cash":1.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0821-01","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":3.19,"gross_charge":3.93,"discounted_cash":1.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0173-01","type":"NDC"}],"standard_charges":[{"minimum":8.9,"maximum":12.02,"gross_charge":14.83,"discounted_cash":4.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0173-01","type":"NDC"}],"standard_charges":[{"minimum":2.23,"maximum":12.02,"gross_charge":14.83,"discounted_cash":4.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0805-21","type":"NDC"}],"standard_charges":[{"minimum":34.52,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0805-21","type":"NDC"}],"standard_charges":[{"minimum":8.63,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.78,"maximum":15.91,"gross_charge":19.63,"discounted_cash":5.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.95,"maximum":15.91,"gross_charge":19.63,"discounted_cash":5.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 20 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0076-06","type":"NDC"}],"standard_charges":[{"minimum":51,"maximum":68.85,"gross_charge":84.99,"discounted_cash":25.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 20 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0076-06","type":"NDC"}],"standard_charges":[{"minimum":12.75,"maximum":68.85,"gross_charge":84.99,"discounted_cash":25.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 36 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0312-37","type":"NDC"}],"standard_charges":[{"minimum":139.31,"maximum":188.07,"gross_charge":232.18,"discounted_cash":68.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.31,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 36 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0312-37","type":"NDC"}],"standard_charges":[{"minimum":34.83,"maximum":188.07,"gross_charge":232.18,"discounted_cash":68.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":188.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":188.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":188.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":139.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.44,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 54 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0565-21","type":"NDC"}],"standard_charges":[{"minimum":118.82,"maximum":160.4,"gross_charge":198.02,"discounted_cash":58.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.82,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 54 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0565-21","type":"NDC"}],"standard_charges":[{"minimum":29.71,"maximum":160.4,"gross_charge":198.02,"discounted_cash":58.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 54 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":259.82,"maximum":350.75,"gross_charge":433.02,"discounted_cash":128.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":350.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":259.82,"methodology":"fee schedule"}]}]},{"description":"METHYLPHENIDATE ER 54 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":64.96,"maximum":350.75,"gross_charge":433.02,"discounted_cash":128.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":350.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":350.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":350.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":259.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.61,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0676-01","type":"NDC"}],"standard_charges":[{"minimum":30.14,"maximum":40.69,"gross_charge":50.23,"discounted_cash":14.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.14,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0676-01","type":"NDC"}],"standard_charges":[{"minimum":7.54,"maximum":40.69,"gross_charge":50.23,"discounted_cash":14.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0886-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":0.47,"gross_charge":0.58,"discounted_cash":0.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0886-01","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.47,"gross_charge":0.58,"discounted_cash":0.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.94,"maximum":2.62,"gross_charge":3.23,"discounted_cash":0.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.49,"maximum":2.62,"gross_charge":3.23,"discounted_cash":0.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.93,"maximum":2.61,"gross_charge":3.21,"discounted_cash":0.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.49,"maximum":2.61,"gross_charge":3.21,"discounted_cash":0.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.74,"maximum":13.14,"gross_charge":16.22,"discounted_cash":4.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.44,"maximum":13.14,"gross_charge":16.22,"discounted_cash":4.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0023-01","type":"NDC"}],"standard_charges":[{"minimum":1.66,"maximum":2.24,"gross_charge":2.76,"discounted_cash":0.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0023-01","type":"NDC"}],"standard_charges":[{"minimum":0.42,"maximum":2.24,"gross_charge":2.76,"discounted_cash":0.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0532-31","type":"NDC"}],"standard_charges":[{"minimum":98.14,"maximum":132.49,"gross_charge":163.56,"discounted_cash":48.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.14,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0532-31","type":"NDC"}],"standard_charges":[{"minimum":24.54,"maximum":132.49,"gross_charge":163.56,"discounted_cash":48.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.72,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":89.26,"maximum":120.5,"gross_charge":148.76,"discounted_cash":44.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.26,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.32,"maximum":120.5,"gross_charge":148.76,"discounted_cash":44.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":89.56,"maximum":120.91,"gross_charge":149.26,"discounted_cash":44.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.56,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.39,"maximum":120.91,"gross_charge":149.26,"discounted_cash":44.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.86,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0533-31","type":"NDC"}],"standard_charges":[{"minimum":111.47,"maximum":150.48,"gross_charge":185.77,"discounted_cash":54.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.47,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0533-31","type":"NDC"}],"standard_charges":[{"minimum":27.87,"maximum":150.48,"gross_charge":185.77,"discounted_cash":54.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8733-01","type":"NDC"}],"standard_charges":[{"minimum":56.07,"maximum":75.7,"gross_charge":93.45,"discounted_cash":27.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.07,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8733-01","type":"NDC"}],"standard_charges":[{"minimum":14.02,"maximum":75.7,"gross_charge":93.45,"discounted_cash":27.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":36.99,"maximum":49.93,"gross_charge":61.64,"discounted_cash":18.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.99,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.25,"maximum":49.93,"gross_charge":61.64,"discounted_cash":18.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":101.45,"maximum":136.95,"gross_charge":169.07,"discounted_cash":50.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.45,"methodology":"fee schedule"}]}]},{"description":"METOLAZONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":25.37,"maximum":136.95,"gross_charge":169.07,"discounted_cash":50.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.82,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0542-15","type":"NDC"}],"standard_charges":[{"minimum":12.23,"maximum":16.51,"gross_charge":20.38,"discounted_cash":6.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0542-15","type":"NDC"}],"standard_charges":[{"minimum":3.06,"maximum":16.51,"gross_charge":20.38,"discounted_cash":6.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.08,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0413-01","type":"NDC"}],"standard_charges":[{"minimum":34.29,"maximum":46.29,"gross_charge":57.14,"discounted_cash":16.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0413-01","type":"NDC"}],"standard_charges":[{"minimum":8.58,"maximum":46.29,"gross_charge":57.14,"discounted_cash":16.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0119-00","type":"NDC"}],"standard_charges":[{"minimum":34.41,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 100 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0119-00","type":"NDC"}],"standard_charges":[{"minimum":8.61,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0852-01","type":"NDC"}],"standard_charges":[{"minimum":5.78,"maximum":7.81,"gross_charge":9.63,"discounted_cash":2.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0852-01","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":7.81,"gross_charge":9.63,"discounted_cash":2.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0825-01","type":"NDC"}],"standard_charges":[{"minimum":19.77,"maximum":26.69,"gross_charge":32.94,"discounted_cash":9.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0825-01","type":"NDC"}],"standard_charges":[{"minimum":4.95,"maximum":26.69,"gross_charge":32.94,"discounted_cash":9.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0390-01","type":"NDC"}],"standard_charges":[{"minimum":57.57,"maximum":77.72,"gross_charge":95.95,"discounted_cash":28.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.57,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0390-01","type":"NDC"}],"standard_charges":[{"minimum":14.4,"maximum":77.72,"gross_charge":95.95,"discounted_cash":28.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0356-03","type":"NDC"}],"standard_charges":[{"minimum":51.69,"maximum":69.79,"gross_charge":86.15,"discounted_cash":25.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.69,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0356-03","type":"NDC"}],"standard_charges":[{"minimum":12.93,"maximum":69.79,"gross_charge":86.15,"discounted_cash":25.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.23,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0541-15","type":"NDC"}],"standard_charges":[{"minimum":8.33,"maximum":11.25,"gross_charge":13.88,"discounted_cash":4.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0541-15","type":"NDC"}],"standard_charges":[{"minimum":2.09,"maximum":11.25,"gross_charge":13.88,"discounted_cash":4.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0402-11","type":"NDC"}],"standard_charges":[{"minimum":0.65,"maximum":0.88,"gross_charge":1.08,"discounted_cash":0.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0402-11","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.88,"gross_charge":1.08,"discounted_cash":0.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0402-65","type":"NDC"}],"standard_charges":[{"minimum":21.48,"maximum":28.99,"gross_charge":35.79,"discounted_cash":10.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.48,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0402-65","type":"NDC"}],"standard_charges":[{"minimum":5.37,"maximum":28.99,"gross_charge":35.79,"discounted_cash":10.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0122-00","type":"NDC"}],"standard_charges":[{"minimum":17.91,"maximum":24.18,"gross_charge":29.84,"discounted_cash":8.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.91,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0122-00","type":"NDC"}],"standard_charges":[{"minimum":4.48,"maximum":24.18,"gross_charge":29.84,"discounted_cash":8.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70436-0183-01","type":"NDC"}],"standard_charges":[{"minimum":3.38,"maximum":4.57,"gross_charge":5.63,"discounted_cash":1.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"}]}]},{"description":"METOPROLOL SUCCINATE ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70436-0183-01","type":"NDC"}],"standard_charges":[{"minimum":0.85,"maximum":4.57,"gross_charge":5.63,"discounted_cash":1.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0557-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":0.61,"gross_charge":0.75,"discounted_cash":0.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0557-01","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.61,"gross_charge":0.75,"discounted_cash":0.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0139-70","type":"NDC"}],"standard_charges":[{"minimum":10.83,"maximum":14.63,"gross_charge":18.05,"discounted_cash":5.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0139-70","type":"NDC"}],"standard_charges":[{"minimum":2.71,"maximum":14.63,"gross_charge":18.05,"discounted_cash":5.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0184-49","type":"NDC"}],"standard_charges":[{"minimum":9.99,"maximum":13.49,"gross_charge":16.65,"discounted_cash":4.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0184-49","type":"NDC"}],"standard_charges":[{"minimum":2.5,"maximum":13.49,"gross_charge":16.65,"discounted_cash":4.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0455-70","type":"NDC"}],"standard_charges":[{"minimum":69.65,"maximum":94.02,"gross_charge":116.07,"discounted_cash":34.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.65,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0455-70","type":"NDC"}],"standard_charges":[{"minimum":17.42,"maximum":94.02,"gross_charge":116.07,"discounted_cash":34.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.22,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"73473-0303-70","type":"NDC"}],"standard_charges":[{"minimum":49.49,"maximum":66.81,"gross_charge":82.47,"discounted_cash":24.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.49,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"73473-0303-70","type":"NDC"}],"standard_charges":[{"minimum":12.38,"maximum":66.81,"gross_charge":82.47,"discounted_cash":24.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.5,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.89,"maximum":17.4,"gross_charge":21.48,"discounted_cash":6.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.23,"maximum":17.4,"gross_charge":21.48,"discounted_cash":6.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":72.38,"maximum":97.72,"gross_charge":120.63,"discounted_cash":35.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.38,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % (37.5 MG/5 GRAM) VAGINAL GEL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.1,"maximum":97.72,"gross_charge":120.63,"discounted_cash":35.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.13,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4116-06","type":"NDC"}],"standard_charges":[{"minimum":27.95,"maximum":37.73,"gross_charge":46.58,"discounted_cash":13.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.95,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 0.75 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4116-06","type":"NDC"}],"standard_charges":[{"minimum":6.99,"maximum":37.73,"gross_charge":46.58,"discounted_cash":13.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4164-03","type":"NDC"}],"standard_charges":[{"minimum":86.64,"maximum":116.97,"gross_charge":144.4,"discounted_cash":42.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.64,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4164-03","type":"NDC"}],"standard_charges":[{"minimum":21.66,"maximum":116.97,"gross_charge":144.4,"discounted_cash":42.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0936-61","type":"NDC"}],"standard_charges":[{"minimum":60.61,"maximum":81.82,"gross_charge":101.01,"discounted_cash":29.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.61,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 1 % TOPICAL GEL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0936-61","type":"NDC"}],"standard_charges":[{"minimum":15.16,"maximum":81.82,"gross_charge":101.01,"discounted_cash":29.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.21,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0664-01","type":"NDC"}],"standard_charges":[{"minimum":3.92,"maximum":5.29,"gross_charge":6.53,"discounted_cash":1.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0664-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":5.29,"gross_charge":6.53,"discounted_cash":1.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0664-50","type":"NDC"}],"standard_charges":[{"minimum":32.19,"maximum":43.45,"gross_charge":53.64,"discounted_cash":15.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.19,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0664-50","type":"NDC"}],"standard_charges":[{"minimum":8.05,"maximum":43.45,"gross_charge":53.64,"discounted_cash":15.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0535-11","type":"NDC"}],"standard_charges":[{"minimum":0.31,"maximum":0.42,"gross_charge":0.51,"discounted_cash":0.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0535-11","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.42,"gross_charge":0.51,"discounted_cash":0.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.19,"maximum":47.5,"gross_charge":58.64,"discounted_cash":17.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.19,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.8,"maximum":47.5,"gross_charge":58.64,"discounted_cash":17.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0239-01","type":"NDC"}],"standard_charges":[{"minimum":20.79,"maximum":28.06,"gross_charge":34.64,"discounted_cash":10.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0239-01","type":"NDC"}],"standard_charges":[{"minimum":5.2,"maximum":28.06,"gross_charge":34.64,"discounted_cash":10.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":42.69,"maximum":57.63,"gross_charge":71.14,"discounted_cash":21.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.69,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.68,"maximum":57.63,"gross_charge":71.14,"discounted_cash":21.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":76.54,"maximum":103.33,"gross_charge":127.56,"discounted_cash":37.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.54,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.14,"maximum":103.33,"gross_charge":127.56,"discounted_cash":37.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.52,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0956-01","type":"NDC"}],"standard_charges":[{"minimum":15.87,"maximum":21.42,"gross_charge":26.44,"discounted_cash":7.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 200 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0956-01","type":"NDC"}],"standard_charges":[{"minimum":3.97,"maximum":21.42,"gross_charge":26.44,"discounted_cash":7.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.85,"maximum":56.49,"gross_charge":69.74,"discounted_cash":20.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.47,"maximum":56.49,"gross_charge":69.74,"discounted_cash":20.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":51.93,"maximum":70.11,"gross_charge":86.55,"discounted_cash":25.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.93,"methodology":"fee schedule"}]}]},{"description":"MEXILETINE 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.99,"maximum":70.11,"gross_charge":86.55,"discounted_cash":25.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11701-0045-23","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":0.43,"gross_charge":0.53,"discounted_cash":0.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11701-0045-23","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.43,"gross_charge":0.53,"discounted_cash":0.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61269-0735-56","type":"NDC"}],"standard_charges":[{"minimum":1.31,"maximum":1.76,"gross_charge":2.17,"discounted_cash":0.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61269-0735-56","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":1.76,"gross_charge":2.17,"discounted_cash":0.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.69,"maximum":0.93,"gross_charge":1.14,"discounted_cash":0.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":0.93,"gross_charge":1.14,"discounted_cash":0.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.24,"maximum":1.67,"gross_charge":2.06,"discounted_cash":0.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.31,"maximum":1.67,"gross_charge":2.06,"discounted_cash":0.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.46,"maximum":1.97,"gross_charge":2.43,"discounted_cash":0.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"}]}]},{"description":"MICONAZOLE NITRATE 2 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.37,"maximum":1.97,"gross_charge":2.43,"discounted_cash":0.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":33.15,"maximum":44.76,"gross_charge":55.25,"discounted_cash":16.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.29,"maximum":44.76,"gross_charge":55.25,"discounted_cash":16.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0737-01","type":"NDC"}],"standard_charges":[{"minimum":18.08,"maximum":24.41,"gross_charge":30.13,"discounted_cash":8.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0737-01","type":"NDC"}],"standard_charges":[{"minimum":4.52,"maximum":24.41,"gross_charge":30.13,"discounted_cash":8.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.4,"maximum":9.98,"gross_charge":12.32,"discounted_cash":3.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.85,"maximum":9.98,"gross_charge":12.32,"discounted_cash":3.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0453-01","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":1.02,"gross_charge":1.25,"discounted_cash":0.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0453-01","type":"NDC"}],"standard_charges":[{"minimum":0.19,"maximum":1.02,"gross_charge":1.25,"discounted_cash":0.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-1321-01","type":"NDC"}],"standard_charges":[{"minimum":37.17,"maximum":50.18,"gross_charge":61.94,"discounted_cash":18.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.17,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-1321-01","type":"NDC"}],"standard_charges":[{"minimum":9.3,"maximum":50.18,"gross_charge":61.94,"discounted_cash":18.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0241-01","type":"NDC"}],"standard_charges":[{"minimum":29.61,"maximum":39.97,"gross_charge":49.34,"discounted_cash":14.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.61,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0241-01","type":"NDC"}],"standard_charges":[{"minimum":7.41,"maximum":39.97,"gross_charge":49.34,"discounted_cash":14.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.31,"maximum":23.37,"gross_charge":28.84,"discounted_cash":8.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.33,"maximum":23.37,"gross_charge":28.84,"discounted_cash":8.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.15,"maximum":24.5,"gross_charge":30.24,"discounted_cash":8.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.15,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.54,"maximum":24.5,"gross_charge":30.24,"discounted_cash":8.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.87,"maximum":41.67,"gross_charge":51.44,"discounted_cash":15.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.87,"methodology":"fee schedule"}]}]},{"description":"MIDODRINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":41.67,"gross_charge":51.44,"discounted_cash":15.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL LIGHT STERILE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63323-0254-10","type":"NDC"}],"standard_charges":[{"minimum":9.7,"maximum":13.09,"gross_charge":16.16,"discounted_cash":4.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL LIGHT STERILE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63323-0254-10","type":"NDC"}],"standard_charges":[{"minimum":2.43,"maximum":13.09,"gross_charge":16.16,"discounted_cash":4.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"48433-0202-30","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":1.11,"gross_charge":1.36,"discounted_cash":0.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"48433-0202-30","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":1.11,"gross_charge":1.36,"discounted_cash":0.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54162-0190-16","type":"NDC"}],"standard_charges":[{"minimum":2.35,"maximum":3.17,"gross_charge":3.91,"discounted_cash":1.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"54162-0190-16","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":3.17,"gross_charge":3.91,"discounted_cash":1.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70677-1110-01","type":"NDC"}],"standard_charges":[{"minimum":3.2,"maximum":4.32,"gross_charge":5.33,"discounted_cash":1.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70677-1110-01","type":"NDC"}],"standard_charges":[{"minimum":0.8,"maximum":4.32,"gross_charge":5.33,"discounted_cash":1.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.07,"maximum":2.79,"gross_charge":3.44,"discounted_cash":1.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.52,"maximum":2.79,"gross_charge":3.44,"discounted_cash":1.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.92,"maximum":3.94,"gross_charge":4.86,"discounted_cash":1.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"}]}]},{"description":"MINERAL OIL ORAL","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.73,"maximum":3.94,"gross_charge":4.86,"discounted_cash":1.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0482-01","type":"NDC"}],"standard_charges":[{"minimum":13.16,"maximum":17.77,"gross_charge":21.93,"discounted_cash":6.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0482-01","type":"NDC"}],"standard_charges":[{"minimum":3.29,"maximum":17.77,"gross_charge":21.93,"discounted_cash":6.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.39,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0544-01","type":"NDC"}],"standard_charges":[{"minimum":13.64,"maximum":18.42,"gross_charge":22.73,"discounted_cash":6.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0544-01","type":"NDC"}],"standard_charges":[{"minimum":3.41,"maximum":18.42,"gross_charge":22.73,"discounted_cash":6.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0851-88","type":"NDC"}],"standard_charges":[{"minimum":14.91,"maximum":20.13,"gross_charge":24.84,"discounted_cash":7.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57664-0851-88","type":"NDC"}],"standard_charges":[{"minimum":3.73,"maximum":20.13,"gross_charge":24.84,"discounted_cash":7.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0151-06","type":"NDC"}],"standard_charges":[{"minimum":187.41,"maximum":253.01,"gross_charge":312.35,"discounted_cash":92.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.41,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 25 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0151-06","type":"NDC"}],"standard_charges":[{"minimum":46.86,"maximum":253.01,"gross_charge":312.35,"discounted_cash":92.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":253.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":253.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":253.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.47,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0152-06","type":"NDC"}],"standard_charges":[{"minimum":126.23,"maximum":170.41,"gross_charge":210.38,"discounted_cash":62.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.23,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0152-06","type":"NDC"}],"standard_charges":[{"minimum":31.56,"maximum":170.41,"gross_charge":210.38,"discounted_cash":62.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1160-03","type":"NDC"}],"standard_charges":[{"minimum":6.72,"maximum":9.07,"gross_charge":11.19,"discounted_cash":3.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 50 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1160-03","type":"NDC"}],"standard_charges":[{"minimum":1.68,"maximum":9.07,"gross_charge":11.19,"discounted_cash":3.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 50 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":252.84,"maximum":341.33,"gross_charge":421.39,"discounted_cash":124.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"}]}]},{"description":"MIRABEGRON ER 50 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":63.21,"maximum":341.33,"gross_charge":421.39,"discounted_cash":124.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":341.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":252.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.28,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0098-10","type":"NDC"}],"standard_charges":[{"minimum":7.88,"maximum":10.64,"gross_charge":13.13,"discounted_cash":3.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0098-10","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":10.64,"gross_charge":13.13,"discounted_cash":3.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0119-11","type":"NDC"}],"standard_charges":[{"minimum":8.54,"maximum":11.53,"gross_charge":14.23,"discounted_cash":4.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"}]}]},{"description":"MIRTAZAPINE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0119-11","type":"NDC"}],"standard_charges":[{"minimum":2.14,"maximum":11.53,"gross_charge":14.23,"discounted_cash":4.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"}]}]},{"description":"MISOPROSTOL 200 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0746-60","type":"NDC"}],"standard_charges":[{"minimum":10.13,"maximum":13.67,"gross_charge":16.87,"discounted_cash":5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.13,"methodology":"fee schedule"}]}]},{"description":"MISOPROSTOL 200 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0746-60","type":"NDC"}],"standard_charges":[{"minimum":2.54,"maximum":13.67,"gross_charge":16.87,"discounted_cash":5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"}]}]},{"description":"MISOPROSTOL 200 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0161-06","type":"NDC"}],"standard_charges":[{"minimum":23.96,"maximum":32.34,"gross_charge":39.92,"discounted_cash":11.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"}]}]},{"description":"MISOPROSTOL 200 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0161-06","type":"NDC"}],"standard_charges":[{"minimum":5.99,"maximum":32.34,"gross_charge":39.92,"discounted_cash":11.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0561-01","type":"NDC"}],"standard_charges":[{"minimum":3.79,"maximum":5.12,"gross_charge":6.31,"discounted_cash":1.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0561-01","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":5.12,"gross_charge":6.31,"discounted_cash":1.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55253-0801-30","type":"NDC"}],"standard_charges":[{"minimum":82.86,"maximum":111.87,"gross_charge":138.1,"discounted_cash":40.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.86,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55253-0801-30","type":"NDC"}],"standard_charges":[{"minimum":20.72,"maximum":111.87,"gross_charge":138.1,"discounted_cash":40.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.62,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0601-30","type":"NDC"}],"standard_charges":[{"minimum":2.73,"maximum":3.68,"gross_charge":4.54,"discounted_cash":1.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0601-30","type":"NDC"}],"standard_charges":[{"minimum":0.69,"maximum":3.68,"gross_charge":4.54,"discounted_cash":1.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0621-11","type":"NDC"}],"standard_charges":[{"minimum":6.52,"maximum":8.8,"gross_charge":10.86,"discounted_cash":3.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0621-11","type":"NDC"}],"standard_charges":[{"minimum":1.63,"maximum":8.8,"gross_charge":10.86,"discounted_cash":3.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0621-21","type":"NDC"}],"standard_charges":[{"minimum":195.15,"maximum":263.46,"gross_charge":325.25,"discounted_cash":96.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":263.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":263.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":263.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":195.15,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0621-21","type":"NDC"}],"standard_charges":[{"minimum":48.79,"maximum":263.46,"gross_charge":325.25,"discounted_cash":96.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":263.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":263.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":263.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":195.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.05,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":40.89,"maximum":55.21,"gross_charge":68.15,"discounted_cash":20.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.23,"maximum":55.21,"gross_charge":68.15,"discounted_cash":20.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":113.92,"maximum":153.79,"gross_charge":189.86,"discounted_cash":56.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.92,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.48,"maximum":153.79,"gross_charge":189.86,"discounted_cash":56.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55253-0802-30","type":"NDC"}],"standard_charges":[{"minimum":125.12,"maximum":168.91,"gross_charge":208.52,"discounted_cash":61.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.12,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55253-0802-30","type":"NDC"}],"standard_charges":[{"minimum":31.28,"maximum":168.91,"gross_charge":208.52,"discounted_cash":61.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0721-11","type":"NDC"}],"standard_charges":[{"minimum":4.09,"maximum":5.52,"gross_charge":6.81,"discounted_cash":2.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0721-11","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":5.52,"gross_charge":6.81,"discounted_cash":2.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0721-21","type":"NDC"}],"standard_charges":[{"minimum":120.24,"maximum":162.32,"gross_charge":200.39,"discounted_cash":59.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.24,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0721-21","type":"NDC"}],"standard_charges":[{"minimum":30.06,"maximum":162.32,"gross_charge":200.39,"discounted_cash":59.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.08,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":53.19,"maximum":71.81,"gross_charge":88.65,"discounted_cash":26.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.3,"maximum":71.81,"gross_charge":88.65,"discounted_cash":26.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":99.8,"maximum":134.73,"gross_charge":166.33,"discounted_cash":49.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.8,"methodology":"fee schedule"}]}]},{"description":"MODAFINIL 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.95,"maximum":134.73,"gross_charge":166.33,"discounted_cash":49.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.27,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78206-0113-01","type":"NDC"}],"standard_charges":[{"minimum":63.56,"maximum":85.8,"gross_charge":105.92,"discounted_cash":31.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.56,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78206-0113-01","type":"NDC"}],"standard_charges":[{"minimum":15.89,"maximum":85.8,"gross_charge":105.92,"discounted_cash":31.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.25,"maximum":12.49,"gross_charge":15.41,"discounted_cash":4.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.32,"maximum":12.49,"gross_charge":15.41,"discounted_cash":4.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78206-0126-01","type":"NDC"}],"standard_charges":[{"minimum":60.29,"maximum":81.39,"gross_charge":100.47,"discounted_cash":29.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.29,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78206-0126-01","type":"NDC"}],"standard_charges":[{"minimum":15.08,"maximum":81.39,"gross_charge":100.47,"discounted_cash":29.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.1,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78206-0126-02","type":"NDC"}],"standard_charges":[{"minimum":33.59,"maximum":45.34,"gross_charge":55.97,"discounted_cash":16.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.59,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"78206-0126-02","type":"NDC"}],"standard_charges":[{"minimum":8.4,"maximum":45.34,"gross_charge":55.97,"discounted_cash":16.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":54.79,"maximum":73.97,"gross_charge":91.31,"discounted_cash":27.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.7,"maximum":73.97,"gross_charge":91.31,"discounted_cash":27.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":121.49,"maximum":164.01,"gross_charge":202.48,"discounted_cash":59.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.49,"methodology":"fee schedule"}]}]},{"description":"MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.38,"maximum":164.01,"gross_charge":202.48,"discounted_cash":59.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0575-15","type":"NDC"}],"standard_charges":[{"minimum":10.79,"maximum":14.57,"gross_charge":17.98,"discounted_cash":5.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.79,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0575-15","type":"NDC"}],"standard_charges":[{"minimum":2.7,"maximum":14.57,"gross_charge":17.98,"discounted_cash":5.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0248-05","type":"NDC"}],"standard_charges":[{"minimum":21.42,"maximum":28.91,"gross_charge":35.69,"discounted_cash":10.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0248-05","type":"NDC"}],"standard_charges":[{"minimum":5.36,"maximum":28.91,"gross_charge":35.69,"discounted_cash":10.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.65,"maximum":13.03,"gross_charge":16.08,"discounted_cash":4.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.42,"maximum":13.03,"gross_charge":16.08,"discounted_cash":4.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.59,"maximum":26.44,"gross_charge":32.64,"discounted_cash":9.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"}]}]},{"description":"MONTELUKAST 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.9,"maximum":26.44,"gross_charge":32.64,"discounted_cash":9.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.53,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0001-59","type":"NDC"}],"standard_charges":[{"minimum":0.71,"maximum":0.96,"gross_charge":1.18,"discounted_cash":0.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68094-0001-59","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.96,"gross_charge":1.18,"discounted_cash":0.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.45,"maximum":0.6,"gross_charge":0.74,"discounted_cash":0.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":0.6,"gross_charge":0.74,"discounted_cash":0.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.79,"maximum":1.07,"gross_charge":1.31,"discounted_cash":0.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":1.07,"gross_charge":1.31,"discounted_cash":0.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 15 MG IMMEDIATE RELEASE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.85,"maximum":60.55,"gross_charge":74.75,"discounted_cash":22.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.85,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 15 MG IMMEDIATE RELEASE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.22,"maximum":60.55,"gross_charge":74.75,"discounted_cash":22.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 30 MG IMMEDIATE RELEASE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":76.12,"maximum":102.76,"gross_charge":126.86,"discounted_cash":37.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 30 MG IMMEDIATE RELEASE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.03,"maximum":102.76,"gross_charge":126.86,"discounted_cash":37.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 100 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":47.85,"maximum":64.6,"gross_charge":79.75,"discounted_cash":23.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 100 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.97,"maximum":64.6,"gross_charge":79.75,"discounted_cash":23.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.95,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 100 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":170.94,"maximum":230.77,"gross_charge":284.89,"discounted_cash":84.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 100 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":42.74,"maximum":230.77,"gross_charge":284.89,"discounted_cash":84.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 15 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0403-01","type":"NDC"}],"standard_charges":[{"minimum":36.15,"maximum":48.8,"gross_charge":60.24,"discounted_cash":17.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 15 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0403-01","type":"NDC"}],"standard_charges":[{"minimum":9.04,"maximum":48.8,"gross_charge":60.24,"discounted_cash":17.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 15 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.37,"maximum":39.65,"gross_charge":48.94,"discounted_cash":14.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.37,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 15 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.35,"maximum":39.65,"gross_charge":48.94,"discounted_cash":14.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.79,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0802-01","type":"NDC"}],"standard_charges":[{"minimum":19.17,"maximum":25.88,"gross_charge":31.94,"discounted_cash":9.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42858-0802-01","type":"NDC"}],"standard_charges":[{"minimum":4.8,"maximum":25.88,"gross_charge":31.94,"discounted_cash":9.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.39,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0404-01","type":"NDC"}],"standard_charges":[{"minimum":49.77,"maximum":67.19,"gross_charge":82.95,"discounted_cash":24.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.77,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0404-01","type":"NDC"}],"standard_charges":[{"minimum":12.45,"maximum":67.19,"gross_charge":82.95,"discounted_cash":24.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.71,"maximum":79.26,"gross_charge":97.85,"discounted_cash":28.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.68,"maximum":79.26,"gross_charge":97.85,"discounted_cash":28.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.57,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":66.99,"maximum":90.44,"gross_charge":111.65,"discounted_cash":33.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"}]}]},{"description":"MORPHINE ER 30 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.75,"maximum":90.44,"gross_charge":111.65,"discounted_cash":33.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.33,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0643-01","type":"NDC"}],"standard_charges":[{"minimum":16.16,"maximum":21.82,"gross_charge":26.93,"discounted_cash":7.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.16,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0643-01","type":"NDC"}],"standard_charges":[{"minimum":4.04,"maximum":21.82,"gross_charge":26.93,"discounted_cash":7.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0582-04","type":"NDC"}],"standard_charges":[{"minimum":40.25,"maximum":54.34,"gross_charge":67.08,"discounted_cash":19.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0582-04","type":"NDC"}],"standard_charges":[{"minimum":10.07,"maximum":54.34,"gross_charge":67.08,"discounted_cash":19.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0840-03","type":"NDC"}],"standard_charges":[{"minimum":13.82,"maximum":18.65,"gross_charge":23.02,"discounted_cash":6.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0840-03","type":"NDC"}],"standard_charges":[{"minimum":3.46,"maximum":18.65,"gross_charge":23.02,"discounted_cash":6.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72266-0158-01","type":"NDC"}],"standard_charges":[{"minimum":6.94,"maximum":9.37,"gross_charge":11.56,"discounted_cash":3.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72266-0158-01","type":"NDC"}],"standard_charges":[{"minimum":1.74,"maximum":9.37,"gross_charge":11.56,"discounted_cash":3.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.42,"maximum":4.61,"gross_charge":5.69,"discounted_cash":1.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.42,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":4.61,"gross_charge":5.69,"discounted_cash":1.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.44,"maximum":20.85,"gross_charge":25.73,"discounted_cash":7.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"}]}]},{"description":"MOXIFLOXACIN 0.5 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.86,"maximum":20.85,"gross_charge":25.73,"discounted_cash":7.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.15,"methodology":"fee schedule"}]}]},{"description":"MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.33,"maximum":5.85,"gross_charge":7.21,"discounted_cash":2.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"}]}]},{"description":"MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.09,"maximum":5.85,"gross_charge":7.21,"discounted_cash":2.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"}]}]},{"description":"MULTIVITAMIN TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.82,"maximum":2.46,"gross_charge":3.03,"discounted_cash":0.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"}]}]},{"description":"MULTIVITAMIN TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.46,"maximum":2.46,"gross_charge":3.03,"discounted_cash":0.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"}]}]},{"description":"NABUMETONE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0358-01","type":"NDC"}],"standard_charges":[{"minimum":14.24,"maximum":19.23,"gross_charge":23.73,"discounted_cash":7.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.24,"methodology":"fee schedule"}]}]},{"description":"NABUMETONE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0358-01","type":"NDC"}],"standard_charges":[{"minimum":3.56,"maximum":19.23,"gross_charge":23.73,"discounted_cash":7.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"NABUMETONE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0965-07","type":"NDC"}],"standard_charges":[{"minimum":13.94,"maximum":18.82,"gross_charge":23.23,"discounted_cash":6.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"}]}]},{"description":"NABUMETONE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0965-07","type":"NDC"}],"standard_charges":[{"minimum":3.49,"maximum":18.82,"gross_charge":23.23,"discounted_cash":6.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"}]}]},{"description":"NABUMETONE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0965-12","type":"NDC"}],"standard_charges":[{"minimum":66.39,"maximum":89.63,"gross_charge":110.65,"discounted_cash":32.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.39,"methodology":"fee schedule"}]}]},{"description":"NABUMETONE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0965-12","type":"NDC"}],"standard_charges":[{"minimum":16.6,"maximum":89.63,"gross_charge":110.65,"discounted_cash":32.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.13,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0812-01","type":"NDC"}],"standard_charges":[{"minimum":2.91,"maximum":3.93,"gross_charge":4.85,"discounted_cash":1.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0812-01","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":3.93,"gross_charge":4.85,"discounted_cash":1.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0302-25","type":"NDC"}],"standard_charges":[{"minimum":51.45,"maximum":69.45,"gross_charge":85.74,"discounted_cash":25.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.45,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0302-25","type":"NDC"}],"standard_charges":[{"minimum":12.87,"maximum":69.45,"gross_charge":85.74,"discounted_cash":25.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.15,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0302-95","type":"NDC"}],"standard_charges":[{"minimum":1.79,"maximum":2.42,"gross_charge":2.98,"discounted_cash":0.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0302-95","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":2.42,"gross_charge":2.98,"discounted_cash":0.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1123-09","type":"NDC"}],"standard_charges":[{"minimum":15.48,"maximum":20.89,"gross_charge":25.79,"discounted_cash":7.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1123-09","type":"NDC"}],"standard_charges":[{"minimum":3.87,"maximum":20.89,"gross_charge":25.79,"discounted_cash":7.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":31.37,"maximum":42.35,"gross_charge":52.28,"discounted_cash":15.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.37,"methodology":"fee schedule"}]}]},{"description":"NADOLOL 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.85,"maximum":42.35,"gross_charge":52.28,"discounted_cash":15.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57841-1300-01","type":"NDC"}],"standard_charges":[{"minimum":204.82,"maximum":276.51,"gross_charge":341.36,"discounted_cash":101.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.82,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57841-1300-01","type":"NDC"}],"standard_charges":[{"minimum":51.21,"maximum":276.51,"gross_charge":341.36,"discounted_cash":101.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.28,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 12.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":192.72,"maximum":260.18,"gross_charge":321.2,"discounted_cash":95.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.72,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 12.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":48.18,"maximum":260.18,"gross_charge":321.2,"discounted_cash":95.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.24,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57841-1301-03","type":"NDC"}],"standard_charges":[{"minimum":682.55,"maximum":921.44,"gross_charge":1137.57,"discounted_cash":336.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":921.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":921.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":921.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":682.55,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57841-1301-03","type":"NDC"}],"standard_charges":[{"minimum":170.64,"maximum":921.44,"gross_charge":1137.57,"discounted_cash":336.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":921.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":921.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":921.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":682.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.52,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"82625-8802-03","type":"NDC"}],"standard_charges":[{"minimum":760.8,"maximum":1027.08,"gross_charge":1268,"discounted_cash":375.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":760.8,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"82625-8802-03","type":"NDC"}],"standard_charges":[{"minimum":190.2,"maximum":1027.08,"gross_charge":1268,"discounted_cash":375.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1027.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":760.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":253.6,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":642.21,"maximum":866.99,"gross_charge":1070.35,"discounted_cash":316.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":866.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":866.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":866.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":642.21,"methodology":"fee schedule"}]}]},{"description":"NALOXEGOL 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":160.56,"maximum":866.99,"gross_charge":1070.35,"discounted_cash":316.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":866.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":866.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":866.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":642.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":214.07,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0326-83","type":"NDC"}],"standard_charges":[{"minimum":20.75,"maximum":28.01,"gross_charge":34.58,"discounted_cash":10.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.75,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0326-83","type":"NDC"}],"standard_charges":[{"minimum":5.19,"maximum":28.01,"gross_charge":34.58,"discounted_cash":10.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.92,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0291-21","type":"NDC"}],"standard_charges":[{"minimum":44.55,"maximum":60.15,"gross_charge":74.25,"discounted_cash":21.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0291-21","type":"NDC"}],"standard_charges":[{"minimum":11.14,"maximum":60.15,"gross_charge":74.25,"discounted_cash":21.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.58,"maximum":23.74,"gross_charge":29.3,"discounted_cash":8.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.4,"maximum":23.74,"gross_charge":29.3,"discounted_cash":8.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.61,"maximum":37.27,"gross_charge":46.01,"discounted_cash":13.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"}]}]},{"description":"NALTREXONE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.91,"maximum":37.27,"gross_charge":46.01,"discounted_cash":13.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"}]}]},{"description":"NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.74,"maximum":2.35,"gross_charge":2.9,"discounted_cash":0.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"}]}]},{"description":"NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.44,"maximum":2.35,"gross_charge":2.9,"discounted_cash":0.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.79,"maximum":6.47,"gross_charge":7.98,"discounted_cash":2.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"}]}]},{"description":"NAPHAZOLINE 0.025 %-PHENIRAMINE 0.3 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":6.47,"gross_charge":7.98,"discounted_cash":2.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"}]}]},{"description":"NATEGLINIDE 120 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0329-90","type":"NDC"}],"standard_charges":[{"minimum":25.79,"maximum":34.82,"gross_charge":42.98,"discounted_cash":12.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"}]}]},{"description":"NATEGLINIDE 120 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0329-90","type":"NDC"}],"standard_charges":[{"minimum":6.45,"maximum":34.82,"gross_charge":42.98,"discounted_cash":12.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"}]}]},{"description":"NATEGLINIDE 120 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0722-16","type":"NDC"}],"standard_charges":[{"minimum":27.63,"maximum":37.3,"gross_charge":46.04,"discounted_cash":13.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"}]}]},{"description":"NATEGLINIDE 120 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0722-16","type":"NDC"}],"standard_charges":[{"minimum":6.91,"maximum":37.3,"gross_charge":46.04,"discounted_cash":13.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0587-30","type":"NDC"}],"standard_charges":[{"minimum":7.61,"maximum":10.27,"gross_charge":12.67,"discounted_cash":3.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0587-30","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":10.27,"gross_charge":12.67,"discounted_cash":3.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0139-30","type":"NDC"}],"standard_charges":[{"minimum":3.9,"maximum":5.26,"gross_charge":6.49,"discounted_cash":1.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0139-30","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":5.26,"gross_charge":6.49,"discounted_cash":1.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":41.36,"maximum":55.84,"gross_charge":68.93,"discounted_cash":20.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.36,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.34,"maximum":55.84,"gross_charge":68.93,"discounted_cash":20.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.52,"maximum":39.86,"gross_charge":49.2,"discounted_cash":14.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.38,"maximum":39.86,"gross_charge":49.2,"discounted_cash":14.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":42.19,"maximum":56.96,"gross_charge":70.31,"discounted_cash":20.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.19,"methodology":"fee schedule"}]}]},{"description":"NEBIVOLOL 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.55,"maximum":56.96,"gross_charge":70.31,"discounted_cash":20.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"}]}]},{"description":"NEOMYCIN 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":45.69,"maximum":61.69,"gross_charge":76.15,"discounted_cash":22.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.69,"methodology":"fee schedule"}]}]},{"description":"NEOMYCIN 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.43,"maximum":61.69,"gross_charge":76.15,"discounted_cash":22.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"}]}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10000 UNIT/ML-0.1% EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0830-60","type":"NDC"}],"standard_charges":[{"minimum":8.04,"maximum":10.86,"gross_charge":13.4,"discounted_cash":3.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"}]}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10000 UNIT/ML-0.1% EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0830-60","type":"NDC"}],"standard_charges":[{"minimum":2.01,"maximum":10.86,"gross_charge":13.4,"discounted_cash":3.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"}]}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10000 UNIT/ML-0.1% EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0630-06","type":"NDC"}],"standard_charges":[{"minimum":5.42,"maximum":7.32,"gross_charge":9.03,"discounted_cash":2.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"}]}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10000 UNIT/ML-0.1% EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0630-06","type":"NDC"}],"standard_charges":[{"minimum":1.36,"maximum":7.32,"gross_charge":9.03,"discounted_cash":2.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0501-09","type":"NDC"}],"standard_charges":[{"minimum":164.82,"maximum":222.5,"gross_charge":274.69,"discounted_cash":81.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":222.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":222.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":222.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.82,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0501-09","type":"NDC"}],"standard_charges":[{"minimum":41.21,"maximum":222.5,"gross_charge":274.69,"discounted_cash":81.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":222.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":222.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":222.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0205-90","type":"NDC"}],"standard_charges":[{"minimum":430.82,"maximum":581.61,"gross_charge":718.03,"discounted_cash":212.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":581.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":581.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":430.82,"methodology":"fee schedule"}]}]},{"description":"NICARDIPINE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0205-90","type":"NDC"}],"standard_charges":[{"minimum":107.71,"maximum":581.61,"gross_charge":718.03,"discounted_cash":212.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":581.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":581.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":581.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":430.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.61,"methodology":"fee schedule"}]}]},{"description":"NICOTINE (POLACRILEX) 4 MG GUM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.79,"maximum":24.01,"gross_charge":29.64,"discounted_cash":8.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"}]}]},{"description":"NICOTINE (POLACRILEX) 4 MG GUM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.45,"maximum":24.01,"gross_charge":29.64,"discounted_cash":8.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.85,"maximum":14.64,"gross_charge":18.07,"discounted_cash":5.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.72,"maximum":14.64,"gross_charge":18.07,"discounted_cash":5.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7063-00","type":"NDC"}],"standard_charges":[{"minimum":1.19,"maximum":1.61,"gross_charge":1.98,"discounted_cash":0.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7063-00","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":1.61,"gross_charge":1.98,"discounted_cash":0.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.14,"maximum":15.04,"gross_charge":18.56,"discounted_cash":5.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.79,"maximum":15.04,"gross_charge":18.56,"discounted_cash":5.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7061-00","type":"NDC"}],"standard_charges":[{"minimum":0.93,"maximum":1.26,"gross_charge":1.55,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-7061-00","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":1.26,"gross_charge":1.55,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.68,"maximum":17.11,"gross_charge":21.12,"discounted_cash":6.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.17,"maximum":17.11,"gross_charge":21.12,"discounted_cash":6.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0211-01","type":"NDC"}],"standard_charges":[{"minimum":170.52,"maximum":230.2,"gross_charge":284.19,"discounted_cash":84.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.52,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0211-01","type":"NDC"}],"standard_charges":[{"minimum":42.63,"maximum":230.2,"gross_charge":284.19,"discounted_cash":84.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.84,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 30 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.5,"maximum":38.47,"gross_charge":47.49,"discounted_cash":14.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 30 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.13,"maximum":38.47,"gross_charge":47.49,"discounted_cash":14.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 30 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":56.25,"maximum":75.94,"gross_charge":93.75,"discounted_cash":27.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.25,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 30 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.07,"maximum":75.94,"gross_charge":93.75,"discounted_cash":27.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 60 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0598-01","type":"NDC"}],"standard_charges":[{"minimum":129.05,"maximum":174.22,"gross_charge":215.08,"discounted_cash":63.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.05,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 60 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0598-01","type":"NDC"}],"standard_charges":[{"minimum":32.27,"maximum":174.22,"gross_charge":215.08,"discounted_cash":63.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 60 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.43,"maximum":39.73,"gross_charge":49.04,"discounted_cash":14.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.43,"methodology":"fee schedule"}]}]},{"description":"NIFEDIPINE ER 60 MG TABLETEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.36,"maximum":39.73,"gross_charge":49.04,"discounted_cash":14.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"}]}]},{"description":"NILOTINIB HCL 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2362.5,"maximum":3189.38,"gross_charge":3937.5,"discounted_cash":1165.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3189.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3189.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3189.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2362.5,"methodology":"fee schedule"}]}]},{"description":"NILOTINIB HCL 200 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":590.63,"maximum":3189.38,"gross_charge":3937.5,"discounted_cash":1165.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3189.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3189.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3189.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2362.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":748.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":590.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":787.5,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0512-00","type":"NDC"}],"standard_charges":[{"minimum":57.39,"maximum":77.48,"gross_charge":95.65,"discounted_cash":28.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0512-00","type":"NDC"}],"standard_charges":[{"minimum":14.35,"maximum":77.48,"gross_charge":95.65,"discounted_cash":28.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0210-52","type":"NDC"}],"standard_charges":[{"minimum":7.22,"maximum":9.74,"gross_charge":12.02,"discounted_cash":3.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0210-52","type":"NDC"}],"standard_charges":[{"minimum":1.81,"maximum":9.74,"gross_charge":12.02,"discounted_cash":3.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0209-13","type":"NDC"}],"standard_charges":[{"minimum":16.09,"maximum":21.72,"gross_charge":26.81,"discounted_cash":7.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69452-0209-13","type":"NDC"}],"standard_charges":[{"minimum":4.03,"maximum":21.72,"gross_charge":26.81,"discounted_cash":7.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG/ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.68,"maximum":0.92,"gross_charge":1.13,"discounted_cash":0.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG/ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":0.92,"gross_charge":1.13,"discounted_cash":0.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG/ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.28,"maximum":1.73,"gross_charge":2.13,"discounted_cash":0.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"}]}]},{"description":"NIMODIPINE 30 MG/ML ORAL LIQUID","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":1.73,"gross_charge":2.13,"discounted_cash":0.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 150 MG (RENAL DOSING) - RITONAVIR 100 MG TABLETS IN A DOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":79.85,"maximum":107.79,"gross_charge":133.07,"discounted_cash":39.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.85,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 150 MG (RENAL DOSING) - RITONAVIR 100 MG TABLETS IN A DOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.97,"maximum":107.79,"gross_charge":133.07,"discounted_cash":39.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.62,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 150 MG (RENAL DOSING) - RITONAVIR 100 MG TABLETS IN A DOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":797.7,"maximum":1076.89,"gross_charge":1329.49,"discounted_cash":393.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":797.7,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 150 MG (RENAL DOSING) - RITONAVIR 100 MG TABLETS IN A DOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":199.43,"maximum":1076.89,"gross_charge":1329.49,"discounted_cash":393.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1076.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1076.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1076.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":797.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":252.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":265.9,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLETDOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":76.41,"maximum":103.15,"gross_charge":127.34,"discounted_cash":37.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLETDOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.11,"maximum":103.15,"gross_charge":127.34,"discounted_cash":37.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLETDOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":763.35,"maximum":1030.53,"gross_charge":1272.25,"discounted_cash":376.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1030.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1030.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1030.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":763.35,"methodology":"fee schedule"}]}]},{"description":"NIRMATRELVIR 300 MG (150 MG X2)-RITONAVIR 100 MG TABLETDOSE PACK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":190.84,"maximum":1030.53,"gross_charge":1272.25,"discounted_cash":376.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1030.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1030.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1030.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":763.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":254.45,"methodology":"fee schedule"}]}]},{"description":"NITAZOXANIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0526-03","type":"NDC"}],"standard_charges":[{"minimum":1958.34,"maximum":2643.76,"gross_charge":3263.89,"discounted_cash":966.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2643.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2643.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2643.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1958.34,"methodology":"fee schedule"}]}]},{"description":"NITAZOXANIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0526-03","type":"NDC"}],"standard_charges":[{"minimum":489.59,"maximum":2643.76,"gross_charge":3263.89,"discounted_cash":966.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2643.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2643.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2643.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1958.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":620.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.78,"methodology":"fee schedule"}]}]},{"description":"NITAZOXANIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0526-60","type":"NDC"}],"standard_charges":[{"minimum":387.19,"maximum":522.71,"gross_charge":645.31,"discounted_cash":191.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":522.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.19,"methodology":"fee schedule"}]}]},{"description":"NITAZOXANIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0526-60","type":"NDC"}],"standard_charges":[{"minimum":96.8,"maximum":522.71,"gross_charge":645.31,"discounted_cash":191.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":522.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":522.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":522.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.07,"methodology":"fee schedule"}]}]},{"description":"NITAZOXANIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67546-0111-12","type":"NDC"}],"standard_charges":[{"minimum":2217.97,"maximum":2994.26,"gross_charge":3696.61,"discounted_cash":1094.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2994.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2994.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2994.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2217.97,"methodology":"fee schedule"}]}]},{"description":"NITAZOXANIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67546-0111-12","type":"NDC"}],"standard_charges":[{"minimum":554.5,"maximum":2994.26,"gross_charge":3696.61,"discounted_cash":1094.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2994.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2994.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2994.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2217.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":702.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":554.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.33,"methodology":"fee schedule"}]}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0307-01","type":"NDC"}],"standard_charges":[{"minimum":32.25,"maximum":43.53,"gross_charge":53.74,"discounted_cash":15.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.25,"methodology":"fee schedule"}]}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0307-01","type":"NDC"}],"standard_charges":[{"minimum":8.07,"maximum":43.53,"gross_charge":53.74,"discounted_cash":15.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"}]}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0001-00","type":"NDC"}],"standard_charges":[{"minimum":49.29,"maximum":66.55,"gross_charge":82.15,"discounted_cash":24.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"}]}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0001-00","type":"NDC"}],"standard_charges":[{"minimum":12.33,"maximum":66.55,"gross_charge":82.15,"discounted_cash":24.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"}]}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0446-11","type":"NDC"}],"standard_charges":[{"minimum":149.27,"maximum":201.52,"gross_charge":248.78,"discounted_cash":73.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.27,"methodology":"fee schedule"}]}]},{"description":"NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0446-11","type":"NDC"}],"standard_charges":[{"minimum":37.32,"maximum":201.52,"gross_charge":248.78,"discounted_cash":73.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0296-03","type":"NDC"}],"standard_charges":[{"minimum":9.03,"maximum":12.19,"gross_charge":15.04,"discounted_cash":4.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0296-03","type":"NDC"}],"standard_charges":[{"minimum":2.26,"maximum":12.19,"gross_charge":15.04,"discounted_cash":4.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.34,"maximum":0.46,"gross_charge":0.56,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.09,"maximum":0.46,"gross_charge":0.56,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49730-0111-30","type":"NDC"}],"standard_charges":[{"minimum":11.89,"maximum":16.05,"gross_charge":19.81,"discounted_cash":5.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49730-0111-30","type":"NDC"}],"standard_charges":[{"minimum":2.98,"maximum":16.05,"gross_charge":19.81,"discounted_cash":5.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0309-30","type":"NDC"}],"standard_charges":[{"minimum":11.71,"maximum":15.81,"gross_charge":19.51,"discounted_cash":5.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0309-30","type":"NDC"}],"standard_charges":[{"minimum":2.93,"maximum":15.81,"gross_charge":19.51,"discounted_cash":5.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.33,"maximum":8.54,"gross_charge":10.54,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.59,"maximum":8.54,"gross_charge":10.54,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.24,"maximum":15.18,"gross_charge":18.73,"discounted_cash":5.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.81,"maximum":15.18,"gross_charge":18.73,"discounted_cash":5.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0515-01","type":"NDC"}],"standard_charges":[{"minimum":29.18,"maximum":39.39,"gross_charge":48.62,"discounted_cash":14.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.18,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.3 MG/HR TRANSDERMAL 24 HOUR PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0515-01","type":"NDC"}],"standard_charges":[{"minimum":7.3,"maximum":39.39,"gross_charge":48.62,"discounted_cash":14.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-3304-03","type":"NDC"}],"standard_charges":[{"minimum":5.26,"maximum":7.1,"gross_charge":8.76,"discounted_cash":2.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-3304-03","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":7.1,"gross_charge":8.76,"discounted_cash":2.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0639-45","type":"NDC"}],"standard_charges":[{"minimum":1.6,"maximum":2.16,"gross_charge":2.66,"discounted_cash":0.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0639-45","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":2.16,"gross_charge":2.66,"discounted_cash":0.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0266-04","type":"NDC"}],"standard_charges":[{"minimum":1.63,"maximum":2.2,"gross_charge":2.71,"discounted_cash":0.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0266-04","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":2.2,"gross_charge":2.71,"discounted_cash":0.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.84,"maximum":26.78,"gross_charge":33.06,"discounted_cash":9.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.96,"maximum":26.78,"gross_charge":33.06,"discounted_cash":9.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 2 % TRANSDERMAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.29,"maximum":1.75,"gross_charge":2.15,"discounted_cash":0.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 2 % TRANSDERMAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.33,"maximum":1.75,"gross_charge":2.15,"discounted_cash":0.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"28595-0120-49","type":"NDC"}],"standard_charges":[{"minimum":72.57,"maximum":97.97,"gross_charge":120.94,"discounted_cash":35.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.57,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"28595-0120-49","type":"NDC"}],"standard_charges":[{"minimum":18.15,"maximum":97.97,"gross_charge":120.94,"discounted_cash":35.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.19,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0210-01","type":"NDC"}],"standard_charges":[{"minimum":57.92,"maximum":78.19,"gross_charge":96.52,"discounted_cash":28.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.92,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0210-01","type":"NDC"}],"standard_charges":[{"minimum":14.48,"maximum":78.19,"gross_charge":96.52,"discounted_cash":28.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0241-50","type":"NDC"}],"standard_charges":[{"minimum":57.93,"maximum":78.2,"gross_charge":96.54,"discounted_cash":28.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0241-50","type":"NDC"}],"standard_charges":[{"minimum":14.49,"maximum":78.2,"gross_charge":96.54,"discounted_cash":28.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70003-0300-65","type":"NDC"}],"standard_charges":[{"minimum":102.83,"maximum":138.81,"gross_charge":171.37,"discounted_cash":50.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.83,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70003-0300-65","type":"NDC"}],"standard_charges":[{"minimum":25.71,"maximum":138.81,"gross_charge":171.37,"discounted_cash":50.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.28,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN ER 2.5 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.39,"maximum":24.82,"gross_charge":30.64,"discounted_cash":9.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN ER 2.5 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.6,"maximum":24.82,"gross_charge":30.64,"discounted_cash":9.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN ER 6.5 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.39,"maximum":28.87,"gross_charge":35.64,"discounted_cash":10.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.39,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN ER 6.5 MG CAPSULEEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.35,"maximum":28.87,"gross_charge":35.64,"discounted_cash":10.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.13,"methodology":"fee schedule"}]}]},{"description":"NORETHINDRONE ACETATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0304-50","type":"NDC"}],"standard_charges":[{"minimum":17.82,"maximum":24.05,"gross_charge":29.69,"discounted_cash":8.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"}]}]},{"description":"NORETHINDRONE ACETATE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0304-50","type":"NDC"}],"standard_charges":[{"minimum":4.46,"maximum":24.05,"gross_charge":29.69,"discounted_cash":8.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0059-11","type":"NDC"}],"standard_charges":[{"minimum":3.77,"maximum":5.09,"gross_charge":6.28,"discounted_cash":1.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0059-11","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":5.09,"gross_charge":6.28,"discounted_cash":1.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.77,"maximum":7.79,"gross_charge":9.61,"discounted_cash":2.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.45,"maximum":7.79,"gross_charge":9.61,"discounted_cash":2.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.06,"maximum":14.93,"gross_charge":18.43,"discounted_cash":5.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.77,"maximum":14.93,"gross_charge":18.43,"discounted_cash":5.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.62,"maximum":15.69,"gross_charge":19.36,"discounted_cash":5.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.91,"maximum":15.69,"gross_charge":19.36,"discounted_cash":5.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.5,"maximum":16.88,"gross_charge":20.83,"discounted_cash":6.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.13,"maximum":16.88,"gross_charge":20.83,"discounted_cash":6.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.17,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.68,"maximum":17.12,"gross_charge":21.13,"discounted_cash":6.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.17,"maximum":17.12,"gross_charge":21.13,"discounted_cash":6.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0769-01","type":"NDC"}],"standard_charges":[{"minimum":1.85,"maximum":2.49,"gross_charge":3.07,"discounted_cash":0.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0769-01","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":2.49,"gross_charge":3.07,"discounted_cash":0.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42543-0052-61","type":"NDC"}],"standard_charges":[{"minimum":2.43,"maximum":3.29,"gross_charge":4.05,"discounted_cash":1.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42543-0052-61","type":"NDC"}],"standard_charges":[{"minimum":0.61,"maximum":3.29,"gross_charge":4.05,"discounted_cash":1.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42543-0352-15","type":"NDC"}],"standard_charges":[{"minimum":3.63,"maximum":4.9,"gross_charge":6.04,"discounted_cash":1.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42543-0352-15","type":"NDC"}],"standard_charges":[{"minimum":0.91,"maximum":4.9,"gross_charge":6.04,"discounted_cash":1.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68308-0152-15","type":"NDC"}],"standard_charges":[{"minimum":4.22,"maximum":5.7,"gross_charge":7.03,"discounted_cash":2.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68308-0152-15","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":5.7,"gross_charge":7.03,"discounted_cash":2.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0370-01","type":"NDC"}],"standard_charges":[{"minimum":4.29,"maximum":5.79,"gross_charge":7.14,"discounted_cash":2.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0370-01","type":"NDC"}],"standard_charges":[{"minimum":1.08,"maximum":5.79,"gross_charge":7.14,"discounted_cash":2.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0306-15","type":"NDC"}],"standard_charges":[{"minimum":4.38,"maximum":5.91,"gross_charge":7.29,"discounted_cash":2.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69315-0306-15","type":"NDC"}],"standard_charges":[{"minimum":1.1,"maximum":5.91,"gross_charge":7.29,"discounted_cash":2.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.64,"maximum":7.61,"gross_charge":9.39,"discounted_cash":2.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.41,"maximum":7.61,"gross_charge":9.39,"discounted_cash":2.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.55,"maximum":15.59,"gross_charge":19.24,"discounted_cash":5.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOPICAL POWDER","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.89,"maximum":15.59,"gross_charge":19.24,"discounted_cash":5.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0800-40","type":"NDC"}],"standard_charges":[{"minimum":0.74,"maximum":0.99,"gross_charge":1.22,"discounted_cash":0.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0800-40","type":"NDC"}],"standard_charges":[{"minimum":0.19,"maximum":0.99,"gross_charge":1.22,"discounted_cash":0.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0037-01","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":0.8,"gross_charge":0.98,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0037-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.8,"gross_charge":0.98,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":1.09,"gross_charge":1.34,"discounted_cash":0.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.21,"maximum":1.09,"gross_charge":1.34,"discounted_cash":0.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0880-94","type":"NDC"}],"standard_charges":[{"minimum":3.27,"maximum":4.41,"gross_charge":5.44,"discounted_cash":1.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0880-94","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":4.41,"gross_charge":5.44,"discounted_cash":1.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1263-02","type":"NDC"}],"standard_charges":[{"minimum":16.2,"maximum":21.87,"gross_charge":26.99,"discounted_cash":7.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1263-02","type":"NDC"}],"standard_charges":[{"minimum":4.05,"maximum":21.87,"gross_charge":26.99,"discounted_cash":7.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8689-01","type":"NDC"}],"standard_charges":[{"minimum":19.08,"maximum":25.75,"gross_charge":31.79,"discounted_cash":9.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63629-8689-01","type":"NDC"}],"standard_charges":[{"minimum":4.77,"maximum":25.75,"gross_charge":31.79,"discounted_cash":9.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0545-02","type":"NDC"}],"standard_charges":[{"minimum":42.84,"maximum":57.83,"gross_charge":71.39,"discounted_cash":21.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0545-02","type":"NDC"}],"standard_charges":[{"minimum":10.71,"maximum":57.83,"gross_charge":71.39,"discounted_cash":21.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0314-35","type":"NDC"}],"standard_charges":[{"minimum":14.03,"maximum":18.94,"gross_charge":23.38,"discounted_cash":6.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0314-35","type":"NDC"}],"standard_charges":[{"minimum":3.51,"maximum":18.94,"gross_charge":23.38,"discounted_cash":6.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":76.67,"maximum":103.51,"gross_charge":127.78,"discounted_cash":37.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.67,"methodology":"fee schedule"}]}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000 UNIT/G-0.1 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.17,"maximum":103.51,"gross_charge":127.78,"discounted_cash":37.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.56,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0713-10","type":"NDC"}],"standard_charges":[{"minimum":3.9,"maximum":5.27,"gross_charge":6.5,"discounted_cash":1.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0713-10","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":5.27,"gross_charge":6.5,"discounted_cash":1.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0713-11","type":"NDC"}],"standard_charges":[{"minimum":7.4,"maximum":9.99,"gross_charge":12.33,"discounted_cash":3.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0713-11","type":"NDC"}],"standard_charges":[{"minimum":1.85,"maximum":9.99,"gross_charge":12.33,"discounted_cash":3.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0515-05","type":"NDC"}],"standard_charges":[{"minimum":7.91,"maximum":10.67,"gross_charge":13.17,"discounted_cash":3.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64980-0515-05","type":"NDC"}],"standard_charges":[{"minimum":1.98,"maximum":10.67,"gross_charge":13.17,"discounted_cash":3.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70756-0607-30","type":"NDC"}],"standard_charges":[{"minimum":8.95,"maximum":12.08,"gross_charge":14.91,"discounted_cash":4.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"}]}]},{"description":"OFLOXACIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70756-0607-30","type":"NDC"}],"standard_charges":[{"minimum":2.24,"maximum":12.08,"gross_charge":14.91,"discounted_cash":4.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0380-90","type":"NDC"}],"standard_charges":[{"minimum":4.24,"maximum":5.72,"gross_charge":7.06,"discounted_cash":2.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0380-90","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":5.72,"gross_charge":7.06,"discounted_cash":2.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0086-30","type":"NDC"}],"standard_charges":[{"minimum":32.45,"maximum":43.81,"gross_charge":54.08,"discounted_cash":16.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.45,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0086-30","type":"NDC"}],"standard_charges":[{"minimum":8.12,"maximum":43.81,"gross_charge":54.08,"discounted_cash":16.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0320-55","type":"NDC"}],"standard_charges":[{"minimum":10.2,"maximum":13.77,"gross_charge":16.99,"discounted_cash":5.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0320-55","type":"NDC"}],"standard_charges":[{"minimum":2.55,"maximum":13.77,"gross_charge":16.99,"discounted_cash":5.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0615-13","type":"NDC"}],"standard_charges":[{"minimum":32.87,"maximum":44.37,"gross_charge":54.77,"discounted_cash":16.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.87,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0615-13","type":"NDC"}],"standard_charges":[{"minimum":8.22,"maximum":44.37,"gross_charge":54.77,"discounted_cash":16.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0262-81","type":"NDC"}],"standard_charges":[{"minimum":12.75,"maximum":17.22,"gross_charge":21.25,"discounted_cash":6.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0262-81","type":"NDC"}],"standard_charges":[{"minimum":3.19,"maximum":17.22,"gross_charge":21.25,"discounted_cash":6.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.25,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0306-32","type":"NDC"}],"standard_charges":[{"minimum":14.18,"maximum":19.14,"gross_charge":23.62,"discounted_cash":7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0306-32","type":"NDC"}],"standard_charges":[{"minimum":3.55,"maximum":19.14,"gross_charge":23.62,"discounted_cash":7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-3275-00","type":"NDC"}],"standard_charges":[{"minimum":22.41,"maximum":30.25,"gross_charge":37.34,"discounted_cash":11.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-3275-00","type":"NDC"}],"standard_charges":[{"minimum":5.61,"maximum":30.25,"gross_charge":37.34,"discounted_cash":11.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.13,"maximum":1.53,"gross_charge":1.88,"discounted_cash":0.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":1.53,"gross_charge":1.88,"discounted_cash":0.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":31.57,"maximum":42.62,"gross_charge":52.61,"discounted_cash":15.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.57,"methodology":"fee schedule"}]}]},{"description":"OLANZAPINE 5 MG DISINTEGRATING TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.9,"maximum":42.62,"gross_charge":52.61,"discounted_cash":15.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0630-31","type":"NDC"}],"standard_charges":[{"minimum":5.37,"maximum":7.25,"gross_charge":8.95,"discounted_cash":2.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0630-31","type":"NDC"}],"standard_charges":[{"minimum":1.35,"maximum":7.25,"gross_charge":8.95,"discounted_cash":2.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0256-66","type":"NDC"}],"standard_charges":[{"minimum":4.3,"maximum":5.8,"gross_charge":7.16,"discounted_cash":2.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0256-66","type":"NDC"}],"standard_charges":[{"minimum":1.08,"maximum":5.8,"gross_charge":7.16,"discounted_cash":2.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0468-13","type":"NDC"}],"standard_charges":[{"minimum":15.38,"maximum":20.76,"gross_charge":25.62,"discounted_cash":7.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0468-13","type":"NDC"}],"standard_charges":[{"minimum":3.85,"maximum":20.76,"gross_charge":25.62,"discounted_cash":7.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0797-01","type":"NDC"}],"standard_charges":[{"minimum":7.28,"maximum":9.83,"gross_charge":12.13,"discounted_cash":3.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0797-01","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":9.83,"gross_charge":12.13,"discounted_cash":3.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.43,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0675-11","type":"NDC"}],"standard_charges":[{"minimum":3.95,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0675-11","type":"NDC"}],"standard_charges":[{"minimum":0.99,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1264-01","type":"NDC"}],"standard_charges":[{"minimum":28.78,"maximum":38.85,"gross_charge":47.96,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.78,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1264-01","type":"NDC"}],"standard_charges":[{"minimum":7.2,"maximum":38.85,"gross_charge":47.96,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.46,"maximum":23.57,"gross_charge":29.09,"discounted_cash":8.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.37,"maximum":23.57,"gross_charge":29.09,"discounted_cash":8.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":83.48,"maximum":112.69,"gross_charge":139.12,"discounted_cash":41.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.48,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 6 MG/ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.87,"maximum":112.69,"gross_charge":139.12,"discounted_cash":41.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.83,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0415-10","type":"NDC"}],"standard_charges":[{"minimum":48.09,"maximum":64.92,"gross_charge":80.14,"discounted_cash":23.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0415-10","type":"NDC"}],"standard_charges":[{"minimum":12.03,"maximum":64.92,"gross_charge":80.14,"discounted_cash":23.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0677-11","type":"NDC"}],"standard_charges":[{"minimum":5.72,"maximum":7.72,"gross_charge":9.52,"discounted_cash":2.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0677-11","type":"NDC"}],"standard_charges":[{"minimum":1.43,"maximum":7.72,"gross_charge":9.52,"discounted_cash":2.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1266-01","type":"NDC"}],"standard_charges":[{"minimum":31.38,"maximum":42.37,"gross_charge":52.3,"discounted_cash":15.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.38,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1266-01","type":"NDC"}],"standard_charges":[{"minimum":7.85,"maximum":42.37,"gross_charge":52.3,"discounted_cash":15.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0044-11","type":"NDC"}],"standard_charges":[{"minimum":4.56,"maximum":6.15,"gross_charge":7.59,"discounted_cash":2.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"}]}]},{"description":"OSELTAMIVIR 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0044-11","type":"NDC"}],"standard_charges":[{"minimum":1.14,"maximum":6.15,"gross_charge":7.59,"discounted_cash":2.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"OXANDROLONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0302-02","type":"NDC"}],"standard_charges":[{"minimum":282.06,"maximum":380.78,"gross_charge":470.09,"discounted_cash":139.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":282.06,"methodology":"fee schedule"}]}]},{"description":"OXANDROLONE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0302-02","type":"NDC"}],"standard_charges":[{"minimum":70.52,"maximum":380.78,"gross_charge":470.09,"discounted_cash":139.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":282.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.02,"methodology":"fee schedule"}]}]},{"description":"OXCARBAZEPINE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0184-88","type":"NDC"}],"standard_charges":[{"minimum":33.09,"maximum":44.67,"gross_charge":55.14,"discounted_cash":16.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.09,"methodology":"fee schedule"}]}]},{"description":"OXCARBAZEPINE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0184-88","type":"NDC"}],"standard_charges":[{"minimum":8.28,"maximum":44.67,"gross_charge":55.14,"discounted_cash":16.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"OXCARBAZEPINE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0138-01","type":"NDC"}],"standard_charges":[{"minimum":9.14,"maximum":12.34,"gross_charge":15.23,"discounted_cash":4.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"}]}]},{"description":"OXCARBAZEPINE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0138-01","type":"NDC"}],"standard_charges":[{"minimum":2.29,"maximum":12.34,"gross_charge":15.23,"discounted_cash":4.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"OXCARBAZEPINE 300 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":43.47,"maximum":58.69,"gross_charge":72.45,"discounted_cash":21.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.47,"methodology":"fee schedule"}]}]},{"description":"OXCARBAZEPINE 300 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.87,"maximum":58.69,"gross_charge":72.45,"discounted_cash":21.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"}]}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0480-11","type":"NDC"}],"standard_charges":[{"minimum":0.71,"maximum":0.95,"gross_charge":1.17,"discounted_cash":0.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG TABLETEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0480-11","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.95,"gross_charge":1.17,"discounted_cash":0.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.18,"maximum":4.29,"gross_charge":5.29,"discounted_cash":1.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"}]}]},{"description":"OXYCHLOROSENE SODIUM TOPICAL POWDER FOR SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":4.29,"gross_charge":5.29,"discounted_cash":1.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0184-11","type":"NDC"}],"standard_charges":[{"minimum":32.97,"maximum":44.51,"gross_charge":54.94,"discounted_cash":16.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.97,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0184-11","type":"NDC"}],"standard_charges":[{"minimum":8.25,"maximum":44.51,"gross_charge":54.94,"discounted_cash":16.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 15 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":36.03,"maximum":48.64,"gross_charge":60.04,"discounted_cash":17.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.03,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 15 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.01,"maximum":48.64,"gross_charge":60.04,"discounted_cash":17.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 15 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":40.05,"maximum":54.06,"gross_charge":66.74,"discounted_cash":19.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 15 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.02,"maximum":54.06,"gross_charge":66.74,"discounted_cash":19.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 20 MG/ML ORAL CONCENTRATE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0920-60","type":"NDC"}],"standard_charges":[{"minimum":67.23,"maximum":90.77,"gross_charge":112.05,"discounted_cash":33.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 20 MG/ML ORAL CONCENTRATE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0920-60","type":"NDC"}],"standard_charges":[{"minimum":16.81,"maximum":90.77,"gross_charge":112.05,"discounted_cash":33.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 20 MG/ML ORAL CONCENTRATE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0025-30","type":"NDC"}],"standard_charges":[{"minimum":19.13,"maximum":25.83,"gross_charge":31.88,"discounted_cash":9.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 20 MG/ML ORAL CONCENTRATE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0025-30","type":"NDC"}],"standard_charges":[{"minimum":4.79,"maximum":25.83,"gross_charge":31.88,"discounted_cash":9.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.91,"maximum":36.33,"gross_charge":44.84,"discounted_cash":13.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.73,"maximum":36.33,"gross_charge":44.84,"discounted_cash":13.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0406-40","type":"NDC"}],"standard_charges":[{"minimum":1.2,"maximum":1.62,"gross_charge":1.99,"discounted_cash":0.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0406-40","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":1.62,"gross_charge":1.99,"discounted_cash":0.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64950-0354-55","type":"NDC"}],"standard_charges":[{"minimum":1.26,"maximum":1.7,"gross_charge":2.09,"discounted_cash":0.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64950-0354-55","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":1.7,"gross_charge":2.09,"discounted_cash":0.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0401-01","type":"NDC"}],"standard_charges":[{"minimum":2.91,"maximum":3.93,"gross_charge":4.84,"discounted_cash":1.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0401-01","type":"NDC"}],"standard_charges":[{"minimum":0.73,"maximum":3.93,"gross_charge":4.84,"discounted_cash":1.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.61,"maximum":3.53,"gross_charge":4.35,"discounted_cash":1.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.66,"maximum":3.53,"gross_charge":4.35,"discounted_cash":1.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.01,"maximum":4.06,"gross_charge":5.01,"discounted_cash":1.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":4.06,"gross_charge":5.01,"discounted_cash":1.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 10 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0410-10","type":"NDC"}],"standard_charges":[{"minimum":292.88,"maximum":395.39,"gross_charge":488.13,"discounted_cash":144.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.88,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 10 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0410-10","type":"NDC"}],"standard_charges":[{"minimum":73.22,"maximum":395.39,"gross_charge":488.13,"discounted_cash":144.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.63,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 10 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0410-20","type":"NDC"}],"standard_charges":[{"minimum":60.2,"maximum":81.27,"gross_charge":100.33,"discounted_cash":29.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.2,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 10 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0410-20","type":"NDC"}],"standard_charges":[{"minimum":15.05,"maximum":81.27,"gross_charge":100.33,"discounted_cash":29.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.07,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 15 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0415-10","type":"NDC"}],"standard_charges":[{"minimum":431.15,"maximum":582.05,"gross_charge":718.58,"discounted_cash":212.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":582.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":582.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":582.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":431.15,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 15 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0415-10","type":"NDC"}],"standard_charges":[{"minimum":107.79,"maximum":582.05,"gross_charge":718.58,"discounted_cash":212.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":582.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":582.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":582.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":431.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.72,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 15 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0415-20","type":"NDC"}],"standard_charges":[{"minimum":88.53,"maximum":119.51,"gross_charge":147.54,"discounted_cash":43.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.53,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 15 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0415-20","type":"NDC"}],"standard_charges":[{"minimum":22.14,"maximum":119.51,"gross_charge":147.54,"discounted_cash":43.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.51,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 20 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0420-20","type":"NDC"}],"standard_charges":[{"minimum":112.09,"maximum":151.32,"gross_charge":186.81,"discounted_cash":55.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.09,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 20 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0420-20","type":"NDC"}],"standard_charges":[{"minimum":28.03,"maximum":151.32,"gross_charge":186.81,"discounted_cash":55.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 40 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0440-20","type":"NDC"}],"standard_charges":[{"minimum":191.85,"maximum":258.99,"gross_charge":319.74,"discounted_cash":94.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.85,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 40 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0440-20","type":"NDC"}],"standard_charges":[{"minimum":47.97,"maximum":258.99,"gross_charge":319.74,"discounted_cash":94.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":258.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":191.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 80 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0480-10","type":"NDC"}],"standard_charges":[{"minimum":1631.94,"maximum":2203.12,"gross_charge":2719.9,"discounted_cash":805.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2203.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2203.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2203.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1631.94,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 80 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0480-10","type":"NDC"}],"standard_charges":[{"minimum":407.99,"maximum":2203.12,"gross_charge":2719.9,"discounted_cash":805.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2203.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2203.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2203.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1631.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":516.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":407.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.98,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 80 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0480-20","type":"NDC"}],"standard_charges":[{"minimum":334.83,"maximum":452.03,"gross_charge":558.05,"discounted_cash":165.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.83,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE ER 80 MG TABLETCRUSH RESISTANTEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59011-0480-20","type":"NDC"}],"standard_charges":[{"minimum":83.71,"maximum":452.03,"gross_charge":558.05,"discounted_cash":165.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":452.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.61,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0646-11","type":"NDC"}],"standard_charges":[{"minimum":0.39,"maximum":0.53,"gross_charge":0.65,"discounted_cash":0.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0646-11","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":0.53,"gross_charge":0.65,"discounted_cash":0.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0710-01","type":"NDC"}],"standard_charges":[{"minimum":103.19,"maximum":139.3,"gross_charge":171.97,"discounted_cash":50.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.19,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0710-01","type":"NDC"}],"standard_charges":[{"minimum":25.8,"maximum":139.3,"gross_charge":171.97,"discounted_cash":50.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0710-11","type":"NDC"}],"standard_charges":[{"minimum":1.11,"maximum":1.5,"gross_charge":1.85,"discounted_cash":0.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0710-11","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":1.5,"gross_charge":1.85,"discounted_cash":0.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68308-0480-47","type":"NDC"}],"standard_charges":[{"minimum":28.77,"maximum":38.84,"gross_charge":47.94,"discounted_cash":14.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.77,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68308-0480-47","type":"NDC"}],"standard_charges":[{"minimum":7.2,"maximum":38.84,"gross_charge":47.94,"discounted_cash":14.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":33.93,"maximum":45.8,"gross_charge":56.54,"discounted_cash":16.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.93,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.49,"maximum":45.8,"gross_charge":56.54,"discounted_cash":16.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":47.55,"maximum":64.2,"gross_charge":79.25,"discounted_cash":23.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.89,"maximum":64.2,"gross_charge":79.25,"discounted_cash":23.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.85,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":57.33,"maximum":77.4,"gross_charge":95.55,"discounted_cash":28.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.33,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.34,"maximum":77.4,"gross_charge":95.55,"discounted_cash":28.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0644-11","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":0.27,"gross_charge":0.33,"discounted_cash":0.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0644-11","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.27,"gross_charge":0.33,"discounted_cash":0.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0355-11","type":"NDC"}],"standard_charges":[{"minimum":19.35,"maximum":26.12,"gross_charge":32.24,"discounted_cash":9.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0355-11","type":"NDC"}],"standard_charges":[{"minimum":4.84,"maximum":26.12,"gross_charge":32.24,"discounted_cash":9.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68308-0405-47","type":"NDC"}],"standard_charges":[{"minimum":6.2,"maximum":8.37,"gross_charge":10.33,"discounted_cash":3.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68308-0405-47","type":"NDC"}],"standard_charges":[{"minimum":1.55,"maximum":8.37,"gross_charge":10.33,"discounted_cash":3.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.07,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.76,"maximum":14.53,"gross_charge":17.93,"discounted_cash":5.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.69,"maximum":14.53,"gross_charge":17.93,"discounted_cash":5.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.57,"maximum":25.07,"gross_charge":30.94,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.57,"methodology":"fee schedule"}]}]},{"description":"OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.65,"maximum":25.07,"gross_charge":30.94,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"}]}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY (WRAPPER)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0410-59","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":1.79,"gross_charge":2.2,"discounted_cash":0.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"}]}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY (WRAPPER)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0410-59","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":1.79,"gross_charge":2.2,"discounted_cash":0.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"}]}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY (WRAPPER)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.04,"maximum":1.4,"gross_charge":1.72,"discounted_cash":0.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"}]}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY (WRAPPER)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":1.4,"gross_charge":1.72,"discounted_cash":0.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY (WRAPPER)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.22,"maximum":1.64,"gross_charge":2.02,"discounted_cash":0.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"}]}]},{"description":"OXYMETAZOLINE 0.05 % NASAL SPRAY (WRAPPER)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.31,"maximum":1.64,"gross_charge":2.02,"discounted_cash":0.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0639-15","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":4.77,"gross_charge":5.88,"discounted_cash":1.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0639-15","type":"NDC"}],"standard_charges":[{"minimum":0.89,"maximum":4.77,"gross_charge":5.88,"discounted_cash":1.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.37,"maximum":8.6,"gross_charge":10.61,"discounted_cash":3.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.37,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG TABLETDELAYED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.6,"maximum":8.6,"gross_charge":10.61,"discounted_cash":3.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"}]}]},{"description":"PARICALCITOL 1 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49483-0687-03","type":"NDC"}],"standard_charges":[{"minimum":16.55,"maximum":22.34,"gross_charge":27.58,"discounted_cash":8.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"}]}]},{"description":"PARICALCITOL 1 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49483-0687-03","type":"NDC"}],"standard_charges":[{"minimum":4.14,"maximum":22.34,"gross_charge":27.58,"discounted_cash":8.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"}]}]},{"description":"PARICALCITOL 1 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0266-06","type":"NDC"}],"standard_charges":[{"minimum":88.24,"maximum":119.12,"gross_charge":147.06,"discounted_cash":43.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"}]}]},{"description":"PARICALCITOL 1 MCG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0266-06","type":"NDC"}],"standard_charges":[{"minimum":22.06,"maximum":119.12,"gross_charge":147.06,"discounted_cash":43.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0154-90","type":"NDC"}],"standard_charges":[{"minimum":12.39,"maximum":16.73,"gross_charge":20.65,"discounted_cash":6.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13107-0154-90","type":"NDC"}],"standard_charges":[{"minimum":3.1,"maximum":16.73,"gross_charge":20.65,"discounted_cash":6.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0347-09","type":"NDC"}],"standard_charges":[{"minimum":1.81,"maximum":2.44,"gross_charge":3.01,"discounted_cash":0.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0347-09","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":2.44,"gross_charge":3.01,"discounted_cash":0.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0044-11","type":"NDC"}],"standard_charges":[{"minimum":29.91,"maximum":40.38,"gross_charge":49.84,"discounted_cash":14.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0044-11","type":"NDC"}],"standard_charges":[{"minimum":7.48,"maximum":40.38,"gross_charge":49.84,"discounted_cash":14.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.57,"maximum":29.12,"gross_charge":35.94,"discounted_cash":10.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.57,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.4,"maximum":29.12,"gross_charge":35.94,"discounted_cash":10.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.19,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0319-10","type":"NDC"}],"standard_charges":[{"minimum":215.68,"maximum":291.17,"gross_charge":359.46,"discounted_cash":106.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.68,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG/5 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0319-10","type":"NDC"}],"standard_charges":[{"minimum":53.92,"maximum":291.17,"gross_charge":359.46,"discounted_cash":106.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.9,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG/5 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.7,"maximum":11.75,"gross_charge":14.5,"discounted_cash":4.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 10 MG/5 ML ORAL SUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.18,"maximum":11.75,"gross_charge":14.5,"discounted_cash":4.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0963-10","type":"NDC"}],"standard_charges":[{"minimum":13.04,"maximum":17.61,"gross_charge":21.73,"discounted_cash":6.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0963-10","type":"NDC"}],"standard_charges":[{"minimum":3.26,"maximum":17.61,"gross_charge":21.73,"discounted_cash":6.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.78,"maximum":11.86,"gross_charge":14.63,"discounted_cash":4.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"}]}]},{"description":"PAROXETINE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":11.86,"gross_charge":14.63,"discounted_cash":4.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"}]}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10572-0100-01","type":"NDC"}],"standard_charges":[{"minimum":14.49,"maximum":19.56,"gross_charge":24.14,"discounted_cash":7.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"}]}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10572-0100-01","type":"NDC"}],"standard_charges":[{"minimum":3.63,"maximum":19.56,"gross_charge":24.14,"discounted_cash":7.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"}]}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0766-21","type":"NDC"}],"standard_charges":[{"minimum":16.89,"maximum":22.8,"gross_charge":28.14,"discounted_cash":8.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"}]}]},{"description":"PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"64380-0766-21","type":"NDC"}],"standard_charges":[{"minimum":4.23,"maximum":22.8,"gross_charge":28.14,"discounted_cash":8.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"}]}]},{"description":"PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0098-01","type":"NDC"}],"standard_charges":[{"minimum":620.43,"maximum":837.59,"gross_charge":1034.05,"discounted_cash":306.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":837.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":837.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":837.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":620.43,"methodology":"fee schedule"}]}]},{"description":"PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0098-01","type":"NDC"}],"standard_charges":[{"minimum":155.11,"maximum":837.59,"gross_charge":1034.05,"discounted_cash":306.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":837.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":837.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":837.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":620.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.81,"methodology":"fee schedule"}]}]},{"description":"PENTOXIFYLLINE ER 400 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0033-06","type":"NDC"}],"standard_charges":[{"minimum":25.11,"maximum":33.9,"gross_charge":41.84,"discounted_cash":12.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"}]}]},{"description":"PENTOXIFYLLINE ER 400 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0033-06","type":"NDC"}],"standard_charges":[{"minimum":6.28,"maximum":33.9,"gross_charge":41.84,"discounted_cash":12.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"}]}]},{"description":"PENTOXIFYLLINE ER 400 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.85,"maximum":20.04,"gross_charge":24.74,"discounted_cash":7.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"}]}]},{"description":"PENTOXIFYLLINE ER 400 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.72,"maximum":20.04,"gross_charge":24.74,"discounted_cash":7.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.95,"methodology":"fee schedule"}]}]},{"description":"PERAMPANEL 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62856-0272-30","type":"NDC"}],"standard_charges":[{"minimum":308.2,"maximum":416.07,"gross_charge":513.66,"discounted_cash":152.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":416.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":416.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":416.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.2,"methodology":"fee schedule"}]}]},{"description":"PERAMPANEL 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62856-0272-30","type":"NDC"}],"standard_charges":[{"minimum":77.05,"maximum":416.07,"gross_charge":513.66,"discounted_cash":152.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":416.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":416.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":416.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.74,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10939-0739-44","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10939-0739-44","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63736-0120-02","type":"NDC"}],"standard_charges":[{"minimum":5.43,"maximum":7.33,"gross_charge":9.04,"discounted_cash":2.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 1 % TOPICAL LIQUID","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63736-0120-02","type":"NDC"}],"standard_charges":[{"minimum":1.36,"maximum":7.33,"gross_charge":9.04,"discounted_cash":2.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0897-01","type":"NDC"}],"standard_charges":[{"minimum":9.51,"maximum":12.84,"gross_charge":15.85,"discounted_cash":4.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0897-01","type":"NDC"}],"standard_charges":[{"minimum":2.38,"maximum":12.84,"gross_charge":15.85,"discounted_cash":4.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0021-07","type":"NDC"}],"standard_charges":[{"minimum":18.09,"maximum":24.42,"gross_charge":30.14,"discounted_cash":8.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"21922-0021-07","type":"NDC"}],"standard_charges":[{"minimum":4.53,"maximum":24.42,"gross_charge":30.14,"discounted_cash":8.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.59,"maximum":79.1,"gross_charge":97.65,"discounted_cash":28.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"}]}]},{"description":"PERMETHRIN 5 % TOPICAL CREAM","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":14.65,"maximum":79.1,"gross_charge":97.65,"discounted_cash":28.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.53,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 95 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46122-0337-65","type":"NDC"}],"standard_charges":[{"minimum":1.23,"maximum":1.67,"gross_charge":2.05,"discounted_cash":0.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 95 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46122-0337-65","type":"NDC"}],"standard_charges":[{"minimum":0.31,"maximum":1.67,"gross_charge":2.05,"discounted_cash":0.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 95 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"87651-0301-52","type":"NDC"}],"standard_charges":[{"minimum":3.99,"maximum":5.38,"gross_charge":6.64,"discounted_cash":1.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 95 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"87651-0301-52","type":"NDC"}],"standard_charges":[{"minimum":1,"maximum":5.38,"gross_charge":6.64,"discounted_cash":1.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 95 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.1,"maximum":2.83,"gross_charge":3.49,"discounted_cash":1.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"}]}]},{"description":"PHENAZOPYRIDINE 95 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.53,"maximum":2.83,"gross_charge":3.49,"discounted_cash":1.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13517-0107-16","type":"NDC"}],"standard_charges":[{"minimum":41.52,"maximum":56.06,"gross_charge":69.2,"discounted_cash":20.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13517-0107-16","type":"NDC"}],"standard_charges":[{"minimum":10.38,"maximum":56.06,"gross_charge":69.2,"discounted_cash":20.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0330-16","type":"NDC"}],"standard_charges":[{"minimum":37.55,"maximum":50.69,"gross_charge":62.58,"discounted_cash":18.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0330-16","type":"NDC"}],"standard_charges":[{"minimum":9.39,"maximum":50.69,"gross_charge":62.58,"discounted_cash":18.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0330-75","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":1.05,"gross_charge":1.29,"discounted_cash":0.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16571-0330-75","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":1.05,"gross_charge":1.29,"discounted_cash":0.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.18,"maximum":2.95,"gross_charge":3.63,"discounted_cash":1.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.55,"maximum":2.95,"gross_charge":3.63,"discounted_cash":1.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.57,"maximum":16.97,"gross_charge":20.95,"discounted_cash":6.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":16.97,"gross_charge":20.95,"discounted_cash":6.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 32.4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0891-60","type":"NDC"}],"standard_charges":[{"minimum":8.72,"maximum":11.77,"gross_charge":14.53,"discounted_cash":4.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.72,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 32.4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71205-0891-60","type":"NDC"}],"standard_charges":[{"minimum":2.18,"maximum":11.77,"gross_charge":14.53,"discounted_cash":4.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 32.4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":32.43,"maximum":43.78,"gross_charge":54.04,"discounted_cash":16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.43,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL 32.4 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.11,"maximum":43.78,"gross_charge":54.04,"discounted_cash":16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"}]}]},{"description":"PHENOXYBENZAMINE 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60219-1502-01","type":"NDC"}],"standard_charges":[{"minimum":1026.96,"maximum":1386.39,"gross_charge":1711.59,"discounted_cash":506.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1386.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1386.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1386.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1026.96,"methodology":"fee schedule"}]}]},{"description":"PHENOXYBENZAMINE 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60219-1502-01","type":"NDC"}],"standard_charges":[{"minimum":256.74,"maximum":1386.39,"gross_charge":1711.59,"discounted_cash":506.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1386.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1386.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1386.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1026.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":325.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":256.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":342.32,"methodology":"fee schedule"}]}]},{"description":"PHENOXYBENZAMINE 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0066-02","type":"NDC"}],"standard_charges":[{"minimum":1625.7,"maximum":2194.7,"gross_charge":2709.5,"discounted_cash":802.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2194.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2194.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2194.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1625.7,"methodology":"fee schedule"}]}]},{"description":"PHENOXYBENZAMINE 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0066-02","type":"NDC"}],"standard_charges":[{"minimum":406.43,"maximum":2194.7,"gross_charge":2709.5,"discounted_cash":802.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2194.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2194.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2194.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1625.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":541.9,"methodology":"fee schedule"}]}]},{"description":"PHENOXYBENZAMINE 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2622.09,"maximum":3539.83,"gross_charge":4370.15,"discounted_cash":1293.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3539.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3539.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3539.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2622.09,"methodology":"fee schedule"}]}]},{"description":"PHENOXYBENZAMINE 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":655.53,"maximum":3539.83,"gross_charge":4370.15,"discounted_cash":1293.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3539.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3539.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3539.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2622.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.03,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 % NASAL SPRAY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.04,"maximum":2.76,"gross_charge":3.4,"discounted_cash":1.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 % NASAL SPRAY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.51,"maximum":2.76,"gross_charge":3.4,"discounted_cash":1.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.23,"maximum":1.66,"gross_charge":2.04,"discounted_cash":0.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.31,"maximum":1.66,"gross_charge":2.04,"discounted_cash":0.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.11,"maximum":5.55,"gross_charge":6.84,"discounted_cash":2.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.03,"maximum":5.55,"gross_charge":6.84,"discounted_cash":2.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.92,"maximum":10.69,"gross_charge":13.19,"discounted_cash":3.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-COCOA BUTTER 88.44 % RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.98,"maximum":10.69,"gross_charge":13.19,"discounted_cash":3.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0188-16","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":1.63,"gross_charge":2.01,"discounted_cash":0.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0188-16","type":"NDC"}],"standard_charges":[{"minimum":0.31,"maximum":1.63,"gross_charge":2.01,"discounted_cash":0.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49348-0198-78","type":"NDC"}],"standard_charges":[{"minimum":1.69,"maximum":2.28,"gross_charge":2.81,"discounted_cash":0.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49348-0198-78","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":2.28,"gross_charge":2.81,"discounted_cash":0.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":1.68,"gross_charge":2.07,"discounted_cash":0.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":1.68,"gross_charge":2.07,"discounted_cash":0.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.5 % NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69536-0050-15","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":2.58,"gross_charge":3.18,"discounted_cash":0.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 0.5 % NASAL SPRAY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69536-0050-15","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":2.58,"gross_charge":3.18,"discounted_cash":0.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 1 % NASAL SPRAY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.29,"maximum":3.09,"gross_charge":3.81,"discounted_cash":1.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 1 % NASAL SPRAY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":3.09,"gross_charge":3.81,"discounted_cash":1.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE INJ 100 MCG/ML IN 0.9 % SOD CHLORIDE IV SYRINGE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62295-3322-07","type":"NDC"}],"standard_charges":[{"minimum":45.42,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE INJ 100 MCG/ML IN 0.9 % SOD CHLORIDE IV SYRINGE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62295-3322-07","type":"NDC"}],"standard_charges":[{"minimum":11.36,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE INJ 100 MCG/ML IN 0.9 % SOD CHLORIDE IV SYRINGE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71449-0001-15","type":"NDC"}],"standard_charges":[{"minimum":49.97,"maximum":67.45,"gross_charge":83.27,"discounted_cash":24.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE INJ 100 MCG/ML IN 0.9 % SOD CHLORIDE IV SYRINGE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71449-0001-15","type":"NDC"}],"standard_charges":[{"minimum":12.5,"maximum":67.45,"gross_charge":83.27,"discounted_cash":24.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.66,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17856-4069-04","type":"NDC"}],"standard_charges":[{"minimum":0.87,"maximum":1.17,"gross_charge":1.44,"discounted_cash":0.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17856-4069-04","type":"NDC"}],"standard_charges":[{"minimum":0.22,"maximum":1.17,"gross_charge":1.44,"discounted_cash":0.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0275-62","type":"NDC"}],"standard_charges":[{"minimum":3.41,"maximum":4.6,"gross_charge":5.67,"discounted_cash":1.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0275-62","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":4.6,"gross_charge":5.67,"discounted_cash":1.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0036-50","type":"NDC"}],"standard_charges":[{"minimum":2.33,"maximum":3.14,"gross_charge":3.87,"discounted_cash":1.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66689-0036-50","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":3.14,"gross_charge":3.87,"discounted_cash":1.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0129-01","type":"NDC"}],"standard_charges":[{"minimum":0.42,"maximum":0.57,"gross_charge":0.7,"discounted_cash":0.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0129-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":0.57,"gross_charge":0.7,"discounted_cash":0.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4146-01","type":"NDC"}],"standard_charges":[{"minimum":21.93,"maximum":29.6,"gross_charge":36.54,"discounted_cash":10.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.93,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-4146-01","type":"NDC"}],"standard_charges":[{"minimum":5.49,"maximum":29.6,"gross_charge":36.54,"discounted_cash":10.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0156-95","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":1.28,"gross_charge":1.57,"discounted_cash":0.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0156-95","type":"NDC"}],"standard_charges":[{"minimum":0.24,"maximum":1.28,"gross_charge":1.57,"discounted_cash":0.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":86.68,"maximum":117.02,"gross_charge":144.46,"discounted_cash":42.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.68,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN 50 MG CHEWABLE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.67,"maximum":117.02,"gross_charge":144.46,"discounted_cash":42.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.9,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":102.05,"maximum":137.76,"gross_charge":170.07,"discounted_cash":50.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.05,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":25.52,"maximum":137.76,"gross_charge":170.07,"discounted_cash":50.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.02,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58151-0118-01","type":"NDC"}],"standard_charges":[{"minimum":82.12,"maximum":110.86,"gross_charge":136.86,"discounted_cash":40.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.12,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58151-0118-01","type":"NDC"}],"standard_charges":[{"minimum":20.53,"maximum":110.86,"gross_charge":136.86,"discounted_cash":40.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":79.72,"maximum":107.62,"gross_charge":132.86,"discounted_cash":39.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.72,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.93,"maximum":107.62,"gross_charge":132.86,"discounted_cash":39.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.58,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1014-01","type":"NDC"}],"standard_charges":[{"minimum":992.57,"maximum":1339.97,"gross_charge":1654.28,"discounted_cash":489.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1339.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1339.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1339.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":992.57,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70710-1014-01","type":"NDC"}],"standard_charges":[{"minimum":248.15,"maximum":1339.97,"gross_charge":1654.28,"discounted_cash":489.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1339.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1339.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1339.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":992.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":314.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":330.86,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0740-30","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":5.42,"gross_charge":6.68,"discounted_cash":1.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0740-30","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":5.42,"gross_charge":6.68,"discounted_cash":1.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0121-01","type":"NDC"}],"standard_charges":[{"minimum":6.14,"maximum":8.29,"gross_charge":10.23,"discounted_cash":3.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0121-01","type":"NDC"}],"standard_charges":[{"minimum":1.54,"maximum":8.29,"gross_charge":10.23,"discounted_cash":3.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0652-11","type":"NDC"}],"standard_charges":[{"minimum":0.9,"maximum":1.22,"gross_charge":1.5,"discounted_cash":0.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0652-11","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":1.22,"gross_charge":1.5,"discounted_cash":0.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0928-95","type":"NDC"}],"standard_charges":[{"minimum":1.42,"maximum":1.92,"gross_charge":2.36,"discounted_cash":0.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0928-95","type":"NDC"}],"standard_charges":[{"minimum":0.36,"maximum":1.92,"gross_charge":2.36,"discounted_cash":0.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.09,"maximum":32.52,"gross_charge":40.14,"discounted_cash":11.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"}]}]},{"description":"PILOCARPINE 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.03,"maximum":32.52,"gross_charge":40.14,"discounted_cash":11.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.03,"methodology":"fee schedule"}]}]},{"description":"PIMAVANSERIN 34 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63090-0340-30","type":"NDC"}],"standard_charges":[{"minimum":2388.59,"maximum":3224.6,"gross_charge":3980.98,"discounted_cash":1178.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3224.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3224.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3224.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2388.59,"methodology":"fee schedule"}]}]},{"description":"PIMAVANSERIN 34 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63090-0340-30","type":"NDC"}],"standard_charges":[{"minimum":597.15,"maximum":3224.6,"gross_charge":3980.98,"discounted_cash":1178.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3224.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3224.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3224.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2388.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":756.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":597.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.2,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0054-07","type":"NDC"}],"standard_charges":[{"minimum":2.48,"maximum":3.34,"gross_charge":4.12,"discounted_cash":1.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0054-07","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":3.34,"gross_charge":4.12,"discounted_cash":1.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0054-10","type":"NDC"}],"standard_charges":[{"minimum":7.26,"maximum":9.81,"gross_charge":12.1,"discounted_cash":3.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0054-10","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":9.81,"gross_charge":12.1,"discounted_cash":3.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0391-01","type":"NDC"}],"standard_charges":[{"minimum":62.13,"maximum":83.88,"gross_charge":103.55,"discounted_cash":30.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.13,"methodology":"fee schedule"}]}]},{"description":"PIOGLITAZONE 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0391-01","type":"NDC"}],"standard_charges":[{"minimum":15.54,"maximum":83.88,"gross_charge":103.55,"discounted_cash":30.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11523-7234-01","type":"NDC"}],"standard_charges":[{"minimum":0.77,"maximum":1.04,"gross_charge":1.28,"discounted_cash":0.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11523-7234-01","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":1.04,"gross_charge":1.28,"discounted_cash":0.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0868-00","type":"NDC"}],"standard_charges":[{"minimum":0.92,"maximum":1.24,"gross_charge":1.52,"discounted_cash":0.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0868-00","type":"NDC"}],"standard_charges":[{"minimum":0.23,"maximum":1.24,"gross_charge":1.52,"discounted_cash":0.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0868-66","type":"NDC"}],"standard_charges":[{"minimum":11.79,"maximum":15.92,"gross_charge":19.65,"discounted_cash":5.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0868-66","type":"NDC"}],"standard_charges":[{"minimum":2.95,"maximum":15.92,"gross_charge":19.65,"discounted_cash":5.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0431-98","type":"NDC"}],"standard_charges":[{"minimum":14.02,"maximum":18.93,"gross_charge":23.36,"discounted_cash":6.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0431-98","type":"NDC"}],"standard_charges":[{"minimum":3.51,"maximum":18.93,"gross_charge":23.36,"discounted_cash":6.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0431-99","type":"NDC"}],"standard_charges":[{"minimum":0.8,"maximum":1.08,"gross_charge":1.33,"discounted_cash":0.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0431-99","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":1.08,"gross_charge":1.33,"discounted_cash":0.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0157-10","type":"NDC"}],"standard_charges":[{"minimum":49.35,"maximum":66.63,"gross_charge":82.25,"discounted_cash":24.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0157-10","type":"NDC"}],"standard_charges":[{"minimum":12.34,"maximum":66.63,"gross_charge":82.25,"discounted_cash":24.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0157-17","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":0.77,"gross_charge":0.95,"discounted_cash":0.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0157-17","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.77,"gross_charge":0.95,"discounted_cash":0.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0198-61","type":"NDC"}],"standard_charges":[{"minimum":16.65,"maximum":22.47,"gross_charge":27.74,"discounted_cash":8.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0198-61","type":"NDC"}],"standard_charges":[{"minimum":4.17,"maximum":22.47,"gross_charge":27.74,"discounted_cash":8.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0198-62","type":"NDC"}],"standard_charges":[{"minimum":0.63,"maximum":0.86,"gross_charge":1.05,"discounted_cash":0.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0198-62","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":0.86,"gross_charge":1.05,"discounted_cash":0.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0760-01","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":0.81,"gross_charge":0.99,"discounted_cash":0.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0760-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.81,"gross_charge":0.99,"discounted_cash":0.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0430-98","type":"NDC"}],"standard_charges":[{"minimum":8.65,"maximum":11.68,"gross_charge":14.41,"discounted_cash":4.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0430-98","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":11.68,"gross_charge":14.41,"discounted_cash":4.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0430-99","type":"NDC"}],"standard_charges":[{"minimum":0.69,"maximum":0.94,"gross_charge":1.15,"discounted_cash":0.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0430-99","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.94,"gross_charge":1.15,"discounted_cash":0.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0302-01","type":"NDC"}],"standard_charges":[{"minimum":0.66,"maximum":0.89,"gross_charge":1.09,"discounted_cash":0.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0302-01","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.89,"gross_charge":1.09,"discounted_cash":0.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0302-04","type":"NDC"}],"standard_charges":[{"minimum":57.51,"maximum":77.64,"gross_charge":95.85,"discounted_cash":28.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0302-04","type":"NDC"}],"standard_charges":[{"minimum":14.38,"maximum":77.64,"gross_charge":95.85,"discounted_cash":28.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.47,"maximum":0.64,"gross_charge":0.78,"discounted_cash":0.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":0.64,"gross_charge":0.78,"discounted_cash":0.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":51.87,"maximum":70.03,"gross_charge":86.45,"discounted_cash":25.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.97,"maximum":70.03,"gross_charge":86.45,"discounted_cash":25.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":62.49,"maximum":84.37,"gross_charge":104.15,"discounted_cash":30.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.49,"methodology":"fee schedule"}]}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":15.63,"maximum":84.37,"gross_charge":104.15,"discounted_cash":30.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"}]}]},{"description":"POLYMYXIN B SULFATE 10000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60758-0908-10","type":"NDC"}],"standard_charges":[{"minimum":6.06,"maximum":8.19,"gross_charge":10.1,"discounted_cash":2.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"}]}]},{"description":"POLYMYXIN B SULFATE 10000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60758-0908-10","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":8.19,"gross_charge":10.1,"discounted_cash":2.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"}]}]},{"description":"POLYMYXIN B SULFATE 10000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0628-10","type":"NDC"}],"standard_charges":[{"minimum":2.45,"maximum":3.31,"gross_charge":4.08,"discounted_cash":1.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"}]}]},{"description":"POLYMYXIN B SULFATE 10000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0628-10","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":3.31,"gross_charge":4.08,"discounted_cash":1.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0203-11","type":"NDC"}],"standard_charges":[{"minimum":6.38,"maximum":8.62,"gross_charge":10.63,"discounted_cash":3.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"}]}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0203-11","type":"NDC"}],"standard_charges":[{"minimum":1.6,"maximum":8.62,"gross_charge":10.63,"discounted_cash":3.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"}]}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.06,"maximum":6.83,"gross_charge":8.43,"discounted_cash":2.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"}]}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.27,"maximum":6.83,"gross_charge":8.43,"discounted_cash":2.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLE 100 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0156-01","type":"NDC"}],"standard_charges":[{"minimum":558.27,"maximum":753.67,"gross_charge":930.45,"discounted_cash":275.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":753.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":753.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.27,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLE 100 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0156-01","type":"NDC"}],"standard_charges":[{"minimum":139.57,"maximum":753.67,"gross_charge":930.45,"discounted_cash":275.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":753.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":753.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":753.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":558.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.09,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLE 100 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0258-07","type":"NDC"}],"standard_charges":[{"minimum":229.88,"maximum":310.34,"gross_charge":383.13,"discounted_cash":113.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":310.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":310.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.88,"methodology":"fee schedule"}]}]},{"description":"POSACONAZOLE 100 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0258-07","type":"NDC"}],"standard_charges":[{"minimum":57.47,"maximum":310.34,"gross_charge":383.13,"discounted_cash":113.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":310.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":310.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":310.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":229.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.63,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51801-0013-30","type":"NDC"}],"standard_charges":[{"minimum":7.23,"maximum":9.76,"gross_charge":12.04,"discounted_cash":3.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51801-0013-30","type":"NDC"}],"standard_charges":[{"minimum":1.81,"maximum":9.76,"gross_charge":12.04,"discounted_cash":3.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51801-0012-01","type":"NDC"}],"standard_charges":[{"minimum":0.38,"maximum":0.52,"gross_charge":0.63,"discounted_cash":0.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51801-0012-01","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":0.52,"gross_charge":0.63,"discounted_cash":0.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51801-0012-30","type":"NDC"}],"standard_charges":[{"minimum":9.14,"maximum":12.33,"gross_charge":15.22,"discounted_cash":4.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51801-0012-30","type":"NDC"}],"standard_charges":[{"minimum":2.29,"maximum":12.33,"gross_charge":15.22,"discounted_cash":4.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0987-01","type":"NDC"}],"standard_charges":[{"minimum":8.36,"maximum":11.28,"gross_charge":13.92,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0987-01","type":"NDC"}],"standard_charges":[{"minimum":2.09,"maximum":11.28,"gross_charge":13.92,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0133-92","type":"NDC"}],"standard_charges":[{"minimum":67.29,"maximum":90.84,"gross_charge":112.14,"discounted_cash":33.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.29,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0133-92","type":"NDC"}],"standard_charges":[{"minimum":16.83,"maximum":90.84,"gross_charge":112.14,"discounted_cash":33.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.55,"maximum":11.55,"gross_charge":14.25,"discounted_cash":4.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":11.55,"gross_charge":14.25,"discounted_cash":4.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.64,"maximum":22.47,"gross_charge":27.73,"discounted_cash":8.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.16,"maximum":22.47,"gross_charge":27.73,"discounted_cash":8.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.98,"maximum":33.73,"gross_charge":41.63,"discounted_cash":12.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.25,"maximum":33.73,"gross_charge":41.63,"discounted_cash":12.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":40.29,"maximum":54.39,"gross_charge":67.14,"discounted_cash":19.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.08,"maximum":54.39,"gross_charge":67.14,"discounted_cash":19.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.37,"maximum":0.5,"gross_charge":0.61,"discounted_cash":0.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.1,"maximum":0.5,"gross_charge":0.61,"discounted_cash":0.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0235-00","type":"NDC"}],"standard_charges":[{"minimum":12.44,"maximum":16.8,"gross_charge":20.73,"discounted_cash":6.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0235-00","type":"NDC"}],"standard_charges":[{"minimum":3.11,"maximum":16.8,"gross_charge":20.73,"discounted_cash":6.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0360-09","type":"NDC"}],"standard_charges":[{"minimum":29.99,"maximum":40.49,"gross_charge":49.98,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.99,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0360-09","type":"NDC"}],"standard_charges":[{"minimum":7.5,"maximum":40.49,"gross_charge":49.98,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0338-01","type":"NDC"}],"standard_charges":[{"minimum":9.62,"maximum":12.99,"gross_charge":16.03,"discounted_cash":4.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE ER 20 MEQ TABLETEXTENDED RELEASE(PART/CRYST)","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72603-0338-01","type":"NDC"}],"standard_charges":[{"minimum":2.41,"maximum":12.99,"gross_charge":16.03,"discounted_cash":4.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71740-0112-30","type":"NDC"}],"standard_charges":[{"minimum":236.2,"maximum":318.87,"gross_charge":393.66,"discounted_cash":116.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.2,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71740-0112-30","type":"NDC"}],"standard_charges":[{"minimum":59.05,"maximum":318.87,"gross_charge":393.66,"discounted_cash":116.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":318.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":318.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":318.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.74,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0280-30","type":"NDC"}],"standard_charges":[{"minimum":196.54,"maximum":265.33,"gross_charge":327.56,"discounted_cash":96.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":265.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":265.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":265.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.54,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0280-30","type":"NDC"}],"standard_charges":[{"minimum":49.14,"maximum":265.33,"gross_charge":327.56,"discounted_cash":96.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":265.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":265.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":265.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":196.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.52,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.04,"maximum":8.15,"gross_charge":10.06,"discounted_cash":2.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.51,"maximum":8.15,"gross_charge":10.06,"discounted_cash":2.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"}]}]},{"description":"POVIDONE-IODINE 10 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.75,"maximum":1.01,"gross_charge":1.24,"discounted_cash":0.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"}]}]},{"description":"POVIDONE-IODINE 10 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.19,"maximum":1.01,"gross_charge":1.24,"discounted_cash":0.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"}]}]},{"description":"POVIDONE-IODINE 10 % TOPICAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67618-0150-04","type":"NDC"}],"standard_charges":[{"minimum":1.14,"maximum":1.54,"gross_charge":1.9,"discounted_cash":0.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"}]}]},{"description":"POVIDONE-IODINE 10 % TOPICAL SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67618-0150-04","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":1.54,"gross_charge":1.9,"discounted_cash":0.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0092-90","type":"NDC"}],"standard_charges":[{"minimum":8.02,"maximum":10.83,"gross_charge":13.36,"discounted_cash":3.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0092-90","type":"NDC"}],"standard_charges":[{"minimum":2.01,"maximum":10.83,"gross_charge":13.36,"discounted_cash":3.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0440-11","type":"NDC"}],"standard_charges":[{"minimum":11.12,"maximum":15.01,"gross_charge":18.53,"discounted_cash":5.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0440-11","type":"NDC"}],"standard_charges":[{"minimum":2.78,"maximum":15.01,"gross_charge":18.53,"discounted_cash":5.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0182-90","type":"NDC"}],"standard_charges":[{"minimum":2.08,"maximum":2.81,"gross_charge":3.46,"discounted_cash":1.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"}]}]},{"description":"PRAMIPEXOLE 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0182-90","type":"NDC"}],"standard_charges":[{"minimum":0.52,"maximum":2.81,"gross_charge":3.46,"discounted_cash":1.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"PRAMOXINE 1 % TOPICAL FOAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0180-15","type":"NDC"}],"standard_charges":[{"minimum":24.68,"maximum":33.32,"gross_charge":41.13,"discounted_cash":12.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"}]}]},{"description":"PRAMOXINE 1 % TOPICAL FOAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0180-15","type":"NDC"}],"standard_charges":[{"minimum":6.17,"maximum":33.32,"gross_charge":41.13,"discounted_cash":12.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"}]}]},{"description":"PRAMOXINE 1 % TOPICAL FOAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68220-0143-15","type":"NDC"}],"standard_charges":[{"minimum":22.72,"maximum":30.67,"gross_charge":37.86,"discounted_cash":11.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"}]}]},{"description":"PRAMOXINE 1 % TOPICAL FOAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68220-0143-15","type":"NDC"}],"standard_charges":[{"minimum":5.68,"maximum":30.67,"gross_charge":37.86,"discounted_cash":11.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.58,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0273-10","type":"NDC"}],"standard_charges":[{"minimum":14.94,"maximum":20.17,"gross_charge":24.89,"discounted_cash":7.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0273-10","type":"NDC"}],"standard_charges":[{"minimum":3.74,"maximum":20.17,"gross_charge":24.89,"discounted_cash":7.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.98,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-4643-03","type":"NDC"}],"standard_charges":[{"minimum":14.7,"maximum":19.85,"gross_charge":24.5,"discounted_cash":7.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-4643-03","type":"NDC"}],"standard_charges":[{"minimum":3.68,"maximum":19.85,"gross_charge":24.5,"discounted_cash":7.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0830-30","type":"NDC"}],"standard_charges":[{"minimum":3.39,"maximum":4.58,"gross_charge":5.65,"discounted_cash":1.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0830-30","type":"NDC"}],"standard_charges":[{"minimum":0.85,"maximum":4.58,"gross_charge":5.65,"discounted_cash":1.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0605-30","type":"NDC"}],"standard_charges":[{"minimum":10.97,"maximum":14.81,"gross_charge":18.28,"discounted_cash":5.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0605-30","type":"NDC"}],"standard_charges":[{"minimum":2.75,"maximum":14.81,"gross_charge":18.28,"discounted_cash":5.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.56,"maximum":22.35,"gross_charge":27.59,"discounted_cash":8.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"}]}]},{"description":"PRASUGREL HCL 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.14,"maximum":22.35,"gross_charge":27.59,"discounted_cash":8.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.31,"maximum":31.47,"gross_charge":38.84,"discounted_cash":11.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.83,"maximum":31.47,"gross_charge":38.84,"discounted_cash":11.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0666-11","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":0.36,"gross_charge":0.44,"discounted_cash":0.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0666-11","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.36,"gross_charge":0.44,"discounted_cash":0.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0666-15","type":"NDC"}],"standard_charges":[{"minimum":9.5,"maximum":12.83,"gross_charge":15.83,"discounted_cash":4.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0666-15","type":"NDC"}],"standard_charges":[{"minimum":2.38,"maximum":12.83,"gross_charge":15.83,"discounted_cash":4.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0486-09","type":"NDC"}],"standard_charges":[{"minimum":23.9,"maximum":32.27,"gross_charge":39.83,"discounted_cash":11.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0486-09","type":"NDC"}],"standard_charges":[{"minimum":5.98,"maximum":32.27,"gross_charge":39.83,"discounted_cash":11.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0196-90","type":"NDC"}],"standard_charges":[{"minimum":5.05,"maximum":6.82,"gross_charge":8.41,"discounted_cash":2.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0196-90","type":"NDC"}],"standard_charges":[{"minimum":1.27,"maximum":6.82,"gross_charge":8.41,"discounted_cash":2.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.64,"maximum":18.41,"gross_charge":22.72,"discounted_cash":6.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.41,"maximum":18.41,"gross_charge":22.72,"discounted_cash":6.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0487-09","type":"NDC"}],"standard_charges":[{"minimum":36.21,"maximum":48.89,"gross_charge":60.35,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0487-09","type":"NDC"}],"standard_charges":[{"minimum":9.06,"maximum":48.89,"gross_charge":60.35,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0072-16","type":"NDC"}],"standard_charges":[{"minimum":36.32,"maximum":49.03,"gross_charge":60.53,"discounted_cash":17.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0072-16","type":"NDC"}],"standard_charges":[{"minimum":9.08,"maximum":49.03,"gross_charge":60.53,"discounted_cash":17.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.66,"maximum":25.2,"gross_charge":31.1,"discounted_cash":9.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.66,"methodology":"fee schedule"}]}]},{"description":"PRAVASTATIN 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.67,"maximum":25.2,"gross_charge":31.1,"discounted_cash":9.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0630-01","type":"NDC"}],"standard_charges":[{"minimum":0.74,"maximum":1,"gross_charge":1.23,"discounted_cash":0.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0630-01","type":"NDC"}],"standard_charges":[{"minimum":0.19,"maximum":1,"gross_charge":1.23,"discounted_cash":0.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-5310-01","type":"NDC"}],"standard_charges":[{"minimum":15.32,"maximum":20.68,"gross_charge":25.52,"discounted_cash":7.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-5310-01","type":"NDC"}],"standard_charges":[{"minimum":3.83,"maximum":20.68,"gross_charge":25.52,"discounted_cash":7.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.11,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0019-10","type":"NDC"}],"standard_charges":[{"minimum":8.24,"maximum":11.13,"gross_charge":13.73,"discounted_cash":4.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0019-10","type":"NDC"}],"standard_charges":[{"minimum":2.06,"maximum":11.13,"gross_charge":13.73,"discounted_cash":4.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.76,"maximum":10.48,"gross_charge":12.93,"discounted_cash":3.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.94,"maximum":10.48,"gross_charge":12.93,"discounted_cash":3.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.51,"maximum":41.19,"gross_charge":50.84,"discounted_cash":15.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.63,"maximum":41.19,"gross_charge":50.84,"discounted_cash":15.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0632-01","type":"NDC"}],"standard_charges":[{"minimum":2.16,"maximum":2.91,"gross_charge":3.59,"discounted_cash":1.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0632-01","type":"NDC"}],"standard_charges":[{"minimum":0.54,"maximum":2.91,"gross_charge":3.59,"discounted_cash":1.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0572-32","type":"NDC"}],"standard_charges":[{"minimum":26.44,"maximum":35.69,"gross_charge":44.06,"discounted_cash":13.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0572-32","type":"NDC"}],"standard_charges":[{"minimum":6.61,"maximum":35.69,"gross_charge":44.06,"discounted_cash":13.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0572-33","type":"NDC"}],"standard_charges":[{"minimum":1.4,"maximum":1.89,"gross_charge":2.33,"discounted_cash":0.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0572-33","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":1.89,"gross_charge":2.33,"discounted_cash":0.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0021-10","type":"NDC"}],"standard_charges":[{"minimum":16.17,"maximum":21.83,"gross_charge":26.94,"discounted_cash":7.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"}]}]},{"description":"PRAZOSIN 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0021-10","type":"NDC"}],"standard_charges":[{"minimum":4.05,"maximum":21.83,"gross_charge":26.94,"discounted_cash":7.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 0.12 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11980-0174-05","type":"NDC"}],"standard_charges":[{"minimum":88.16,"maximum":119.02,"gross_charge":146.93,"discounted_cash":43.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.16,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 0.12 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"11980-0174-05","type":"NDC"}],"standard_charges":[{"minimum":22.04,"maximum":119.02,"gross_charge":146.93,"discounted_cash":43.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.39,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60758-0119-05","type":"NDC"}],"standard_charges":[{"minimum":15.2,"maximum":20.52,"gross_charge":25.33,"discounted_cash":7.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60758-0119-05","type":"NDC"}],"standard_charges":[{"minimum":3.8,"maximum":20.52,"gross_charge":25.33,"discounted_cash":7.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0637-05","type":"NDC"}],"standard_charges":[{"minimum":15.39,"maximum":20.77,"gross_charge":25.64,"discounted_cash":7.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0637-05","type":"NDC"}],"standard_charges":[{"minimum":3.85,"maximum":20.77,"gross_charge":25.64,"discounted_cash":7.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0332-02","type":"NDC"}],"standard_charges":[{"minimum":14.72,"maximum":19.87,"gross_charge":24.53,"discounted_cash":7.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE ACETATE 1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70748-0332-02","type":"NDC"}],"standard_charges":[{"minimum":3.68,"maximum":19.87,"gross_charge":24.53,"discounted_cash":7.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0506-01","type":"NDC"}],"standard_charges":[{"minimum":28.53,"maximum":38.51,"gross_charge":47.54,"discounted_cash":14.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.53,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0506-01","type":"NDC"}],"standard_charges":[{"minimum":7.14,"maximum":38.51,"gross_charge":47.54,"discounted_cash":14.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":611.31,"maximum":825.27,"gross_charge":1018.84,"discounted_cash":301.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":825.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":825.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":825.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":611.31,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 100 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":152.83,"maximum":825.27,"gross_charge":1018.84,"discounted_cash":301.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":825.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":825.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":825.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":611.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.77,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0473-01","type":"NDC"}],"standard_charges":[{"minimum":31.11,"maximum":42,"gross_charge":51.84,"discounted_cash":15.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0473-01","type":"NDC"}],"standard_charges":[{"minimum":7.78,"maximum":42,"gross_charge":51.84,"discounted_cash":15.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0677-05","type":"NDC"}],"standard_charges":[{"minimum":4.46,"maximum":6.02,"gross_charge":7.42,"discounted_cash":2.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 25 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0677-05","type":"NDC"}],"standard_charges":[{"minimum":1.12,"maximum":6.02,"gross_charge":7.42,"discounted_cash":2.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":500.23,"maximum":675.31,"gross_charge":833.71,"discounted_cash":246.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":675.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":675.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":675.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.23,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 25 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":125.06,"maximum":675.31,"gross_charge":833.71,"discounted_cash":246.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":675.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":675.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":675.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":500.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":158.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.75,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0484-11","type":"NDC"}],"standard_charges":[{"minimum":0.36,"maximum":0.49,"gross_charge":0.6,"discounted_cash":0.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0484-11","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.49,"gross_charge":0.6,"discounted_cash":0.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0678-05","type":"NDC"}],"standard_charges":[{"minimum":4.56,"maximum":6.16,"gross_charge":7.6,"discounted_cash":2.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0678-05","type":"NDC"}],"standard_charges":[{"minimum":1.14,"maximum":6.16,"gross_charge":7.6,"discounted_cash":2.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0012-90","type":"NDC"}],"standard_charges":[{"minimum":3.59,"maximum":4.85,"gross_charge":5.98,"discounted_cash":1.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0012-90","type":"NDC"}],"standard_charges":[{"minimum":0.9,"maximum":4.85,"gross_charge":5.98,"discounted_cash":1.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.2,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0569-90","type":"NDC"}],"standard_charges":[{"minimum":1.86,"maximum":2.52,"gross_charge":3.1,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"76282-0569-90","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":2.52,"gross_charge":3.1,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0293-90","type":"NDC"}],"standard_charges":[{"minimum":15.1,"maximum":20.38,"gross_charge":25.16,"discounted_cash":7.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0293-90","type":"NDC"}],"standard_charges":[{"minimum":3.78,"maximum":20.38,"gross_charge":25.16,"discounted_cash":7.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1346-01","type":"NDC"}],"standard_charges":[{"minimum":8.45,"maximum":11.41,"gross_charge":14.08,"discounted_cash":4.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"}]}]},{"description":"PREGABALIN 75 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1346-01","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":11.41,"gross_charge":14.08,"discounted_cash":4.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0545-01","type":"NDC"}],"standard_charges":[{"minimum":21.81,"maximum":29.44,"gross_charge":36.34,"discounted_cash":10.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"53746-0545-01","type":"NDC"}],"standard_charges":[{"minimum":5.46,"maximum":29.44,"gross_charge":36.34,"discounted_cash":10.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.27,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0686-15","type":"NDC"}],"standard_charges":[{"minimum":9.23,"maximum":12.46,"gross_charge":15.38,"discounted_cash":4.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.23,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0686-15","type":"NDC"}],"standard_charges":[{"minimum":2.31,"maximum":12.46,"gross_charge":15.38,"discounted_cash":4.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0202-01","type":"NDC"}],"standard_charges":[{"minimum":38.31,"maximum":51.72,"gross_charge":63.84,"discounted_cash":18.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0202-01","type":"NDC"}],"standard_charges":[{"minimum":9.58,"maximum":51.72,"gross_charge":63.84,"discounted_cash":18.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0202-11","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":0.63,"gross_charge":0.77,"discounted_cash":0.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"PRIMIDONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0202-11","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.63,"gross_charge":0.77,"discounted_cash":0.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"}]}]},{"description":"PROGESTERONE MICRONIZED 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0157-01","type":"NDC"}],"standard_charges":[{"minimum":24.39,"maximum":32.92,"gross_charge":40.64,"discounted_cash":12.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.39,"methodology":"fee schedule"}]}]},{"description":"PROGESTERONE MICRONIZED 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0157-01","type":"NDC"}],"standard_charges":[{"minimum":6.1,"maximum":32.92,"gross_charge":40.64,"discounted_cash":12.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"}]}]},{"description":"PROGESTERONE MICRONIZED 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0374-10","type":"NDC"}],"standard_charges":[{"minimum":30.39,"maximum":41.02,"gross_charge":50.64,"discounted_cash":14.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.39,"methodology":"fee schedule"}]}]},{"description":"PROGESTERONE MICRONIZED 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0374-10","type":"NDC"}],"standard_charges":[{"minimum":7.6,"maximum":41.02,"gross_charge":50.64,"discounted_cash":14.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.13,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-5297-01","type":"NDC"}],"standard_charges":[{"minimum":23.63,"maximum":31.9,"gross_charge":39.38,"discounted_cash":11.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-5297-01","type":"NDC"}],"standard_charges":[{"minimum":5.91,"maximum":31.9,"gross_charge":39.38,"discounted_cash":11.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.93,"maximum":8.01,"gross_charge":9.88,"discounted_cash":2.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.49,"maximum":8.01,"gross_charge":9.88,"discounted_cash":2.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":45.18,"maximum":60.99,"gross_charge":75.29,"discounted_cash":22.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.18,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.3,"maximum":60.99,"gross_charge":75.29,"discounted_cash":22.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":70.28,"maximum":94.88,"gross_charge":117.13,"discounted_cash":34.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.28,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG RECTAL SUPPOSITORY","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.57,"maximum":94.88,"gross_charge":117.13,"discounted_cash":34.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.43,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0256-01","type":"NDC"}],"standard_charges":[{"minimum":12.98,"maximum":17.53,"gross_charge":21.63,"discounted_cash":6.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0256-01","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":17.53,"gross_charge":21.63,"discounted_cash":6.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0230-01","type":"NDC"}],"standard_charges":[{"minimum":14.97,"maximum":20.21,"gross_charge":24.94,"discounted_cash":7.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 150 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0230-01","type":"NDC"}],"standard_charges":[{"minimum":3.75,"maximum":20.21,"gross_charge":24.94,"discounted_cash":7.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 150 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":22.77,"maximum":30.74,"gross_charge":37.94,"discounted_cash":11.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 150 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.7,"maximum":30.74,"gross_charge":37.94,"discounted_cash":11.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.59,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 225 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0257-01","type":"NDC"}],"standard_charges":[{"minimum":11.84,"maximum":15.99,"gross_charge":19.73,"discounted_cash":5.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 225 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59651-0257-01","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":15.99,"gross_charge":19.73,"discounted_cash":5.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 225 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0231-01","type":"NDC"}],"standard_charges":[{"minimum":22.29,"maximum":30.09,"gross_charge":37.14,"discounted_cash":11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.29,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 225 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0231-01","type":"NDC"}],"standard_charges":[{"minimum":5.58,"maximum":30.09,"gross_charge":37.14,"discounted_cash":11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 225 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.27,"maximum":24.66,"gross_charge":30.44,"discounted_cash":9.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE 225 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.57,"maximum":24.66,"gross_charge":30.44,"discounted_cash":9.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0825-01","type":"NDC"}],"standard_charges":[{"minimum":64.86,"maximum":87.56,"gross_charge":108.09,"discounted_cash":32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.86,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0825-01","type":"NDC"}],"standard_charges":[{"minimum":16.22,"maximum":87.56,"gross_charge":108.09,"discounted_cash":32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0113-02","type":"NDC"}],"standard_charges":[{"minimum":146.34,"maximum":197.56,"gross_charge":243.9,"discounted_cash":72.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.34,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0113-02","type":"NDC"}],"standard_charges":[{"minimum":36.59,"maximum":197.56,"gross_charge":243.9,"discounted_cash":72.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0113-09","type":"NDC"}],"standard_charges":[{"minimum":162.6,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.6,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0113-09","type":"NDC"}],"standard_charges":[{"minimum":40.65,"maximum":219.51,"gross_charge":271,"discounted_cash":80.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.2,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0114-60","type":"NDC"}],"standard_charges":[{"minimum":192.76,"maximum":260.23,"gross_charge":321.26,"discounted_cash":95.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.76,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0114-60","type":"NDC"}],"standard_charges":[{"minimum":48.19,"maximum":260.23,"gross_charge":321.26,"discounted_cash":95.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.26,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0130-60","type":"NDC"}],"standard_charges":[{"minimum":16.54,"maximum":22.33,"gross_charge":27.56,"discounted_cash":8.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 225 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0130-60","type":"NDC"}],"standard_charges":[{"minimum":4.14,"maximum":22.33,"gross_charge":27.56,"discounted_cash":8.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 325 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0115-60","type":"NDC"}],"standard_charges":[{"minimum":248.45,"maximum":335.41,"gross_charge":414.08,"discounted_cash":122.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":248.45,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 325 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0115-60","type":"NDC"}],"standard_charges":[{"minimum":62.12,"maximum":335.41,"gross_charge":414.08,"discounted_cash":122.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":248.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.82,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 325 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0409-60","type":"NDC"}],"standard_charges":[{"minimum":85.27,"maximum":115.11,"gross_charge":142.11,"discounted_cash":42.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.27,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 325 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0409-60","type":"NDC"}],"standard_charges":[{"minimum":21.32,"maximum":115.11,"gross_charge":142.11,"discounted_cash":42.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0827-01","type":"NDC"}],"standard_charges":[{"minimum":164.13,"maximum":221.58,"gross_charge":273.55,"discounted_cash":80.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.13,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0827-01","type":"NDC"}],"standard_charges":[{"minimum":41.04,"maximum":221.58,"gross_charge":273.55,"discounted_cash":80.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":221.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":164.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0116-60","type":"NDC"}],"standard_charges":[{"minimum":192.83,"maximum":260.32,"gross_charge":321.38,"discounted_cash":95.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.83,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66993-0116-60","type":"NDC"}],"standard_charges":[{"minimum":48.21,"maximum":260.32,"gross_charge":321.38,"discounted_cash":95.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":260.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":260.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":260.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":192.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.28,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0410-60","type":"NDC"}],"standard_charges":[{"minimum":86.03,"maximum":116.14,"gross_charge":143.38,"discounted_cash":42.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.03,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0410-60","type":"NDC"}],"standard_charges":[{"minimum":21.51,"maximum":116.14,"gross_charge":143.38,"discounted_cash":42.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0132-60","type":"NDC"}],"standard_charges":[{"minimum":51.11,"maximum":68.99,"gross_charge":85.17,"discounted_cash":25.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.11,"methodology":"fee schedule"}]}]},{"description":"PROPAFENONE ER 425 MG CAPSULEEXTENDED RELEASE 12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69680-0132-60","type":"NDC"}],"standard_charges":[{"minimum":12.78,"maximum":68.99,"gross_charge":85.17,"discounted_cash":25.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0587-01","type":"NDC"}],"standard_charges":[{"minimum":14.18,"maximum":19.15,"gross_charge":23.63,"discounted_cash":7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0587-01","type":"NDC"}],"standard_charges":[{"minimum":3.55,"maximum":19.15,"gross_charge":23.63,"discounted_cash":7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.83,"maximum":26.77,"gross_charge":33.04,"discounted_cash":9.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.96,"maximum":26.77,"gross_charge":33.04,"discounted_cash":9.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0609-01","type":"NDC"}],"standard_charges":[{"minimum":28.83,"maximum":38.92,"gross_charge":48.04,"discounted_cash":14.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0609-01","type":"NDC"}],"standard_charges":[{"minimum":7.21,"maximum":38.92,"gross_charge":48.04,"discounted_cash":14.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.61,"maximum":35.92,"gross_charge":44.34,"discounted_cash":13.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.66,"maximum":35.92,"gross_charge":44.34,"discounted_cash":13.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0522-01","type":"NDC"}],"standard_charges":[{"minimum":19.41,"maximum":26.2,"gross_charge":32.34,"discounted_cash":9.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0522-01","type":"NDC"}],"standard_charges":[{"minimum":4.86,"maximum":26.2,"gross_charge":32.34,"discounted_cash":9.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0817-01","type":"NDC"}],"standard_charges":[{"minimum":65.67,"maximum":88.66,"gross_charge":109.45,"discounted_cash":32.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.67,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0817-01","type":"NDC"}],"standard_charges":[{"minimum":16.42,"maximum":88.66,"gross_charge":109.45,"discounted_cash":32.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.89,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0215-01","type":"NDC"}],"standard_charges":[{"minimum":117.65,"maximum":158.82,"gross_charge":196.07,"discounted_cash":58.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":158.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.65,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 60 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0215-01","type":"NDC"}],"standard_charges":[{"minimum":29.42,"maximum":158.82,"gross_charge":196.07,"discounted_cash":58.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":158.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":158.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43478-0901-88","type":"NDC"}],"standard_charges":[{"minimum":73.78,"maximum":99.6,"gross_charge":122.96,"discounted_cash":36.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.78,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43478-0901-88","type":"NDC"}],"standard_charges":[{"minimum":18.45,"maximum":99.6,"gross_charge":122.96,"discounted_cash":36.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.6,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0226-01","type":"NDC"}],"standard_charges":[{"minimum":121.13,"maximum":163.52,"gross_charge":201.87,"discounted_cash":59.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.13,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0226-01","type":"NDC"}],"standard_charges":[{"minimum":30.29,"maximum":163.52,"gross_charge":201.87,"discounted_cash":59.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0531-01","type":"NDC"}],"standard_charges":[{"minimum":19.29,"maximum":26.04,"gross_charge":32.14,"discounted_cash":9.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0531-01","type":"NDC"}],"standard_charges":[{"minimum":4.83,"maximum":26.04,"gross_charge":32.14,"discounted_cash":9.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":115.61,"maximum":156.07,"gross_charge":192.67,"discounted_cash":57.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL ER 80 MG CAPSULE24 HREXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.91,"maximum":156.07,"gross_charge":192.67,"discounted_cash":57.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.54,"methodology":"fee schedule"}]}]},{"description":"PROPYLTHIOURACIL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70752-0171-10","type":"NDC"}],"standard_charges":[{"minimum":36.27,"maximum":48.96,"gross_charge":60.44,"discounted_cash":17.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"}]}]},{"description":"PROPYLTHIOURACIL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70752-0171-10","type":"NDC"}],"standard_charges":[{"minimum":9.07,"maximum":48.96,"gross_charge":60.44,"discounted_cash":17.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"37000-0024-04","type":"NDC"}],"standard_charges":[{"minimum":8.34,"maximum":11.26,"gross_charge":13.9,"discounted_cash":4.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"}]}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"37000-0024-04","type":"NDC"}],"standard_charges":[{"minimum":2.09,"maximum":11.26,"gross_charge":13.9,"discounted_cash":4.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"}]}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"37000-0254-45","type":"NDC"}],"standard_charges":[{"minimum":7.34,"maximum":9.91,"gross_charge":12.23,"discounted_cash":3.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.34,"methodology":"fee schedule"}]}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"37000-0254-45","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":9.91,"gross_charge":12.23,"discounted_cash":3.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"}]}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"37000-0741-08","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":0.44,"gross_charge":0.54,"discounted_cash":0.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"PSYLLIUM HUSK 3.4 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"37000-0741-08","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.44,"gross_charge":0.54,"discounted_cash":0.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"PYRAZINAMIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0735-60","type":"NDC"}],"standard_charges":[{"minimum":120.92,"maximum":163.24,"gross_charge":201.53,"discounted_cash":59.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"}]}]},{"description":"PYRAZINAMIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0735-60","type":"NDC"}],"standard_charges":[{"minimum":30.23,"maximum":163.24,"gross_charge":201.53,"discounted_cash":59.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.31,"methodology":"fee schedule"}]}]},{"description":"PYRAZINAMIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61748-0012-06","type":"NDC"}],"standard_charges":[{"minimum":157.51,"maximum":212.64,"gross_charge":262.51,"discounted_cash":77.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":212.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":212.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":212.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.51,"methodology":"fee schedule"}]}]},{"description":"PYRAZINAMIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61748-0012-06","type":"NDC"}],"standard_charges":[{"minimum":39.38,"maximum":212.64,"gross_charge":262.51,"discounted_cash":77.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":212.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":212.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":212.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.51,"methodology":"fee schedule"}]}]},{"description":"PYRAZINAMIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67253-0660-10","type":"NDC"}],"standard_charges":[{"minimum":109.07,"maximum":147.24,"gross_charge":181.77,"discounted_cash":53.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"}]}]},{"description":"PYRAZINAMIDE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67253-0660-10","type":"NDC"}],"standard_charges":[{"minimum":27.27,"maximum":147.24,"gross_charge":181.77,"discounted_cash":53.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0494-01","type":"NDC"}],"standard_charges":[{"minimum":41.97,"maximum":56.66,"gross_charge":69.94,"discounted_cash":20.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.97,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0494-01","type":"NDC"}],"standard_charges":[{"minimum":10.5,"maximum":56.66,"gross_charge":69.94,"discounted_cash":20.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0494-11","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":0.68,"gross_charge":0.83,"discounted_cash":0.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0494-11","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.68,"gross_charge":0.83,"discounted_cash":0.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0659-06","type":"NDC"}],"standard_charges":[{"minimum":5.68,"maximum":7.67,"gross_charge":9.46,"discounted_cash":2.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0659-06","type":"NDC"}],"standard_charges":[{"minimum":1.42,"maximum":7.67,"gross_charge":9.46,"discounted_cash":2.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0302-10","type":"NDC"}],"standard_charges":[{"minimum":57.63,"maximum":77.81,"gross_charge":96.05,"discounted_cash":28.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.63,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68682-0302-10","type":"NDC"}],"standard_charges":[{"minimum":14.41,"maximum":77.81,"gross_charge":96.05,"discounted_cash":28.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.21,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":54.63,"maximum":73.76,"gross_charge":91.05,"discounted_cash":26.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.66,"maximum":73.76,"gross_charge":91.05,"discounted_cash":26.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0335-30","type":"NDC"}],"standard_charges":[{"minimum":119.36,"maximum":161.13,"gross_charge":198.92,"discounted_cash":58.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.36,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG TABLETEXTENDED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0335-30","type":"NDC"}],"standard_charges":[{"minimum":29.84,"maximum":161.13,"gross_charge":198.92,"discounted_cash":58.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.79,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":265.71,"maximum":358.71,"gross_charge":442.84,"discounted_cash":131.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":358.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":358.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"}]}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":66.43,"maximum":358.71,"gross_charge":442.84,"discounted_cash":131.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":358.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":358.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":358.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.57,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0632-15","type":"NDC"}],"standard_charges":[{"minimum":4.13,"maximum":5.58,"gross_charge":6.88,"discounted_cash":2.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0632-15","type":"NDC"}],"standard_charges":[{"minimum":1.04,"maximum":5.58,"gross_charge":6.88,"discounted_cash":2.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0185-00","type":"NDC"}],"standard_charges":[{"minimum":6.92,"maximum":9.34,"gross_charge":11.53,"discounted_cash":3.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.92,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0185-00","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":9.34,"gross_charge":11.53,"discounted_cash":3.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.31,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.94,"maximum":10.72,"gross_charge":13.23,"discounted_cash":3.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"}]}]},{"description":"QUETIAPINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.99,"maximum":10.72,"gross_charge":13.23,"discounted_cash":3.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"}]}]},{"description":"QUININE 324 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13310-0153-07","type":"NDC"}],"standard_charges":[{"minimum":112.91,"maximum":152.43,"gross_charge":188.18,"discounted_cash":55.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.91,"methodology":"fee schedule"}]}]},{"description":"QUININE 324 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13310-0153-07","type":"NDC"}],"standard_charges":[{"minimum":28.23,"maximum":152.43,"gross_charge":188.18,"discounted_cash":55.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.64,"methodology":"fee schedule"}]}]},{"description":"RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":0.78,"gross_charge":0.96,"discounted_cash":0.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.78,"gross_charge":0.96,"discounted_cash":0.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.93,"maximum":1.25,"gross_charge":1.54,"discounted_cash":0.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"}]}]},{"description":"RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.24,"maximum":1.25,"gross_charge":1.54,"discounted_cash":0.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0213-01","type":"NDC"}],"standard_charges":[{"minimum":27.57,"maximum":37.22,"gross_charge":45.95,"discounted_cash":13.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0213-01","type":"NDC"}],"standard_charges":[{"minimum":6.9,"maximum":37.22,"gross_charge":45.95,"discounted_cash":13.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0505-01","type":"NDC"}],"standard_charges":[{"minimum":44.91,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0505-01","type":"NDC"}],"standard_charges":[{"minimum":11.23,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0505-30","type":"NDC"}],"standard_charges":[{"minimum":13.53,"maximum":18.26,"gross_charge":22.54,"discounted_cash":6.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0505-30","type":"NDC"}],"standard_charges":[{"minimum":3.39,"maximum":18.26,"gross_charge":22.54,"discounted_cash":6.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72241-0010-22","type":"NDC"}],"standard_charges":[{"minimum":6.67,"maximum":9,"gross_charge":11.11,"discounted_cash":3.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72241-0010-22","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":9,"gross_charge":11.11,"discounted_cash":3.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":69.7,"maximum":94.09,"gross_charge":116.16,"discounted_cash":34.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.7,"methodology":"fee schedule"}]}]},{"description":"RALOXIFENE 60 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.43,"maximum":94.09,"gross_charge":116.16,"discounted_cash":34.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.24,"methodology":"fee schedule"}]}]},{"description":"RALTEGRAVIR 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1162.48,"maximum":1569.35,"gross_charge":1937.46,"discounted_cash":573.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1569.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1569.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1569.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1162.48,"methodology":"fee schedule"}]}]},{"description":"RALTEGRAVIR 400 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":290.62,"maximum":1569.35,"gross_charge":1937.46,"discounted_cash":573.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1569.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1569.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1569.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1162.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.5,"methodology":"fee schedule"}]}]},{"description":"RAMIPRIL 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0146-01","type":"NDC"}],"standard_charges":[{"minimum":6.02,"maximum":8.13,"gross_charge":10.03,"discounted_cash":2.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"}]}]},{"description":"RAMIPRIL 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0146-01","type":"NDC"}],"standard_charges":[{"minimum":1.51,"maximum":8.13,"gross_charge":10.03,"discounted_cash":2.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0773-60","type":"NDC"}],"standard_charges":[{"minimum":5.99,"maximum":8.08,"gross_charge":9.97,"discounted_cash":2.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0773-60","type":"NDC"}],"standard_charges":[{"minimum":1.5,"maximum":8.08,"gross_charge":9.97,"discounted_cash":2.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45963-0418-06","type":"NDC"}],"standard_charges":[{"minimum":23.52,"maximum":31.76,"gross_charge":39.2,"discounted_cash":11.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45963-0418-06","type":"NDC"}],"standard_charges":[{"minimum":5.88,"maximum":31.76,"gross_charge":39.2,"discounted_cash":11.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50228-0423-60","type":"NDC"}],"standard_charges":[{"minimum":16.61,"maximum":22.43,"gross_charge":27.68,"discounted_cash":8.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50228-0423-60","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":22.43,"gross_charge":27.68,"discounted_cash":8.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1003-01","type":"NDC"}],"standard_charges":[{"minimum":225.89,"maximum":304.95,"gross_charge":376.47,"discounted_cash":111.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.89,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-1003-01","type":"NDC"}],"standard_charges":[{"minimum":56.48,"maximum":304.95,"gross_charge":376.47,"discounted_cash":111.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.3,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0017-60","type":"NDC"}],"standard_charges":[{"minimum":10.45,"maximum":14.11,"gross_charge":17.41,"discounted_cash":5.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63304-0017-60","type":"NDC"}],"standard_charges":[{"minimum":2.62,"maximum":14.11,"gross_charge":17.41,"discounted_cash":5.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.49,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0319-60","type":"NDC"}],"standard_charges":[{"minimum":7.5,"maximum":10.12,"gross_charge":12.49,"discounted_cash":3.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0319-60","type":"NDC"}],"standard_charges":[{"minimum":1.88,"maximum":10.12,"gross_charge":12.49,"discounted_cash":3.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70756-0703-60","type":"NDC"}],"standard_charges":[{"minimum":10.41,"maximum":14.06,"gross_charge":17.35,"discounted_cash":5.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"}]}]},{"description":"RANOLAZINE ER 500 MG TABLETEXTENDED RELEASE12 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70756-0703-60","type":"NDC"}],"standard_charges":[{"minimum":2.61,"maximum":14.06,"gross_charge":17.35,"discounted_cash":5.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"}]}]},{"description":"RASAGILINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0139-30","type":"NDC"}],"standard_charges":[{"minimum":150.97,"maximum":203.81,"gross_charge":251.61,"discounted_cash":74.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.97,"methodology":"fee schedule"}]}]},{"description":"RASAGILINE 1 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47781-0139-30","type":"NDC"}],"standard_charges":[{"minimum":37.75,"maximum":203.81,"gross_charge":251.61,"discounted_cash":74.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"}]}]},{"description":"RIBAVIRIN 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0207-68","type":"NDC"}],"standard_charges":[{"minimum":56.54,"maximum":76.33,"gross_charge":94.23,"discounted_cash":27.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.54,"methodology":"fee schedule"}]}]},{"description":"RIBAVIRIN 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0207-68","type":"NDC"}],"standard_charges":[{"minimum":14.14,"maximum":76.33,"gross_charge":94.23,"discounted_cash":27.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1350-01","type":"NDC"}],"standard_charges":[{"minimum":641.67,"maximum":866.26,"gross_charge":1069.45,"discounted_cash":316.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":866.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":866.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":866.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":641.67,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-1350-01","type":"NDC"}],"standard_charges":[{"minimum":160.42,"maximum":866.26,"gross_charge":1069.45,"discounted_cash":316.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":866.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":866.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":866.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":641.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.89,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0285-01","type":"NDC"}],"standard_charges":[{"minimum":436.85,"maximum":589.75,"gross_charge":728.08,"discounted_cash":215.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.85,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0285-01","type":"NDC"}],"standard_charges":[{"minimum":109.22,"maximum":589.75,"gross_charge":728.08,"discounted_cash":215.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.62,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0041-10","type":"NDC"}],"standard_charges":[{"minimum":729.54,"maximum":984.88,"gross_charge":1215.89,"discounted_cash":359.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":729.54,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0041-10","type":"NDC"}],"standard_charges":[{"minimum":182.39,"maximum":984.88,"gross_charge":1215.89,"discounted_cash":359.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":984.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":984.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":984.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":729.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":448.38,"maximum":605.31,"gross_charge":747.29,"discounted_cash":221.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":448.38,"methodology":"fee schedule"}]}]},{"description":"RIFABUTIN 150 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":112.1,"maximum":605.31,"gross_charge":747.29,"discounted_cash":221.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":448.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149.46,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0358-01","type":"NDC"}],"standard_charges":[{"minimum":36.21,"maximum":48.88,"gross_charge":60.34,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0358-01","type":"NDC"}],"standard_charges":[{"minimum":9.06,"maximum":48.88,"gross_charge":60.34,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0659-06","type":"NDC"}],"standard_charges":[{"minimum":14.19,"maximum":19.16,"gross_charge":23.65,"discounted_cash":7.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0659-06","type":"NDC"}],"standard_charges":[{"minimum":3.55,"maximum":19.16,"gross_charge":23.65,"discounted_cash":7.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.3,"maximum":32.8,"gross_charge":40.49,"discounted_cash":11.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"}]}]},{"description":"RIFAMPIN 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.08,"maximum":32.8,"gross_charge":40.49,"discounted_cash":11.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"}]}]},{"description":"RIFAXIMIN 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65649-0301-03","type":"NDC"}],"standard_charges":[{"minimum":174.54,"maximum":235.63,"gross_charge":290.89,"discounted_cash":86.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.54,"methodology":"fee schedule"}]}]},{"description":"RIFAXIMIN 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65649-0301-03","type":"NDC"}],"standard_charges":[{"minimum":43.64,"maximum":235.63,"gross_charge":290.89,"discounted_cash":86.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.18,"methodology":"fee schedule"}]}]},{"description":"RIFAXIMIN 550 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65649-0303-02","type":"NDC"}],"standard_charges":[{"minimum":1794.16,"maximum":2422.12,"gross_charge":2990.26,"discounted_cash":885.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2422.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2422.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2422.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1794.16,"methodology":"fee schedule"}]}]},{"description":"RIFAXIMIN 550 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65649-0303-02","type":"NDC"}],"standard_charges":[{"minimum":448.54,"maximum":2422.12,"gross_charge":2990.26,"discounted_cash":885.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2422.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2422.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2422.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1794.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":568.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":598.06,"methodology":"fee schedule"}]}]},{"description":"RILPIVIRINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59676-0278-01","type":"NDC"}],"standard_charges":[{"minimum":845.81,"maximum":1141.85,"gross_charge":1409.68,"discounted_cash":417.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1141.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1141.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1141.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":845.81,"methodology":"fee schedule"}]}]},{"description":"RILPIVIRINE HCL 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59676-0278-01","type":"NDC"}],"standard_charges":[{"minimum":211.46,"maximum":1141.85,"gross_charge":1409.68,"discounted_cash":417.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1141.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1141.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1141.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":845.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":267.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.94,"methodology":"fee schedule"}]}]},{"description":"RILUZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0538-86","type":"NDC"}],"standard_charges":[{"minimum":44.37,"maximum":59.9,"gross_charge":73.95,"discounted_cash":21.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"}]}]},{"description":"RILUZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0538-86","type":"NDC"}],"standard_charges":[{"minimum":11.1,"maximum":59.9,"gross_charge":73.95,"discounted_cash":21.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"}]}]},{"description":"RIOCIGUAT 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50419-0254-01","type":"NDC"}],"standard_charges":[{"minimum":6576.34,"maximum":8878.06,"gross_charge":10960.56,"discounted_cash":3244.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8878.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8878.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8878.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6576.34,"methodology":"fee schedule"}]}]},{"description":"RIOCIGUAT 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50419-0254-01","type":"NDC"}],"standard_charges":[{"minimum":1644.09,"maximum":8878.06,"gross_charge":10960.56,"discounted_cash":3244.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8878.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8878.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8878.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6576.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2082.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2192.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1644.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2192.12,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0597-30","type":"NDC"}],"standard_charges":[{"minimum":48.1,"maximum":64.93,"gross_charge":80.16,"discounted_cash":23.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.1,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0597-30","type":"NDC"}],"standard_charges":[{"minimum":12.03,"maximum":64.93,"gross_charge":80.16,"discounted_cash":23.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.04,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0364-95","type":"NDC"}],"standard_charges":[{"minimum":4.26,"maximum":5.76,"gross_charge":7.1,"discounted_cash":2.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0364-95","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":5.76,"gross_charge":7.1,"discounted_cash":2.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0687-30","type":"NDC"}],"standard_charges":[{"minimum":23.27,"maximum":31.42,"gross_charge":38.78,"discounted_cash":11.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.27,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0687-30","type":"NDC"}],"standard_charges":[{"minimum":5.82,"maximum":31.42,"gross_charge":38.78,"discounted_cash":11.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":87.04,"maximum":117.5,"gross_charge":145.06,"discounted_cash":42.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.04,"methodology":"fee schedule"}]}]},{"description":"RITONAVIR 100 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":21.76,"maximum":117.5,"gross_charge":145.06,"discounted_cash":42.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.02,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0580-30","type":"NDC"}],"standard_charges":[{"minimum":234.65,"maximum":316.78,"gross_charge":391.08,"discounted_cash":115.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":316.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":316.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":234.65,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0580-30","type":"NDC"}],"standard_charges":[{"minimum":58.67,"maximum":316.78,"gross_charge":391.08,"discounted_cash":115.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":316.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":316.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":316.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":234.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.22,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0578-10","type":"NDC"}],"standard_charges":[{"minimum":781.98,"maximum":1055.68,"gross_charge":1303.3,"discounted_cash":385.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1055.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1055.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1055.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":781.98,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0578-10","type":"NDC"}],"standard_charges":[{"minimum":195.5,"maximum":1055.68,"gross_charge":1303.3,"discounted_cash":385.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1055.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1055.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1055.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":781.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":260.66,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0578-90","type":"NDC"}],"standard_charges":[{"minimum":703.8,"maximum":950.13,"gross_charge":1172.99,"discounted_cash":347.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":950.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":950.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":950.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":703.8,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0578-90","type":"NDC"}],"standard_charges":[{"minimum":175.95,"maximum":950.13,"gross_charge":1172.99,"discounted_cash":347.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":950.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":950.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":950.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":703.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.6,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0577-01","type":"NDC"}],"standard_charges":[{"minimum":3.99,"maximum":5.39,"gross_charge":6.65,"discounted_cash":1.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0577-01","type":"NDC"}],"standard_charges":[{"minimum":1,"maximum":5.39,"gross_charge":6.65,"discounted_cash":1.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0577-10","type":"NDC"}],"standard_charges":[{"minimum":391.07,"maximum":527.94,"gross_charge":651.77,"discounted_cash":192.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 2.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0577-10","type":"NDC"}],"standard_charges":[{"minimum":97.77,"maximum":527.94,"gross_charge":651.77,"discounted_cash":192.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":391.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.36,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0579-01","type":"NDC"}],"standard_charges":[{"minimum":7.9,"maximum":10.66,"gross_charge":13.16,"discounted_cash":3.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"}]}]},{"description":"RIVAROXABAN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0579-01","type":"NDC"}],"standard_charges":[{"minimum":1.98,"maximum":10.66,"gross_charge":13.16,"discounted_cash":3.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0089-09","type":"NDC"}],"standard_charges":[{"minimum":11.6,"maximum":15.66,"gross_charge":19.33,"discounted_cash":5.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0089-09","type":"NDC"}],"standard_charges":[{"minimum":2.9,"maximum":15.66,"gross_charge":19.33,"discounted_cash":5.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0793-06","type":"NDC"}],"standard_charges":[{"minimum":15.46,"maximum":20.87,"gross_charge":25.76,"discounted_cash":7.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0793-06","type":"NDC"}],"standard_charges":[{"minimum":3.87,"maximum":20.87,"gross_charge":25.76,"discounted_cash":7.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0352-60","type":"NDC"}],"standard_charges":[{"minimum":21.08,"maximum":28.45,"gross_charge":35.12,"discounted_cash":10.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0352-60","type":"NDC"}],"standard_charges":[{"minimum":5.27,"maximum":28.45,"gross_charge":35.12,"discounted_cash":10.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.03,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0648-60","type":"NDC"}],"standard_charges":[{"minimum":15.78,"maximum":21.31,"gross_charge":26.3,"discounted_cash":7.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 1.5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0648-60","type":"NDC"}],"standard_charges":[{"minimum":3.95,"maximum":21.31,"gross_charge":26.3,"discounted_cash":7.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.26,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0117-01","type":"NDC"}],"standard_charges":[{"minimum":1.83,"maximum":2.48,"gross_charge":3.05,"discounted_cash":0.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0117-01","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":2.48,"gross_charge":3.05,"discounted_cash":0.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0117-02","type":"NDC"}],"standard_charges":[{"minimum":52.6,"maximum":71.01,"gross_charge":87.66,"discounted_cash":25.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0117-02","type":"NDC"}],"standard_charges":[{"minimum":13.15,"maximum":71.01,"gross_charge":87.66,"discounted_cash":25.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0899-30","type":"NDC"}],"standard_charges":[{"minimum":26.69,"maximum":36.03,"gross_charge":44.48,"discounted_cash":13.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0899-30","type":"NDC"}],"standard_charges":[{"minimum":6.68,"maximum":36.03,"gross_charge":44.48,"discounted_cash":13.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.34,"maximum":4.51,"gross_charge":5.56,"discounted_cash":1.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.84,"maximum":4.51,"gross_charge":5.56,"discounted_cash":1.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.63,"maximum":17.05,"gross_charge":21.04,"discounted_cash":6.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.16,"maximum":17.05,"gross_charge":21.04,"discounted_cash":6.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0115-01","type":"NDC"}],"standard_charges":[{"minimum":1.55,"maximum":2.09,"gross_charge":2.57,"discounted_cash":0.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0115-01","type":"NDC"}],"standard_charges":[{"minimum":0.39,"maximum":2.09,"gross_charge":2.57,"discounted_cash":0.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0115-02","type":"NDC"}],"standard_charges":[{"minimum":44.07,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0115-02","type":"NDC"}],"standard_charges":[{"minimum":11.02,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0897-99","type":"NDC"}],"standard_charges":[{"minimum":0.97,"maximum":1.31,"gross_charge":1.61,"discounted_cash":0.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51991-0897-99","type":"NDC"}],"standard_charges":[{"minimum":0.25,"maximum":1.31,"gross_charge":1.61,"discounted_cash":0.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1,"maximum":1.35,"gross_charge":1.66,"discounted_cash":0.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.25,"maximum":1.35,"gross_charge":1.66,"discounted_cash":0.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.35,"maximum":1.83,"gross_charge":2.25,"discounted_cash":0.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.34,"maximum":1.83,"gross_charge":2.25,"discounted_cash":0.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":27.54,"maximum":37.18,"gross_charge":45.89,"discounted_cash":13.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.89,"maximum":37.18,"gross_charge":45.89,"discounted_cash":13.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0116-02","type":"NDC"}],"standard_charges":[{"minimum":34.65,"maximum":46.77,"gross_charge":57.74,"discounted_cash":17.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"}]}]},{"description":"RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0116-02","type":"NDC"}],"standard_charges":[{"minimum":8.67,"maximum":46.77,"gross_charge":57.74,"discounted_cash":17.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0623-30","type":"NDC"}],"standard_charges":[{"minimum":10.72,"maximum":14.47,"gross_charge":17.86,"discounted_cash":5.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0623-30","type":"NDC"}],"standard_charges":[{"minimum":2.68,"maximum":14.47,"gross_charge":17.86,"discounted_cash":5.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0200-30","type":"NDC"}],"standard_charges":[{"minimum":8.61,"maximum":11.63,"gross_charge":14.35,"discounted_cash":4.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0200-30","type":"NDC"}],"standard_charges":[{"minimum":2.16,"maximum":11.63,"gross_charge":14.35,"discounted_cash":4.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":104.21,"maximum":140.68,"gross_charge":173.67,"discounted_cash":51.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.21,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":26.06,"maximum":140.68,"gross_charge":173.67,"discounted_cash":51.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.74,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":234.04,"maximum":315.95,"gross_charge":390.06,"discounted_cash":115.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":234.04,"methodology":"fee schedule"}]}]},{"description":"ROFLUMILAST 500 MCG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":58.51,"maximum":315.95,"gross_charge":390.06,"discounted_cash":115.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":234.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.02,"methodology":"fee schedule"}]}]},{"description":"ROPINIROLE 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0674-01","type":"NDC"}],"standard_charges":[{"minimum":4.52,"maximum":6.1,"gross_charge":7.53,"discounted_cash":2.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"}]}]},{"description":"ROPINIROLE 0.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10135-0674-01","type":"NDC"}],"standard_charges":[{"minimum":1.13,"maximum":6.1,"gross_charge":7.53,"discounted_cash":2.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0180-90","type":"NDC"}],"standard_charges":[{"minimum":5.59,"maximum":7.55,"gross_charge":9.31,"discounted_cash":2.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.59,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"13668-0180-90","type":"NDC"}],"standard_charges":[{"minimum":1.4,"maximum":7.55,"gross_charge":9.31,"discounted_cash":2.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0989-01","type":"NDC"}],"standard_charges":[{"minimum":2.62,"maximum":3.54,"gross_charge":4.36,"discounted_cash":1.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0989-01","type":"NDC"}],"standard_charges":[{"minimum":0.66,"maximum":3.54,"gross_charge":4.36,"discounted_cash":1.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0262-90","type":"NDC"}],"standard_charges":[{"minimum":3.38,"maximum":4.56,"gross_charge":5.62,"discounted_cash":1.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0262-90","type":"NDC"}],"standard_charges":[{"minimum":0.85,"maximum":4.56,"gross_charge":5.62,"discounted_cash":1.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0990-01","type":"NDC"}],"standard_charges":[{"minimum":5.86,"maximum":7.91,"gross_charge":9.76,"discounted_cash":2.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0990-01","type":"NDC"}],"standard_charges":[{"minimum":1.47,"maximum":7.91,"gross_charge":9.76,"discounted_cash":2.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27808-0157-01","type":"NDC"}],"standard_charges":[{"minimum":5.97,"maximum":8.06,"gross_charge":9.94,"discounted_cash":2.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27808-0157-01","type":"NDC"}],"standard_charges":[{"minimum":1.5,"maximum":8.06,"gross_charge":9.94,"discounted_cash":2.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0263-90","type":"NDC"}],"standard_charges":[{"minimum":3.11,"maximum":4.19,"gross_charge":5.17,"discounted_cash":1.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0263-90","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":4.19,"gross_charge":5.17,"discounted_cash":1.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0004-90","type":"NDC"}],"standard_charges":[{"minimum":3.43,"maximum":4.63,"gross_charge":5.71,"discounted_cash":1.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0004-90","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":4.63,"gross_charge":5.71,"discounted_cash":1.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0261-90","type":"NDC"}],"standard_charges":[{"minimum":3.75,"maximum":5.07,"gross_charge":6.25,"discounted_cash":1.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"}]}]},{"description":"ROSUVASTATIN 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0261-90","type":"NDC"}],"standard_charges":[{"minimum":0.94,"maximum":5.07,"gross_charge":6.25,"discounted_cash":1.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.25,"methodology":"fee schedule"}]}]},{"description":"SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1122.11,"maximum":1514.85,"gross_charge":1870.18,"discounted_cash":553.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1514.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1514.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1514.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1122.11,"methodology":"fee schedule"}]}]},{"description":"SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":280.53,"maximum":1514.85,"gross_charge":1870.18,"discounted_cash":553.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1514.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1514.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1514.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1122.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.04,"methodology":"fee schedule"}]}]},{"description":"SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":374.09,"maximum":505.02,"gross_charge":623.48,"discounted_cash":184.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":505.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":505.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":505.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":374.09,"methodology":"fee schedule"}]}]},{"description":"SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":93.53,"maximum":505.02,"gross_charge":623.48,"discounted_cash":184.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":505.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":505.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":505.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":374.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.7,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10019-0553-03","type":"NDC"}],"standard_charges":[{"minimum":32.48,"maximum":43.85,"gross_charge":54.13,"discounted_cash":16.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.48,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10019-0553-03","type":"NDC"}],"standard_charges":[{"minimum":8.12,"maximum":43.85,"gross_charge":54.13,"discounted_cash":16.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10019-0553-04","type":"NDC"}],"standard_charges":[{"minimum":77.83,"maximum":105.07,"gross_charge":129.71,"discounted_cash":38.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.83,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10019-0553-04","type":"NDC"}],"standard_charges":[{"minimum":19.46,"maximum":105.07,"gross_charge":129.71,"discounted_cash":38.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.95,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0580-01","type":"NDC"}],"standard_charges":[{"minimum":11.58,"maximum":15.64,"gross_charge":19.3,"discounted_cash":5.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0580-01","type":"NDC"}],"standard_charges":[{"minimum":2.9,"maximum":15.64,"gross_charge":19.3,"discounted_cash":5.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0580-46","type":"NDC"}],"standard_charges":[{"minimum":115.1,"maximum":155.39,"gross_charge":191.83,"discounted_cash":56.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.1,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0580-46","type":"NDC"}],"standard_charges":[{"minimum":28.78,"maximum":155.39,"gross_charge":191.83,"discounted_cash":56.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0505-01","type":"NDC"}],"standard_charges":[{"minimum":3.27,"maximum":4.42,"gross_charge":5.45,"discounted_cash":1.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0505-01","type":"NDC"}],"standard_charges":[{"minimum":0.82,"maximum":4.42,"gross_charge":5.45,"discounted_cash":1.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0505-10","type":"NDC"}],"standard_charges":[{"minimum":56.19,"maximum":75.85,"gross_charge":93.64,"discounted_cash":27.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.19,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50742-0505-10","type":"NDC"}],"standard_charges":[{"minimum":14.05,"maximum":75.85,"gross_charge":93.64,"discounted_cash":27.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66758-0208-54","type":"NDC"}],"standard_charges":[{"minimum":41.94,"maximum":56.62,"gross_charge":69.9,"discounted_cash":20.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.94,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66758-0208-54","type":"NDC"}],"standard_charges":[{"minimum":10.49,"maximum":56.62,"gross_charge":69.9,"discounted_cash":20.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66758-0208-58","type":"NDC"}],"standard_charges":[{"minimum":10.53,"maximum":14.21,"gross_charge":17.54,"discounted_cash":5.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"66758-0208-58","type":"NDC"}],"standard_charges":[{"minimum":2.64,"maximum":14.21,"gross_charge":17.54,"discounted_cash":5.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.32,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.83,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":11.11,"maximum":15,"gross_charge":18.51,"discounted_cash":5.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.78,"maximum":15,"gross_charge":18.51,"discounted_cash":5.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":38.02,"maximum":51.33,"gross_charge":63.36,"discounted_cash":18.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.51,"maximum":51.33,"gross_charge":63.36,"discounted_cash":18.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":74.37,"maximum":100.4,"gross_charge":123.94,"discounted_cash":36.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.37,"methodology":"fee schedule"}]}]},{"description":"SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.6,"maximum":100.4,"gross_charge":123.94,"discounted_cash":36.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.79,"methodology":"fee schedule"}]}]},{"description":"SELEGILINE 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67253-0700-06","type":"NDC"}],"standard_charges":[{"minimum":56.15,"maximum":75.8,"gross_charge":93.57,"discounted_cash":27.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.15,"methodology":"fee schedule"}]}]},{"description":"SELEGILINE 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67253-0700-06","type":"NDC"}],"standard_charges":[{"minimum":14.04,"maximum":75.8,"gross_charge":93.57,"discounted_cash":27.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.72,"methodology":"fee schedule"}]}]},{"description":"SELEGILINE 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0504-10","type":"NDC"}],"standard_charges":[{"minimum":15.03,"maximum":20.29,"gross_charge":25.04,"discounted_cash":7.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"}]}]},{"description":"SELEGILINE 5 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0504-10","type":"NDC"}],"standard_charges":[{"minimum":3.76,"maximum":20.29,"gross_charge":25.04,"discounted_cash":7.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"}]}]},{"description":"SELENIUM SULFIDE 1 % SHAMPOO","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.06,"maximum":12.24,"gross_charge":15.1,"discounted_cash":4.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"}]}]},{"description":"SELENIUM SULFIDE 1 % SHAMPOO","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.27,"maximum":12.24,"gross_charge":15.1,"discounted_cash":4.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"}]}]},{"description":"SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.24,"maximum":3.02,"gross_charge":3.72,"discounted_cash":1.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.56,"maximum":3.02,"gross_charge":3.72,"discounted_cash":1.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"}]}]},{"description":"SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":5.67,"gross_charge":7,"discounted_cash":2.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.05,"maximum":5.67,"gross_charge":7,"discounted_cash":2.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.77,"maximum":9.13,"gross_charge":11.27,"discounted_cash":3.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"}]}]},{"description":"SENNA LEAF EXTRACT 176 MG/5 ML ORAL SYRUP","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.7,"maximum":9.13,"gross_charge":11.27,"discounted_cash":3.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"}]}]},{"description":"SENNOSIDES 8.6 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67618-0300-20","type":"NDC"}],"standard_charges":[{"minimum":3.09,"maximum":4.18,"gross_charge":5.15,"discounted_cash":1.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"}]}]},{"description":"SENNOSIDES 8.6 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67618-0300-20","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":4.18,"gross_charge":5.15,"discounted_cash":1.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0353-02","type":"NDC"}],"standard_charges":[{"minimum":54.69,"maximum":73.84,"gross_charge":91.15,"discounted_cash":26.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.69,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0353-02","type":"NDC"}],"standard_charges":[{"minimum":13.68,"maximum":73.84,"gross_charge":91.15,"discounted_cash":26.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.23,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0231-01","type":"NDC"}],"standard_charges":[{"minimum":22.23,"maximum":30.01,"gross_charge":37.04,"discounted_cash":10.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0231-01","type":"NDC"}],"standard_charges":[{"minimum":5.56,"maximum":30.01,"gross_charge":37.04,"discounted_cash":10.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.41,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0612-04","type":"NDC"}],"standard_charges":[{"minimum":2.24,"maximum":3.03,"gross_charge":3.73,"discounted_cash":1.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0612-04","type":"NDC"}],"standard_charges":[{"minimum":0.56,"maximum":3.03,"gross_charge":3.73,"discounted_cash":1.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0352-09","type":"NDC"}],"standard_charges":[{"minimum":4.51,"maximum":6.09,"gross_charge":7.51,"discounted_cash":2.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"}]}]},{"description":"SERTRALINE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0352-09","type":"NDC"}],"standard_charges":[{"minimum":1.13,"maximum":6.09,"gross_charge":7.51,"discounted_cash":2.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0814-01","type":"NDC"}],"standard_charges":[{"minimum":29.73,"maximum":40.14,"gross_charge":49.55,"discounted_cash":14.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.73,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0814-01","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":40.14,"gross_charge":49.55,"discounted_cash":14.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0789-27","type":"NDC"}],"standard_charges":[{"minimum":32.97,"maximum":44.51,"gross_charge":54.95,"discounted_cash":16.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.97,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0789-27","type":"NDC"}],"standard_charges":[{"minimum":8.25,"maximum":44.51,"gross_charge":54.95,"discounted_cash":16.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58468-0130-01","type":"NDC"}],"standard_charges":[{"minimum":882.36,"maximum":1191.18,"gross_charge":1470.59,"discounted_cash":435.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1191.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1191.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1191.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":882.36,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58468-0130-01","type":"NDC"}],"standard_charges":[{"minimum":220.59,"maximum":1191.18,"gross_charge":1470.59,"discounted_cash":435.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1191.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1191.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1191.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":882.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.12,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0058-27","type":"NDC"}],"standard_charges":[{"minimum":54.53,"maximum":73.61,"gross_charge":90.87,"discounted_cash":26.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.53,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0058-27","type":"NDC"}],"standard_charges":[{"minimum":13.64,"maximum":73.61,"gross_charge":90.87,"discounted_cash":26.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.18,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0921-27","type":"NDC"}],"standard_charges":[{"minimum":31.84,"maximum":42.98,"gross_charge":53.06,"discounted_cash":15.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.84,"methodology":"fee schedule"}]}]},{"description":"SEVELAMER CARBONATE 800 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0921-27","type":"NDC"}],"standard_charges":[{"minimum":7.96,"maximum":42.98,"gross_charge":53.06,"discounted_cash":15.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.62,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0717-15","type":"NDC"}],"standard_charges":[{"minimum":13.61,"maximum":18.38,"gross_charge":22.68,"discounted_cash":6.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0717-15","type":"NDC"}],"standard_charges":[{"minimum":3.41,"maximum":18.38,"gross_charge":22.68,"discounted_cash":6.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0033-01","type":"NDC"}],"standard_charges":[{"minimum":22.07,"maximum":29.79,"gross_charge":36.77,"discounted_cash":10.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0033-01","type":"NDC"}],"standard_charges":[{"minimum":5.52,"maximum":29.79,"gross_charge":36.77,"discounted_cash":10.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0176-05","type":"NDC"}],"standard_charges":[{"minimum":28.28,"maximum":38.17,"gross_charge":47.12,"discounted_cash":13.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.28,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0176-05","type":"NDC"}],"standard_charges":[{"minimum":7.07,"maximum":38.17,"gross_charge":47.12,"discounted_cash":13.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0869-11","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":0.54,"gross_charge":0.66,"discounted_cash":0.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0869-11","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":0.54,"gross_charge":0.66,"discounted_cash":0.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.37,"maximum":23.45,"gross_charge":28.94,"discounted_cash":8.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"}]}]},{"description":"SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.35,"maximum":23.45,"gross_charge":28.94,"discounted_cash":8.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.79,"methodology":"fee schedule"}]}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"12870-0001-01","type":"NDC"}],"standard_charges":[{"minimum":37.89,"maximum":51.15,"gross_charge":63.14,"discounted_cash":18.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"}]}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"12870-0001-01","type":"NDC"}],"standard_charges":[{"minimum":9.48,"maximum":51.15,"gross_charge":63.14,"discounted_cash":18.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"}]}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"12870-0001-02","type":"NDC"}],"standard_charges":[{"minimum":34.83,"maximum":47.02,"gross_charge":58.04,"discounted_cash":17.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"}]}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"12870-0001-02","type":"NDC"}],"standard_charges":[{"minimum":8.71,"maximum":47.02,"gross_charge":58.04,"discounted_cash":17.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"}]}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.3,"maximum":3.1,"gross_charge":3.82,"discounted_cash":1.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":3.1,"gross_charge":3.82,"discounted_cash":1.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0210-50","type":"NDC"}],"standard_charges":[{"minimum":4.4,"maximum":5.94,"gross_charge":7.33,"discounted_cash":2.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0210-50","type":"NDC"}],"standard_charges":[{"minimum":1.1,"maximum":5.94,"gross_charge":7.33,"discounted_cash":2.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0210-55","type":"NDC"}],"standard_charges":[{"minimum":4.61,"maximum":6.23,"gross_charge":7.68,"discounted_cash":2.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43598-0210-55","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":6.23,"gross_charge":7.68,"discounted_cash":2.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0131-05","type":"NDC"}],"standard_charges":[{"minimum":4.94,"maximum":6.67,"gross_charge":8.23,"discounted_cash":2.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0131-05","type":"NDC"}],"standard_charges":[{"minimum":1.24,"maximum":6.67,"gross_charge":8.23,"discounted_cash":2.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61570-0131-50","type":"NDC"}],"standard_charges":[{"minimum":7.97,"maximum":10.76,"gross_charge":13.28,"discounted_cash":3.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61570-0131-50","type":"NDC"}],"standard_charges":[{"minimum":2,"maximum":10.76,"gross_charge":13.28,"discounted_cash":3.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.66,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61570-0131-55","type":"NDC"}],"standard_charges":[{"minimum":4.19,"maximum":5.66,"gross_charge":6.98,"discounted_cash":2.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61570-0131-55","type":"NDC"}],"standard_charges":[{"minimum":1.05,"maximum":5.66,"gross_charge":6.98,"discounted_cash":2.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0124-05","type":"NDC"}],"standard_charges":[{"minimum":7.43,"maximum":10.03,"gross_charge":12.38,"discounted_cash":3.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0124-05","type":"NDC"}],"standard_charges":[{"minimum":1.86,"maximum":10.03,"gross_charge":12.38,"discounted_cash":3.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0124-50","type":"NDC"}],"standard_charges":[{"minimum":5.54,"maximum":7.48,"gross_charge":9.23,"discounted_cash":2.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"}]}]},{"description":"SILVER SULFADIAZINE 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0124-50","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":7.48,"gross_charge":9.23,"discounted_cash":2.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"19903-0010-21","type":"NDC"}],"standard_charges":[{"minimum":3,"maximum":4.05,"gross_charge":4.99,"discounted_cash":1.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"19903-0010-21","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":4.05,"gross_charge":4.99,"discounted_cash":1.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPSSUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.13,"maximum":1.52,"gross_charge":1.87,"discounted_cash":0.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DROPSSUSPENSION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":1.52,"gross_charge":1.87,"discounted_cash":0.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24385-0118-78","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":1.33,"gross_charge":1.63,"discounted_cash":0.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24385-0118-78","type":"NDC"}],"standard_charges":[{"minimum":0.25,"maximum":1.33,"gross_charge":1.63,"discounted_cash":0.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"77333-0812-25","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.25,"gross_charge":0.3,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"77333-0812-25","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.25,"gross_charge":0.3,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.1,"maximum":1.49,"gross_charge":1.83,"discounted_cash":0.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"}]}]},{"description":"SIMETHICONE 80 MG CHEWABLE TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":1.49,"gross_charge":1.83,"discounted_cash":0.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"}]}]},{"description":"SODIUM BICARBONATE 650 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"77333-0831-25","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":0.22,"gross_charge":0.26,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"}]}]},{"description":"SODIUM BICARBONATE 650 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"77333-0831-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.22,"gross_charge":0.26,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0623-12","type":"NDC"}],"standard_charges":[{"minimum":3.66,"maximum":4.94,"gross_charge":6.09,"discounted_cash":1.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0623-12","type":"NDC"}],"standard_charges":[{"minimum":0.92,"maximum":4.94,"gross_charge":6.09,"discounted_cash":1.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.95,"maximum":2.64,"gross_charge":3.25,"discounted_cash":0.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.49,"maximum":2.64,"gross_charge":3.25,"discounted_cash":0.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0622-35","type":"NDC"}],"standard_charges":[{"minimum":6.36,"maximum":8.59,"gross_charge":10.6,"discounted_cash":3.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0622-35","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":8.59,"gross_charge":10.6,"discounted_cash":3.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0385-55","type":"NDC"}],"standard_charges":[{"minimum":10.12,"maximum":13.66,"gross_charge":16.86,"discounted_cash":5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0385-55","type":"NDC"}],"standard_charges":[{"minimum":2.53,"maximum":13.66,"gross_charge":16.86,"discounted_cash":5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.15,"maximum":8.3,"gross_charge":10.24,"discounted_cash":3.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 5 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.54,"maximum":8.3,"gross_charge":10.24,"discounted_cash":3.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"}]}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.78,"maximum":3.76,"gross_charge":4.63,"discounted_cash":1.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"}]}]},{"description":"SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.7,"maximum":3.76,"gross_charge":4.63,"discounted_cash":1.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.93,"methodology":"fee schedule"}]}]},{"description":"SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0268-10","type":"NDC"}],"standard_charges":[{"minimum":18.69,"maximum":25.23,"gross_charge":31.14,"discounted_cash":9.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"}]}]},{"description":"SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69543-0268-10","type":"NDC"}],"standard_charges":[{"minimum":4.68,"maximum":25.23,"gross_charge":31.14,"discounted_cash":9.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.23,"methodology":"fee schedule"}]}]},{"description":"SODIUM HYPOCHLORITE 0.125 % SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.18,"maximum":9.69,"gross_charge":11.96,"discounted_cash":3.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"}]}]},{"description":"SODIUM HYPOCHLORITE 0.125 % SOLUTION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.8,"maximum":9.69,"gross_charge":11.96,"discounted_cash":3.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.4,"methodology":"fee schedule"}]}]},{"description":"SODIUM HYPOCHLORITE 0.25 % SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"39328-0063-25","type":"NDC"}],"standard_charges":[{"minimum":6.61,"maximum":8.92,"gross_charge":11.01,"discounted_cash":3.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"}]}]},{"description":"SODIUM HYPOCHLORITE 0.25 % SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"39328-0063-25","type":"NDC"}],"standard_charges":[{"minimum":1.66,"maximum":8.92,"gross_charge":11.01,"discounted_cash":3.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"}]}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46287-0006-60","type":"NDC"}],"standard_charges":[{"minimum":12.43,"maximum":16.78,"gross_charge":20.71,"discounted_cash":6.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"}]}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46287-0006-60","type":"NDC"}],"standard_charges":[{"minimum":3.11,"maximum":16.78,"gross_charge":20.71,"discounted_cash":6.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"}]}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46287-0006-60","type":"NDC"}],"standard_charges":[{"minimum":12.36,"maximum":16.68,"gross_charge":20.59,"discounted_cash":6.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46287-0006-60","type":"NDC"}],"standard_charges":[{"minimum":3.09,"maximum":16.68,"gross_charge":20.59,"discounted_cash":6.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"}]}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0356-01","type":"NDC"}],"standard_charges":[{"minimum":13.37,"maximum":18.04,"gross_charge":22.27,"discounted_cash":6.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"}]}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62559-0356-01","type":"NDC"}],"standard_charges":[{"minimum":3.35,"maximum":18.04,"gross_charge":22.27,"discounted_cash":6.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.46,"methodology":"fee schedule"}]}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.89,"maximum":14.71,"gross_charge":18.15,"discounted_cash":5.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"}]}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.73,"maximum":14.71,"gross_charge":18.15,"discounted_cash":5.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"}]}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":119.03,"maximum":160.68,"gross_charge":198.37,"discounted_cash":58.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.03,"methodology":"fee schedule"}]}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.76,"maximum":160.68,"gross_charge":198.37,"discounted_cash":58.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.68,"methodology":"fee schedule"}]}]},{"description":"SOFOSBUVIR 400 MG-VELPATASVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-2201-01","type":"NDC"}],"standard_charges":[{"minimum":104673.21,"maximum":141308.84,"gross_charge":174455.35,"discounted_cash":51638.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141308.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141308.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141308.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104673.21,"methodology":"fee schedule"}]}]},{"description":"SOFOSBUVIR 400 MG-VELPATASVIR 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-2201-01","type":"NDC"}],"standard_charges":[{"minimum":26168.31,"maximum":141308.84,"gross_charge":174455.35,"discounted_cash":51638.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141308.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141308.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141308.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104673.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33146.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34891.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26168.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34891.07,"methodology":"fee schedule"}]}]},{"description":"SORAFENIB 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50419-0488-58","type":"NDC"}],"standard_charges":[{"minimum":15311.22,"maximum":20670.14,"gross_charge":25518.69,"discounted_cash":7553.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20670.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20670.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20670.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15311.22,"methodology":"fee schedule"}]}]},{"description":"SORAFENIB 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50419-0488-58","type":"NDC"}],"standard_charges":[{"minimum":3827.81,"maximum":20670.14,"gross_charge":25518.69,"discounted_cash":7553.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20670.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20670.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20670.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15311.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4848.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5103.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3827.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5103.74,"methodology":"fee schedule"}]}]},{"description":"SORBITOL 70 % SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46287-0500-30","type":"NDC"}],"standard_charges":[{"minimum":1.47,"maximum":1.98,"gross_charge":2.44,"discounted_cash":0.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"}]}]},{"description":"SORBITOL 70 % SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"46287-0500-30","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":1.98,"gross_charge":2.44,"discounted_cash":0.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"SOTALOL 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0080-00","type":"NDC"}],"standard_charges":[{"minimum":6.26,"maximum":8.45,"gross_charge":10.43,"discounted_cash":3.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"}]}]},{"description":"SOTALOL 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0080-00","type":"NDC"}],"standard_charges":[{"minimum":1.57,"maximum":8.45,"gross_charge":10.43,"discounted_cash":3.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"}]}]},{"description":"SOTALOL 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69584-0841-10","type":"NDC"}],"standard_charges":[{"minimum":3.44,"maximum":4.65,"gross_charge":5.73,"discounted_cash":1.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"}]}]},{"description":"SOTALOL 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69584-0841-10","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":4.65,"gross_charge":5.73,"discounted_cash":1.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"}]}]},{"description":"SPIRONOLACTONE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.56,"maximum":8.86,"gross_charge":10.93,"discounted_cash":3.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.56,"methodology":"fee schedule"}]}]},{"description":"SPIRONOLACTONE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.64,"maximum":8.86,"gross_charge":10.93,"discounted_cash":3.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.19,"methodology":"fee schedule"}]}]},{"description":"SPIRONOLACTONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0085-01","type":"NDC"}],"standard_charges":[{"minimum":5.48,"maximum":7.4,"gross_charge":9.13,"discounted_cash":2.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.48,"methodology":"fee schedule"}]}]},{"description":"SPIRONOLACTONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0085-01","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":7.4,"gross_charge":9.13,"discounted_cash":2.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"}]}]},{"description":"SPIRONOLACTONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0545-10","type":"NDC"}],"standard_charges":[{"minimum":15.51,"maximum":20.94,"gross_charge":25.84,"discounted_cash":7.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"}]}]},{"description":"SPIRONOLACTONE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0545-10","type":"NDC"}],"standard_charges":[{"minimum":3.88,"maximum":20.94,"gross_charge":25.84,"discounted_cash":7.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29033-0003-05","type":"NDC"}],"standard_charges":[{"minimum":61.89,"maximum":83.56,"gross_charge":103.15,"discounted_cash":30.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.89,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29033-0003-05","type":"NDC"}],"standard_charges":[{"minimum":15.48,"maximum":83.56,"gross_charge":103.15,"discounted_cash":30.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0753-01","type":"NDC"}],"standard_charges":[{"minimum":0.25,"maximum":0.34,"gross_charge":0.41,"discounted_cash":0.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0753-01","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.34,"gross_charge":0.41,"discounted_cash":0.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0753-20","type":"NDC"}],"standard_charges":[{"minimum":17.13,"maximum":23.12,"gross_charge":28.54,"discounted_cash":8.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0753-20","type":"NDC"}],"standard_charges":[{"minimum":4.29,"maximum":23.12,"gross_charge":28.54,"discounted_cash":8.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0401-01","type":"NDC"}],"standard_charges":[{"minimum":8.84,"maximum":11.94,"gross_charge":14.73,"discounted_cash":4.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0401-01","type":"NDC"}],"standard_charges":[{"minimum":2.21,"maximum":11.94,"gross_charge":14.73,"discounted_cash":4.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0401-05","type":"NDC"}],"standard_charges":[{"minimum":41.79,"maximum":56.41,"gross_charge":69.64,"discounted_cash":20.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0401-05","type":"NDC"}],"standard_charges":[{"minimum":10.45,"maximum":56.41,"gross_charge":69.64,"discounted_cash":20.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":12.62,"maximum":17.04,"gross_charge":21.03,"discounted_cash":6.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.16,"maximum":17.04,"gross_charge":21.03,"discounted_cash":6.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.7,"maximum":18.5,"gross_charge":22.83,"discounted_cash":6.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.43,"maximum":18.5,"gross_charge":22.83,"discounted_cash":6.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.57,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":69.99,"maximum":94.49,"gross_charge":116.65,"discounted_cash":34.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.99,"methodology":"fee schedule"}]}]},{"description":"SUCRALFATE 1 GRAM TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":17.5,"maximum":94.49,"gross_charge":116.65,"discounted_cash":34.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.33,"methodology":"fee schedule"}]}]},{"description":"SULBACTAM 1 GRAM-DURLOBACTAM 1 GRAM (0.5 GRAM X2) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68547-0111-10","type":"NDC"}],"standard_charges":[{"minimum":392.73,"maximum":530.19,"gross_charge":654.55,"discounted_cash":193.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.73,"methodology":"fee schedule"}]}]},{"description":"SULBACTAM 1 GRAM-DURLOBACTAM 1 GRAM (0.5 GRAM X2) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68547-0111-10","type":"NDC"}],"standard_charges":[{"minimum":98.19,"maximum":530.19,"gross_charge":654.55,"discounted_cash":193.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":530.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":392.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.91,"methodology":"fee schedule"}]}]},{"description":"SULFADIAZINE 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":215.88,"maximum":291.43,"gross_charge":359.79,"discounted_cash":106.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.88,"methodology":"fee schedule"}]}]},{"description":"SULFADIAZINE 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":53.97,"maximum":291.43,"gross_charge":359.79,"discounted_cash":106.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0028-08","type":"NDC"}],"standard_charges":[{"minimum":4.93,"maximum":6.66,"gross_charge":8.21,"discounted_cash":2.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42292-0028-08","type":"NDC"}],"standard_charges":[{"minimum":1.24,"maximum":6.66,"gross_charge":8.21,"discounted_cash":2.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0531-01","type":"NDC"}],"standard_charges":[{"minimum":8.06,"maximum":10.88,"gross_charge":13.43,"discounted_cash":3.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0531-01","type":"NDC"}],"standard_charges":[{"minimum":2.02,"maximum":10.88,"gross_charge":13.43,"discounted_cash":3.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.2,"maximum":12.42,"gross_charge":15.33,"discounted_cash":4.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"}]}]},{"description":"SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.3,"maximum":12.42,"gross_charge":15.33,"discounted_cash":4.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"}]}]},{"description":"SULFASALAZINE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-5000-06","type":"NDC"}],"standard_charges":[{"minimum":34.47,"maximum":46.53,"gross_charge":57.44,"discounted_cash":17.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"}]}]},{"description":"SULFASALAZINE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-5000-06","type":"NDC"}],"standard_charges":[{"minimum":8.62,"maximum":46.53,"gross_charge":57.44,"discounted_cash":17.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"}]}]},{"description":"SULFASALAZINE 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":10.34,"maximum":13.96,"gross_charge":17.23,"discounted_cash":5.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"}]}]},{"description":"SULFASALAZINE 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.59,"maximum":13.96,"gross_charge":17.23,"discounted_cash":5.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"}]}]},{"description":"SULFASALAZINE 500 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0104-06","type":"NDC"}],"standard_charges":[{"minimum":48.33,"maximum":65.25,"gross_charge":80.55,"discounted_cash":23.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"}]}]},{"description":"SULFASALAZINE 500 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59762-0104-06","type":"NDC"}],"standard_charges":[{"minimum":12.09,"maximum":65.25,"gross_charge":80.55,"discounted_cash":23.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.11,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0797-01","type":"NDC"}],"standard_charges":[{"minimum":1.77,"maximum":2.39,"gross_charge":2.95,"discounted_cash":0.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0797-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":2.39,"gross_charge":2.95,"discounted_cash":0.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0292-09","type":"NDC"}],"standard_charges":[{"minimum":0.83,"maximum":1.12,"gross_charge":1.38,"discounted_cash":0.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0292-09","type":"NDC"}],"standard_charges":[{"minimum":0.21,"maximum":1.12,"gross_charge":1.38,"discounted_cash":0.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0521-69","type":"NDC"}],"standard_charges":[{"minimum":2.27,"maximum":3.06,"gross_charge":3.77,"discounted_cash":1.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0521-69","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":3.06,"gross_charge":3.77,"discounted_cash":1.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"}]}]},{"description":"SUNITINIB MALATE 50 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13490.59,"maximum":18212.3,"gross_charge":22484.31,"discounted_cash":6655.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18212.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18212.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18212.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13490.59,"methodology":"fee schedule"}]}]},{"description":"SUNITINIB MALATE 50 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3372.65,"maximum":18212.3,"gross_charge":22484.31,"discounted_cash":6655.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18212.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18212.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18212.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13490.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4272.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4496.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3372.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4496.87,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51407-0439-60","type":"NDC"}],"standard_charges":[{"minimum":1.99,"maximum":2.69,"gross_charge":3.31,"discounted_cash":0.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51407-0439-60","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":2.69,"gross_charge":3.31,"discounted_cash":0.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0143-10","type":"NDC"}],"standard_charges":[{"minimum":26.67,"maximum":36,"gross_charge":44.44,"discounted_cash":13.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0143-10","type":"NDC"}],"standard_charges":[{"minimum":6.67,"maximum":36,"gross_charge":44.44,"discounted_cash":13.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0269-10","type":"NDC"}],"standard_charges":[{"minimum":27.21,"maximum":36.73,"gross_charge":45.34,"discounted_cash":13.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0269-10","type":"NDC"}],"standard_charges":[{"minimum":6.81,"maximum":36.73,"gross_charge":45.34,"discounted_cash":13.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.8,"maximum":18.63,"gross_charge":22.99,"discounted_cash":6.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"}]}]},{"description":"TAMOXIFEN 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.45,"maximum":18.63,"gross_charge":22.99,"discounted_cash":6.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.6,"methodology":"fee schedule"}]}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0299-11","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":0.38,"gross_charge":0.46,"discounted_cash":0.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"}]}]},{"description":"TAMSULOSIN 0.4 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0299-11","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.38,"gross_charge":0.46,"discounted_cash":0.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"TAPENTADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24510-0050-10","type":"NDC"}],"standard_charges":[{"minimum":581.3,"maximum":784.76,"gross_charge":968.83,"discounted_cash":286.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":784.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":784.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":784.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":581.3,"methodology":"fee schedule"}]}]},{"description":"TAPENTADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24510-0050-10","type":"NDC"}],"standard_charges":[{"minimum":145.33,"maximum":784.76,"gross_charge":968.83,"discounted_cash":286.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":784.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":784.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":784.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":581.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.77,"methodology":"fee schedule"}]}]},{"description":"TAPENTADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0820-04","type":"NDC"}],"standard_charges":[{"minimum":291.44,"maximum":393.45,"gross_charge":485.73,"discounted_cash":143.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":393.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":393.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.44,"methodology":"fee schedule"}]}]},{"description":"TAPENTADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50458-0820-04","type":"NDC"}],"standard_charges":[{"minimum":72.86,"maximum":393.45,"gross_charge":485.73,"discounted_cash":143.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":393.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":393.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":393.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":291.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.15,"methodology":"fee schedule"}]}]},{"description":"TAPENTADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69865-0210-02","type":"NDC"}],"standard_charges":[{"minimum":354.87,"maximum":479.08,"gross_charge":591.45,"discounted_cash":175.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354.87,"methodology":"fee schedule"}]}]},{"description":"TAPENTADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69865-0210-02","type":"NDC"}],"standard_charges":[{"minimum":88.72,"maximum":479.08,"gross_charge":591.45,"discounted_cash":175.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.29,"methodology":"fee schedule"}]}]},{"description":"TEMAZEPAM 15 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0418-20","type":"NDC"}],"standard_charges":[{"minimum":5.6,"maximum":7.56,"gross_charge":9.33,"discounted_cash":2.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"TEMAZEPAM 15 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0418-20","type":"NDC"}],"standard_charges":[{"minimum":1.4,"maximum":7.56,"gross_charge":9.33,"discounted_cash":2.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"}]}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0401-01","type":"NDC"}],"standard_charges":[{"minimum":729.78,"maximum":985.2,"gross_charge":1216.29,"discounted_cash":360.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":985.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":985.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":985.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":729.78,"methodology":"fee schedule"}]}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61958-0401-01","type":"NDC"}],"standard_charges":[{"minimum":182.45,"maximum":985.2,"gross_charge":1216.29,"discounted_cash":360.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":985.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":985.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":985.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":729.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":243.26,"methodology":"fee schedule"}]}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0533-02","type":"NDC"}],"standard_charges":[{"minimum":15.89,"maximum":21.45,"gross_charge":26.48,"discounted_cash":7.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"}]}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0533-02","type":"NDC"}],"standard_charges":[{"minimum":3.98,"maximum":21.45,"gross_charge":26.48,"discounted_cash":7.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"}]}]},{"description":"TERAZOSIN 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.5,"maximum":8.78,"gross_charge":10.83,"discounted_cash":3.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.5,"methodology":"fee schedule"}]}]},{"description":"TERAZOSIN 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.63,"maximum":8.78,"gross_charge":10.83,"discounted_cash":3.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"}]}]},{"description":"TERAZOSIN 2 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0384-06","type":"NDC"}],"standard_charges":[{"minimum":7.16,"maximum":9.67,"gross_charge":11.93,"discounted_cash":3.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"}]}]},{"description":"TERAZOSIN 2 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0384-06","type":"NDC"}],"standard_charges":[{"minimum":1.79,"maximum":9.67,"gross_charge":11.93,"discounted_cash":3.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"}]}]},{"description":"TERBINAFINE HCL 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10939-0204-44","type":"NDC"}],"standard_charges":[{"minimum":4.07,"maximum":5.5,"gross_charge":6.78,"discounted_cash":2.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"}]}]},{"description":"TERBINAFINE HCL 1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10939-0204-44","type":"NDC"}],"standard_charges":[{"minimum":1.02,"maximum":5.5,"gross_charge":6.78,"discounted_cash":2.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"}]}]},{"description":"TERBINAFINE HCL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0859-07","type":"NDC"}],"standard_charges":[{"minimum":13.82,"maximum":18.66,"gross_charge":23.03,"discounted_cash":6.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"}]}]},{"description":"TERBINAFINE HCL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0859-07","type":"NDC"}],"standard_charges":[{"minimum":3.46,"maximum":18.66,"gross_charge":23.03,"discounted_cash":6.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"}]}]},{"description":"TETRABENAZINE 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0277-23","type":"NDC"}],"standard_charges":[{"minimum":879.24,"maximum":1186.98,"gross_charge":1465.4,"discounted_cash":433.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1186.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1186.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1186.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.24,"methodology":"fee schedule"}]}]},{"description":"TETRABENAZINE 12.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0277-23","type":"NDC"}],"standard_charges":[{"minimum":219.81,"maximum":1186.98,"gross_charge":1465.4,"discounted_cash":433.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1186.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1186.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1186.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":879.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":219.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":293.08,"methodology":"fee schedule"}]}]},{"description":"TETRABENAZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0179-23","type":"NDC"}],"standard_charges":[{"minimum":1758.41,"maximum":2373.85,"gross_charge":2930.67,"discounted_cash":867.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2373.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2373.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2373.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1758.41,"methodology":"fee schedule"}]}]},{"description":"TETRABENAZINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"47335-0179-23","type":"NDC"}],"standard_charges":[{"minimum":439.61,"maximum":2373.85,"gross_charge":2930.67,"discounted_cash":867.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2373.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2373.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2373.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1758.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":556.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":439.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.14,"methodology":"fee schedule"}]}]},{"description":"TETRAHYDROZOLINE 0.05 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.72,"maximum":0.98,"gross_charge":1.2,"discounted_cash":0.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"}]}]},{"description":"TETRAHYDROZOLINE 0.05 % EYE DROPS","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":0.98,"gross_charge":1.2,"discounted_cash":0.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"THALIDOMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59572-0210-15","type":"NDC"}],"standard_charges":[{"minimum":4661.52,"maximum":6293.05,"gross_charge":7769.19,"discounted_cash":2299.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6293.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6293.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6293.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4661.52,"methodology":"fee schedule"}]}]},{"description":"THALIDOMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59572-0210-15","type":"NDC"}],"standard_charges":[{"minimum":1165.38,"maximum":6293.05,"gross_charge":7769.19,"discounted_cash":2299.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6293.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6293.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6293.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4661.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1476.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1553.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1165.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1553.84,"methodology":"fee schedule"}]}]},{"description":"THALIDOMIDE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59572-0205-14","type":"NDC"}],"standard_charges":[{"minimum":2871.84,"maximum":3876.98,"gross_charge":4786.39,"discounted_cash":1416.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3876.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2871.84,"methodology":"fee schedule"}]}]},{"description":"THALIDOMIDE 50 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59572-0205-14","type":"NDC"}],"standard_charges":[{"minimum":717.96,"maximum":3876.98,"gross_charge":4786.39,"discounted_cash":1416.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3876.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2871.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":717.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":957.28,"methodology":"fee schedule"}]}]},{"description":"THEOPHYLLINE ER 200 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52244-0200-10","type":"NDC"}],"standard_charges":[{"minimum":287.42,"maximum":388.02,"gross_charge":479.03,"discounted_cash":141.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":388.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":388.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":388.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":287.42,"methodology":"fee schedule"}]}]},{"description":"THEOPHYLLINE ER 200 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52244-0200-10","type":"NDC"}],"standard_charges":[{"minimum":71.86,"maximum":388.02,"gross_charge":479.03,"discounted_cash":141.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":388.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":388.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":388.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":287.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.81,"methodology":"fee schedule"}]}]},{"description":"THEOPHYLLINE ER 300 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52244-0300-10","type":"NDC"}],"standard_charges":[{"minimum":353.19,"maximum":476.81,"gross_charge":588.65,"discounted_cash":174.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":353.19,"methodology":"fee schedule"}]}]},{"description":"THEOPHYLLINE ER 300 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52244-0300-10","type":"NDC"}],"standard_charges":[{"minimum":88.3,"maximum":476.81,"gross_charge":588.65,"discounted_cash":174.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":476.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":476.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":476.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":353.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.73,"methodology":"fee schedule"}]}]},{"description":"THERAPEUTIC MULTIVITAMIN TABLET (WRAPPER)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.3,"maximum":3.11,"gross_charge":3.83,"discounted_cash":1.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"THERAPEUTIC MULTIVITAMIN TABLET (WRAPPER)","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":3.11,"gross_charge":3.83,"discounted_cash":1.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"80681-0098-00","type":"NDC"}],"standard_charges":[{"minimum":1.64,"maximum":2.22,"gross_charge":2.73,"discounted_cash":0.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"80681-0098-00","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":2.22,"gross_charge":2.73,"discounted_cash":0.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"THIORIDAZINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.31,"maximum":27.42,"gross_charge":33.84,"discounted_cash":10.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"}]}]},{"description":"THIORIDAZINE 10 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.08,"maximum":27.42,"gross_charge":33.84,"discounted_cash":10.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"}]}]},{"description":"THIORIDAZINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":39.69,"maximum":53.58,"gross_charge":66.14,"discounted_cash":19.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"}]}]},{"description":"THIORIDAZINE 25 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.93,"maximum":53.58,"gross_charge":66.14,"discounted_cash":19.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"}]}]},{"description":"THIOTHIXENE 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60219-1673-01","type":"NDC"}],"standard_charges":[{"minimum":52.17,"maximum":70.43,"gross_charge":86.95,"discounted_cash":25.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.17,"methodology":"fee schedule"}]}]},{"description":"THIOTHIXENE 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60219-1673-01","type":"NDC"}],"standard_charges":[{"minimum":13.05,"maximum":70.43,"gross_charge":86.95,"discounted_cash":25.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"}]}]},{"description":"THIOTHIXENE 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0014-10","type":"NDC"}],"standard_charges":[{"minimum":40.47,"maximum":54.63,"gross_charge":67.44,"discounted_cash":19.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"}]}]},{"description":"THIOTHIXENE 1 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0014-10","type":"NDC"}],"standard_charges":[{"minimum":10.12,"maximum":54.63,"gross_charge":67.44,"discounted_cash":19.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"}]}]},{"description":"THIOTHIXENE 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":53.31,"maximum":71.97,"gross_charge":88.85,"discounted_cash":26.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"}]}]},{"description":"THIOTHIXENE 1 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.33,"maximum":71.97,"gross_charge":88.85,"discounted_cash":26.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.77,"methodology":"fee schedule"}]}]},{"description":"THYROID (PORK) 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42192-0329-01","type":"NDC"}],"standard_charges":[{"minimum":38.43,"maximum":51.88,"gross_charge":64.04,"discounted_cash":18.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"}]}]},{"description":"THYROID (PORK) 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42192-0329-01","type":"NDC"}],"standard_charges":[{"minimum":9.61,"maximum":51.88,"gross_charge":64.04,"discounted_cash":18.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"THYROID (PORK) 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0311-01","type":"NDC"}],"standard_charges":[{"minimum":35.07,"maximum":47.34,"gross_charge":58.44,"discounted_cash":17.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"}]}]},{"description":"THYROID (PORK) 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"75834-0311-01","type":"NDC"}],"standard_charges":[{"minimum":8.77,"maximum":47.34,"gross_charge":58.44,"discounted_cash":17.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"THYROID (PORK) 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42192-0330-01","type":"NDC"}],"standard_charges":[{"minimum":40.71,"maximum":54.96,"gross_charge":67.84,"discounted_cash":20.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.71,"methodology":"fee schedule"}]}]},{"description":"THYROID (PORK) 60 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42192-0330-01","type":"NDC"}],"standard_charges":[{"minimum":10.18,"maximum":54.96,"gross_charge":67.84,"discounted_cash":20.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"}]}]},{"description":"TICAGRELOR 90 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0368-60","type":"NDC"}],"standard_charges":[{"minimum":12.83,"maximum":17.31,"gross_charge":21.37,"discounted_cash":6.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"TICAGRELOR 90 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0368-60","type":"NDC"}],"standard_charges":[{"minimum":3.21,"maximum":17.31,"gross_charge":21.37,"discounted_cash":6.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"}]}]},{"description":"TICAGRELOR 90 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":246.63,"maximum":332.95,"gross_charge":411.04,"discounted_cash":121.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":246.63,"methodology":"fee schedule"}]}]},{"description":"TICAGRELOR 90 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":61.66,"maximum":332.95,"gross_charge":411.04,"discounted_cash":121.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":332.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":332.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":332.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":246.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.21,"methodology":"fee schedule"}]}]},{"description":"TICAGRELOR 90 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":410.93,"maximum":554.75,"gross_charge":684.87,"discounted_cash":202.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.93,"methodology":"fee schedule"}]}]},{"description":"TICAGRELOR 90 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":102.74,"maximum":554.75,"gross_charge":684.87,"discounted_cash":202.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":554.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":410.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.98,"methodology":"fee schedule"}]}]},{"description":"TINIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0551-02","type":"NDC"}],"standard_charges":[{"minimum":89.55,"maximum":120.89,"gross_charge":149.24,"discounted_cash":44.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.55,"methodology":"fee schedule"}]}]},{"description":"TINIDAZOLE 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43386-0551-02","type":"NDC"}],"standard_charges":[{"minimum":22.39,"maximum":120.89,"gross_charge":149.24,"discounted_cash":44.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.85,"methodology":"fee schedule"}]}]},{"description":"TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.67,"maximum":27.91,"gross_charge":34.45,"discounted_cash":10.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"}]}]},{"description":"TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.17,"maximum":27.91,"gross_charge":34.45,"discounted_cash":10.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"TIZANIDINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0252-03","type":"NDC"}],"standard_charges":[{"minimum":4.67,"maximum":6.31,"gross_charge":7.78,"discounted_cash":2.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"}]}]},{"description":"TIZANIDINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-0252-03","type":"NDC"}],"standard_charges":[{"minimum":1.17,"maximum":6.31,"gross_charge":7.78,"discounted_cash":2.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"}]}]},{"description":"TIZANIDINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72789-0325-90","type":"NDC"}],"standard_charges":[{"minimum":3.21,"maximum":4.34,"gross_charge":5.35,"discounted_cash":1.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"}]}]},{"description":"TIZANIDINE 4 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72789-0325-90","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":4.34,"gross_charge":5.35,"discounted_cash":1.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0643-05","type":"NDC"}],"standard_charges":[{"minimum":5.82,"maximum":7.86,"gross_charge":9.7,"discounted_cash":2.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"61314-0643-05","type":"NDC"}],"standard_charges":[{"minimum":1.46,"maximum":7.86,"gross_charge":9.7,"discounted_cash":2.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.94,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0518-05","type":"NDC"}],"standard_charges":[{"minimum":8.58,"maximum":11.59,"gross_charge":14.3,"discounted_cash":4.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 % EYE DROPS","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0518-05","type":"NDC"}],"standard_charges":[{"minimum":2.15,"maximum":11.59,"gross_charge":14.3,"discounted_cash":4.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":117.79,"maximum":159.02,"gross_charge":196.31,"discounted_cash":58.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.79,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":29.45,"maximum":159.02,"gross_charge":196.31,"discounted_cash":58.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0295-25","type":"NDC"}],"standard_charges":[{"minimum":23.3,"maximum":31.46,"gross_charge":38.83,"discounted_cash":11.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.3,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPSSUSPENSION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"24208-0295-25","type":"NDC"}],"standard_charges":[{"minimum":5.83,"maximum":31.46,"gross_charge":38.83,"discounted_cash":11.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0119-03","type":"NDC"}],"standard_charges":[{"minimum":5.13,"maximum":6.93,"gross_charge":8.55,"discounted_cash":2.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0119-03","type":"NDC"}],"standard_charges":[{"minimum":1.29,"maximum":6.93,"gross_charge":8.55,"discounted_cash":2.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55555-0412-01","type":"NDC"}],"standard_charges":[{"minimum":73.1,"maximum":98.68,"gross_charge":121.82,"discounted_cash":36.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.1,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55555-0412-01","type":"NDC"}],"standard_charges":[{"minimum":18.28,"maximum":98.68,"gross_charge":121.82,"discounted_cash":36.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.37,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0914-46","type":"NDC"}],"standard_charges":[{"minimum":6.03,"maximum":8.14,"gross_charge":10.04,"discounted_cash":2.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65162-0914-46","type":"NDC"}],"standard_charges":[{"minimum":1.51,"maximum":8.14,"gross_charge":10.04,"discounted_cash":2.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":38.7,"maximum":52.25,"gross_charge":64.5,"discounted_cash":19.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":9.68,"maximum":52.25,"gross_charge":64.5,"discounted_cash":19.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"}]}]},{"description":"TOFACITINIB 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3367.04,"maximum":4545.51,"gross_charge":5611.73,"discounted_cash":1661.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4545.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4545.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4545.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3367.04,"methodology":"fee schedule"}]}]},{"description":"TOFACITINIB 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":841.76,"maximum":4545.51,"gross_charge":5611.73,"discounted_cash":1661.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4545.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4545.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4545.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3367.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1066.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":841.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.35,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0768-52","type":"NDC"}],"standard_charges":[{"minimum":28.46,"maximum":38.42,"gross_charge":47.42,"discounted_cash":14.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0768-52","type":"NDC"}],"standard_charges":[{"minimum":7.12,"maximum":38.42,"gross_charge":47.42,"discounted_cash":14.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0768-54","type":"NDC"}],"standard_charges":[{"minimum":354.75,"maximum":478.92,"gross_charge":591.25,"discounted_cash":175.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":478.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":478.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":478.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354.75,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"49884-0768-54","type":"NDC"}],"standard_charges":[{"minimum":88.69,"maximum":478.92,"gross_charge":591.25,"discounted_cash":175.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":478.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":478.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":478.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.25,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0635-33","type":"NDC"}],"standard_charges":[{"minimum":2778.72,"maximum":3751.28,"gross_charge":4631.2,"discounted_cash":1370.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3751.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3751.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3751.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2778.72,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0635-33","type":"NDC"}],"standard_charges":[{"minimum":694.68,"maximum":3751.28,"gross_charge":4631.2,"discounted_cash":1370.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3751.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3751.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3751.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2778.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.24,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0130-11","type":"NDC"}],"standard_charges":[{"minimum":33.03,"maximum":44.59,"gross_charge":55.04,"discounted_cash":16.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.03,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 15 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"72205-0130-11","type":"NDC"}],"standard_charges":[{"minimum":8.26,"maximum":44.59,"gross_charge":55.04,"discounted_cash":16.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0869-03","type":"NDC"}],"standard_charges":[{"minimum":720.23,"maximum":972.31,"gross_charge":1200.38,"discounted_cash":355.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":720.23,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0869-03","type":"NDC"}],"standard_charges":[{"minimum":180.06,"maximum":972.31,"gross_charge":1200.38,"discounted_cash":355.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":972.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":972.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":972.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":720.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":240.08,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59148-0021-50","type":"NDC"}],"standard_charges":[{"minimum":3238.62,"maximum":4372.13,"gross_charge":5397.69,"discounted_cash":1597.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4372.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4372.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4372.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3238.62,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59148-0021-50","type":"NDC"}],"standard_charges":[{"minimum":809.66,"maximum":4372.13,"gross_charge":5397.69,"discounted_cash":1597.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4372.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4372.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4372.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3238.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1025.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":809.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1079.54,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-4705-00","type":"NDC"}],"standard_charges":[{"minimum":2326.5,"maximum":3140.78,"gross_charge":3877.5,"discounted_cash":1147.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3140.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3140.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3140.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2326.5,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-4705-00","type":"NDC"}],"standard_charges":[{"minimum":581.63,"maximum":3140.78,"gross_charge":3877.5,"discounted_cash":1147.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3140.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3140.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3140.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2326.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.5,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-4705-01","type":"NDC"}],"standard_charges":[{"minimum":232.73,"maximum":314.18,"gross_charge":387.87,"discounted_cash":114.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":314.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":314.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.73,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-4705-01","type":"NDC"}],"standard_charges":[{"minimum":58.19,"maximum":314.18,"gross_charge":387.87,"discounted_cash":114.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":314.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":314.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":314.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":232.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.58,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0636-02","type":"NDC"}],"standard_charges":[{"minimum":1754.07,"maximum":2367.99,"gross_charge":2923.44,"discounted_cash":865.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2367.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2367.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2367.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1754.07,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0636-02","type":"NDC"}],"standard_charges":[{"minimum":438.52,"maximum":2367.99,"gross_charge":2923.44,"discounted_cash":865.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2367.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2367.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2367.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1754.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":555.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":584.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":438.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":584.69,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0636-33","type":"NDC"}],"standard_charges":[{"minimum":1815.93,"maximum":2451.5,"gross_charge":3026.54,"discounted_cash":895.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2451.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2451.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1815.93,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 30 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0636-33","type":"NDC"}],"standard_charges":[{"minimum":453.99,"maximum":2451.5,"gross_charge":3026.54,"discounted_cash":895.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2451.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2451.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2451.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1815.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":605.31,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 7.5 MG HALFTAB","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":179.55,"maximum":242.4,"gross_charge":299.25,"discounted_cash":88.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"TOLVAPTAN 7.5 MG HALFTAB","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":44.89,"maximum":242.4,"gross_charge":299.25,"discounted_cash":88.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":242.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":179.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"}]}]},{"description":"TOPIRAMATE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0344-11","type":"NDC"}],"standard_charges":[{"minimum":22.65,"maximum":30.57,"gross_charge":37.74,"discounted_cash":11.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"}]}]},{"description":"TOPIRAMATE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0344-11","type":"NDC"}],"standard_charges":[{"minimum":5.67,"maximum":30.57,"gross_charge":37.74,"discounted_cash":11.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.55,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50111-0916-01","type":"NDC"}],"standard_charges":[{"minimum":4.04,"maximum":5.46,"gross_charge":6.73,"discounted_cash":2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50111-0916-01","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":5.46,"gross_charge":6.73,"discounted_cash":2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0139-01","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":5.78,"gross_charge":7.13,"discounted_cash":2.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 10 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0139-01","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":5.78,"gross_charge":7.13,"discounted_cash":2.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0532-01","type":"NDC"}],"standard_charges":[{"minimum":27.09,"maximum":36.57,"gross_charge":45.14,"discounted_cash":13.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.09,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0532-01","type":"NDC"}],"standard_charges":[{"minimum":6.78,"maximum":36.57,"gross_charge":45.14,"discounted_cash":13.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0141-01","type":"NDC"}],"standard_charges":[{"minimum":25.23,"maximum":34.06,"gross_charge":42.04,"discounted_cash":12.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"57237-0141-01","type":"NDC"}],"standard_charges":[{"minimum":6.31,"maximum":34.06,"gross_charge":42.04,"discounted_cash":12.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0128-01","type":"NDC"}],"standard_charges":[{"minimum":24.81,"maximum":33.49,"gross_charge":41.34,"discounted_cash":12.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0128-01","type":"NDC"}],"standard_charges":[{"minimum":6.21,"maximum":33.49,"gross_charge":41.34,"discounted_cash":12.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0756-15","type":"NDC"}],"standard_charges":[{"minimum":7.46,"maximum":10.07,"gross_charge":12.43,"discounted_cash":3.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.46,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0756-15","type":"NDC"}],"standard_charges":[{"minimum":1.87,"maximum":10.07,"gross_charge":12.43,"discounted_cash":3.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0539-01","type":"NDC"}],"standard_charges":[{"minimum":18.99,"maximum":25.63,"gross_charge":31.64,"discounted_cash":9.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0539-01","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":25.63,"gross_charge":31.64,"discounted_cash":9.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.33,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":23.01,"maximum":31.06,"gross_charge":38.34,"discounted_cash":11.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.01,"methodology":"fee schedule"}]}]},{"description":"TORSEMIDE 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.76,"maximum":31.06,"gross_charge":38.34,"discounted_cash":11.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.67,"methodology":"fee schedule"}]}]},{"description":"TRAMADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0355-01","type":"NDC"}],"standard_charges":[{"minimum":1.58,"maximum":2.14,"gross_charge":2.63,"discounted_cash":0.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"TRAMADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"29300-0355-01","type":"NDC"}],"standard_charges":[{"minimum":0.4,"maximum":2.14,"gross_charge":2.63,"discounted_cash":0.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"}]}]},{"description":"TRAMADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0991-20","type":"NDC"}],"standard_charges":[{"minimum":4.7,"maximum":6.35,"gross_charge":7.83,"discounted_cash":2.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.7,"methodology":"fee schedule"}]}]},{"description":"TRAMADOL 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0991-20","type":"NDC"}],"standard_charges":[{"minimum":1.18,"maximum":6.35,"gross_charge":7.83,"discounted_cash":2.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.57,"methodology":"fee schedule"}]}]},{"description":"TRAZODONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0869-90","type":"NDC"}],"standard_charges":[{"minimum":2.84,"maximum":3.83,"gross_charge":4.72,"discounted_cash":1.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"}]}]},{"description":"TRAZODONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0869-90","type":"NDC"}],"standard_charges":[{"minimum":0.71,"maximum":3.83,"gross_charge":4.72,"discounted_cash":1.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"}]}]},{"description":"TRAZODONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0454-01","type":"NDC"}],"standard_charges":[{"minimum":10.94,"maximum":14.77,"gross_charge":18.23,"discounted_cash":5.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"}]}]},{"description":"TRAZODONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0454-01","type":"NDC"}],"standard_charges":[{"minimum":2.74,"maximum":14.77,"gross_charge":18.23,"discounted_cash":5.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.65,"methodology":"fee schedule"}]}]},{"description":"TRAZODONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0454-11","type":"NDC"}],"standard_charges":[{"minimum":0.19,"maximum":0.26,"gross_charge":0.31,"discounted_cash":0.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"TRAZODONE 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0454-11","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.26,"gross_charge":0.31,"discounted_cash":0.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10370-0268-01","type":"NDC"}],"standard_charges":[{"minimum":480.06,"maximum":648.09,"gross_charge":800.1,"discounted_cash":236.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":648.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":648.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.06,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10370-0268-01","type":"NDC"}],"standard_charges":[{"minimum":120.02,"maximum":648.09,"gross_charge":800.1,"discounted_cash":236.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":648.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":648.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":648.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":480.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.02,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0075-11","type":"NDC"}],"standard_charges":[{"minimum":11.57,"maximum":15.62,"gross_charge":19.28,"discounted_cash":5.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0075-11","type":"NDC"}],"standard_charges":[{"minimum":2.9,"maximum":15.62,"gross_charge":19.28,"discounted_cash":5.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0075-21","type":"NDC"}],"standard_charges":[{"minimum":344.78,"maximum":465.46,"gross_charge":574.63,"discounted_cash":170.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":344.78,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0075-21","type":"NDC"}],"standard_charges":[{"minimum":86.2,"maximum":465.46,"gross_charge":574.63,"discounted_cash":170.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":344.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.93,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0792-01","type":"NDC"}],"standard_charges":[{"minimum":737.76,"maximum":995.97,"gross_charge":1229.59,"discounted_cash":363.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":995.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":995.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":995.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":737.76,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0792-01","type":"NDC"}],"standard_charges":[{"minimum":184.44,"maximum":995.97,"gross_charge":1229.59,"discounted_cash":363.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":995.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":995.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":995.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":737.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.92,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":600.81,"maximum":811.09,"gross_charge":1001.34,"discounted_cash":296.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":811.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":811.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":811.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.81,"methodology":"fee schedule"}]}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":150.21,"maximum":811.09,"gross_charge":1001.34,"discounted_cash":296.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":811.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":811.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":811.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":600.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1282-01","type":"NDC"}],"standard_charges":[{"minimum":1.34,"maximum":1.8,"gross_charge":2.22,"discounted_cash":0.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51672-1282-01","type":"NDC"}],"standard_charges":[{"minimum":0.34,"maximum":1.8,"gross_charge":2.22,"discounted_cash":0.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52565-0014-15","type":"NDC"}],"standard_charges":[{"minimum":2.47,"maximum":3.33,"gross_charge":4.11,"discounted_cash":1.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"52565-0014-15","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":3.33,"gross_charge":4.11,"discounted_cash":1.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.26,"maximum":1.71,"gross_charge":2.1,"discounted_cash":0.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":1.71,"gross_charge":2.1,"discounted_cash":0.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.42,"methodology":"fee schedule"}]}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0327-03","type":"NDC"}],"standard_charges":[{"minimum":76,"maximum":102.6,"gross_charge":126.66,"discounted_cash":37.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"}]}]},{"description":"TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0327-03","type":"NDC"}],"standard_charges":[{"minimum":19,"maximum":102.6,"gross_charge":126.66,"discounted_cash":37.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.34,"methodology":"fee schedule"}]}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0388-00","type":"NDC"}],"standard_charges":[{"minimum":9.56,"maximum":12.91,"gross_charge":15.93,"discounted_cash":4.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"}]}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0388-00","type":"NDC"}],"standard_charges":[{"minimum":2.39,"maximum":12.91,"gross_charge":15.93,"discounted_cash":4.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.19,"methodology":"fee schedule"}]}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":16.77,"maximum":22.64,"gross_charge":27.94,"discounted_cash":8.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"}]}]},{"description":"TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.2,"maximum":22.64,"gross_charge":27.94,"discounted_cash":8.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.59,"methodology":"fee schedule"}]}]},{"description":"TRIHEXYPHENIDYL 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0212-10","type":"NDC"}],"standard_charges":[{"minimum":8.36,"maximum":11.29,"gross_charge":13.93,"discounted_cash":4.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"}]}]},{"description":"TRIHEXYPHENIDYL 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"70954-0212-10","type":"NDC"}],"standard_charges":[{"minimum":2.09,"maximum":11.29,"gross_charge":13.93,"discounted_cash":4.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.79,"methodology":"fee schedule"}]}]},{"description":"TRIHEXYPHENIDYL 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":8.96,"maximum":12.1,"gross_charge":14.93,"discounted_cash":4.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"}]}]},{"description":"TRIHEXYPHENIDYL 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.24,"maximum":12.1,"gross_charge":14.93,"discounted_cash":4.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.99,"methodology":"fee schedule"}]}]},{"description":"TRIMETHOPRIM 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0775-11","type":"NDC"}],"standard_charges":[{"minimum":0.3,"maximum":0.41,"gross_charge":0.5,"discounted_cash":0.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"}]}]},{"description":"TRIMETHOPRIM 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0775-11","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.41,"gross_charge":0.5,"discounted_cash":0.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"TRIMETHOPRIM 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0486-01","type":"NDC"}],"standard_charges":[{"minimum":111.89,"maximum":151.05,"gross_charge":186.47,"discounted_cash":55.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.89,"methodology":"fee schedule"}]}]},{"description":"TRIMETHOPRIM 100 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51862-0486-01","type":"NDC"}],"standard_charges":[{"minimum":27.98,"maximum":151.05,"gross_charge":186.47,"discounted_cash":55.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-3454-06","type":"NDC"}],"standard_charges":[{"minimum":26.22,"maximum":35.4,"gross_charge":43.7,"discounted_cash":12.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60505-3454-06","type":"NDC"}],"standard_charges":[{"minimum":6.56,"maximum":35.4,"gross_charge":43.7,"discounted_cash":12.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.74,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0461-60","type":"NDC"}],"standard_charges":[{"minimum":7.21,"maximum":9.73,"gross_charge":12.01,"discounted_cash":3.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0461-60","type":"NDC"}],"standard_charges":[{"minimum":1.81,"maximum":9.73,"gross_charge":12.01,"discounted_cash":3.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.73,"maximum":18.53,"gross_charge":22.87,"discounted_cash":6.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":3.44,"maximum":18.53,"gross_charge":22.87,"discounted_cash":6.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.06,"maximum":37.88,"gross_charge":46.76,"discounted_cash":13.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"}]}]},{"description":"TROSPIUM 20 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.02,"maximum":37.88,"gross_charge":46.76,"discounted_cash":13.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"}]}]},{"description":"UREA 15 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62530-0000-11","type":"NDC"}],"standard_charges":[{"minimum":17.49,"maximum":23.61,"gross_charge":29.14,"discounted_cash":8.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"}]}]},{"description":"UREA 15 GRAM ORAL POWDER PACKET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62530-0000-11","type":"NDC"}],"standard_charges":[{"minimum":4.38,"maximum":23.61,"gross_charge":29.14,"discounted_cash":8.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"}]}]},{"description":"UREA 20 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58980-0610-30","type":"NDC"}],"standard_charges":[{"minimum":5.08,"maximum":6.86,"gross_charge":8.46,"discounted_cash":2.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"UREA 20 % TOPICAL CREAM","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"58980-0610-30","type":"NDC"}],"standard_charges":[{"minimum":1.27,"maximum":6.86,"gross_charge":8.46,"discounted_cash":2.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0226-00","type":"NDC"}],"standard_charges":[{"minimum":47.31,"maximum":63.87,"gross_charge":78.85,"discounted_cash":23.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.31,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0226-00","type":"NDC"}],"standard_charges":[{"minimum":11.83,"maximum":63.87,"gross_charge":78.85,"discounted_cash":23.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0343-00","type":"NDC"}],"standard_charges":[{"minimum":47.49,"maximum":64.12,"gross_charge":79.15,"discounted_cash":23.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.49,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0343-00","type":"NDC"}],"standard_charges":[{"minimum":11.88,"maximum":64.12,"gross_charge":79.15,"discounted_cash":23.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0473-01","type":"NDC"}],"standard_charges":[{"minimum":27.33,"maximum":36.89,"gross_charge":45.54,"discounted_cash":13.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.33,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0473-01","type":"NDC"}],"standard_charges":[{"minimum":6.84,"maximum":36.89,"gross_charge":45.54,"discounted_cash":13.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.81,"maximum":41.59,"gross_charge":51.34,"discounted_cash":15.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.81,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 250 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.71,"maximum":41.59,"gross_charge":51.34,"discounted_cash":15.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0237-01","type":"NDC"}],"standard_charges":[{"minimum":47.19,"maximum":63.71,"gross_charge":78.65,"discounted_cash":23.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"10702-0237-01","type":"NDC"}],"standard_charges":[{"minimum":11.8,"maximum":63.71,"gross_charge":78.65,"discounted_cash":23.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0923-01","type":"NDC"}],"standard_charges":[{"minimum":26.43,"maximum":35.68,"gross_charge":44.04,"discounted_cash":13.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0923-01","type":"NDC"}],"standard_charges":[{"minimum":6.61,"maximum":35.68,"gross_charge":44.04,"discounted_cash":13.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0503-01","type":"NDC"}],"standard_charges":[{"minimum":67.59,"maximum":91.25,"gross_charge":112.65,"discounted_cash":33.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42806-0503-01","type":"NDC"}],"standard_charges":[{"minimum":16.9,"maximum":91.25,"gross_charge":112.65,"discounted_cash":33.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1540-01","type":"NDC"}],"standard_charges":[{"minimum":28.95,"maximum":39.08,"gross_charge":48.24,"discounted_cash":14.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69238-1540-01","type":"NDC"}],"standard_charges":[{"minimum":7.24,"maximum":39.08,"gross_charge":48.24,"discounted_cash":14.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":55.05,"maximum":74.32,"gross_charge":91.75,"discounted_cash":27.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.05,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":13.77,"maximum":74.32,"gross_charge":91.75,"discounted_cash":27.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.35,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":141.71,"maximum":191.31,"gross_charge":236.18,"discounted_cash":69.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.71,"methodology":"fee schedule"}]}]},{"description":"URSODIOL 300 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":35.43,"maximum":191.31,"gross_charge":236.18,"discounted_cash":69.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":191.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":191.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":191.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":141.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.24,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0698-03","type":"NDC"}],"standard_charges":[{"minimum":10.29,"maximum":13.89,"gross_charge":17.14,"discounted_cash":5.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0698-03","type":"NDC"}],"standard_charges":[{"minimum":2.58,"maximum":13.89,"gross_charge":17.14,"discounted_cash":5.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0093-01","type":"NDC"}],"standard_charges":[{"minimum":1.89,"maximum":2.55,"gross_charge":3.14,"discounted_cash":0.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51079-0093-01","type":"NDC"}],"standard_charges":[{"minimum":0.48,"maximum":2.55,"gross_charge":3.14,"discounted_cash":0.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0448-30","type":"NDC"}],"standard_charges":[{"minimum":14.74,"maximum":19.9,"gross_charge":24.56,"discounted_cash":7.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0448-30","type":"NDC"}],"standard_charges":[{"minimum":3.69,"maximum":19.9,"gross_charge":24.56,"discounted_cash":7.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0448-90","type":"NDC"}],"standard_charges":[{"minimum":44.05,"maximum":59.47,"gross_charge":73.41,"discounted_cash":21.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.05,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0448-90","type":"NDC"}],"standard_charges":[{"minimum":11.02,"maximum":59.47,"gross_charge":73.41,"discounted_cash":21.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0215-11","type":"NDC"}],"standard_charges":[{"minimum":0.67,"maximum":0.9,"gross_charge":1.11,"discounted_cash":0.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0215-11","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":0.9,"gross_charge":1.11,"discounted_cash":0.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":19.31,"maximum":26.07,"gross_charge":32.18,"discounted_cash":9.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"}]}]},{"description":"VALACYCLOVIR 500 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.83,"maximum":26.07,"gross_charge":32.18,"discounted_cash":9.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.44,"methodology":"fee schedule"}]}]},{"description":"VALGANCICLOVIR 450 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0832-60","type":"NDC"}],"standard_charges":[{"minimum":177.42,"maximum":239.51,"gross_charge":295.69,"discounted_cash":87.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":239.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":239.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.42,"methodology":"fee schedule"}]}]},{"description":"VALGANCICLOVIR 450 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0832-60","type":"NDC"}],"standard_charges":[{"minimum":44.36,"maximum":239.51,"gross_charge":295.69,"discounted_cash":87.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":239.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":239.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":239.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":177.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.14,"methodology":"fee schedule"}]}]},{"description":"VALGANCICLOVIR 450 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0762-60","type":"NDC"}],"standard_charges":[{"minimum":76.42,"maximum":103.17,"gross_charge":127.36,"discounted_cash":37.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.42,"methodology":"fee schedule"}]}]},{"description":"VALGANCICLOVIR 450 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0762-60","type":"NDC"}],"standard_charges":[{"minimum":19.11,"maximum":103.17,"gross_charge":127.36,"discounted_cash":37.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID 250 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0086-10","type":"NDC"}],"standard_charges":[{"minimum":15.99,"maximum":21.58,"gross_charge":26.64,"discounted_cash":7.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID 250 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0086-10","type":"NDC"}],"standard_charges":[{"minimum":4,"maximum":21.58,"gross_charge":26.64,"discounted_cash":7.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID 250 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0253-40","type":"NDC"}],"standard_charges":[{"minimum":9.38,"maximum":12.67,"gross_charge":15.63,"discounted_cash":4.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"}]}]},{"description":"VALPROIC ACID 250 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"63739-0253-40","type":"NDC"}],"standard_charges":[{"minimum":2.35,"maximum":12.67,"gross_charge":15.63,"discounted_cash":4.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.13,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0153-90","type":"NDC"}],"standard_charges":[{"minimum":14.4,"maximum":19.44,"gross_charge":23.99,"discounted_cash":7.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0153-90","type":"NDC"}],"standard_charges":[{"minimum":3.6,"maximum":19.44,"gross_charge":23.99,"discounted_cash":7.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0064-10","type":"NDC"}],"standard_charges":[{"minimum":22.61,"maximum":30.52,"gross_charge":37.67,"discounted_cash":11.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0064-10","type":"NDC"}],"standard_charges":[{"minimum":5.66,"maximum":30.52,"gross_charge":37.67,"discounted_cash":11.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.54,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0858-90","type":"NDC"}],"standard_charges":[{"minimum":7.64,"maximum":10.32,"gross_charge":12.73,"discounted_cash":3.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0858-90","type":"NDC"}],"standard_charges":[{"minimum":1.91,"maximum":10.32,"gross_charge":12.73,"discounted_cash":3.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0369-09","type":"NDC"}],"standard_charges":[{"minimum":18.02,"maximum":24.32,"gross_charge":30.02,"discounted_cash":8.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0369-09","type":"NDC"}],"standard_charges":[{"minimum":4.51,"maximum":24.32,"gross_charge":30.02,"discounted_cash":8.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.01,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0362-90","type":"NDC"}],"standard_charges":[{"minimum":12.72,"maximum":17.17,"gross_charge":21.19,"discounted_cash":6.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0362-90","type":"NDC"}],"standard_charges":[{"minimum":3.18,"maximum":17.17,"gross_charge":21.19,"discounted_cash":6.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.24,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0139-01","type":"NDC"}],"standard_charges":[{"minimum":54.09,"maximum":73.03,"gross_charge":90.15,"discounted_cash":26.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0139-01","type":"NDC"}],"standard_charges":[{"minimum":13.53,"maximum":73.03,"gross_charge":90.15,"discounted_cash":26.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0417-90","type":"NDC"}],"standard_charges":[{"minimum":19.64,"maximum":26.51,"gross_charge":32.72,"discounted_cash":9.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.64,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0417-90","type":"NDC"}],"standard_charges":[{"minimum":4.91,"maximum":26.51,"gross_charge":32.72,"discounted_cash":9.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.55,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":24.06,"maximum":32.49,"gross_charge":40.1,"discounted_cash":11.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.06,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 160 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.02,"maximum":32.49,"gross_charge":40.1,"discounted_cash":11.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0154-90","type":"NDC"}],"standard_charges":[{"minimum":21.63,"maximum":29.21,"gross_charge":36.05,"discounted_cash":10.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0154-90","type":"NDC"}],"standard_charges":[{"minimum":5.41,"maximum":29.21,"gross_charge":36.05,"discounted_cash":10.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0065-10","type":"NDC"}],"standard_charges":[{"minimum":28.6,"maximum":38.61,"gross_charge":47.66,"discounted_cash":14.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0065-10","type":"NDC"}],"standard_charges":[{"minimum":7.15,"maximum":38.61,"gross_charge":47.66,"discounted_cash":14.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51660-0143-90","type":"NDC"}],"standard_charges":[{"minimum":15.69,"maximum":21.19,"gross_charge":26.15,"discounted_cash":7.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"51660-0143-90","type":"NDC"}],"standard_charges":[{"minimum":3.93,"maximum":21.19,"gross_charge":26.15,"discounted_cash":7.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.23,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0363-90","type":"NDC"}],"standard_charges":[{"minimum":16.02,"maximum":21.62,"gross_charge":26.69,"discounted_cash":7.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0363-90","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":21.62,"gross_charge":26.69,"discounted_cash":7.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.34,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0047-90","type":"NDC"}],"standard_charges":[{"minimum":28.22,"maximum":38.1,"gross_charge":47.03,"discounted_cash":13.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.22,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0047-90","type":"NDC"}],"standard_charges":[{"minimum":7.06,"maximum":38.1,"gross_charge":47.03,"discounted_cash":13.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.41,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0418-90","type":"NDC"}],"standard_charges":[{"minimum":26.01,"maximum":35.11,"gross_charge":43.34,"discounted_cash":12.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0418-90","type":"NDC"}],"standard_charges":[{"minimum":6.51,"maximum":35.11,"gross_charge":43.34,"discounted_cash":12.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.11,"maximum":40.65,"gross_charge":50.18,"discounted_cash":14.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.11,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 320 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.53,"maximum":40.65,"gross_charge":50.18,"discounted_cash":14.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0152-90","type":"NDC"}],"standard_charges":[{"minimum":15.8,"maximum":21.33,"gross_charge":26.33,"discounted_cash":7.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"31722-0152-90","type":"NDC"}],"standard_charges":[{"minimum":3.95,"maximum":21.33,"gross_charge":26.33,"discounted_cash":7.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.27,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0063-10","type":"NDC"}],"standard_charges":[{"minimum":18.56,"maximum":25.05,"gross_charge":30.92,"discounted_cash":9.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0063-10","type":"NDC"}],"standard_charges":[{"minimum":4.64,"maximum":25.05,"gross_charge":30.92,"discounted_cash":9.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.19,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0857-90","type":"NDC"}],"standard_charges":[{"minimum":6.08,"maximum":8.2,"gross_charge":10.12,"discounted_cash":3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"42291-0857-90","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":8.2,"gross_charge":10.12,"discounted_cash":3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0368-09","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":3.61,"gross_charge":4.45,"discounted_cash":1.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0368-09","type":"NDC"}],"standard_charges":[{"minimum":0.67,"maximum":3.61,"gross_charge":4.45,"discounted_cash":1.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.89,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0732-90","type":"NDC"}],"standard_charges":[{"minimum":12.99,"maximum":17.53,"gross_charge":21.64,"discounted_cash":6.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0732-90","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":17.53,"gross_charge":21.64,"discounted_cash":6.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0361-90","type":"NDC"}],"standard_charges":[{"minimum":11.91,"maximum":16.08,"gross_charge":19.84,"discounted_cash":5.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59746-0361-90","type":"NDC"}],"standard_charges":[{"minimum":2.98,"maximum":16.08,"gross_charge":19.84,"discounted_cash":5.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.97,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0416-90","type":"NDC"}],"standard_charges":[{"minimum":16.18,"maximum":21.84,"gross_charge":26.96,"discounted_cash":7.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"}]}]},{"description":"VALSARTAN 80 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"67877-0416-90","type":"NDC"}],"standard_charges":[{"minimum":4.05,"maximum":21.84,"gross_charge":26.96,"discounted_cash":7.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.4,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 125 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0166-13","type":"NDC"}],"standard_charges":[{"minimum":10.37,"maximum":13.99,"gross_charge":17.27,"discounted_cash":5.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 125 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68180-0166-13","type":"NDC"}],"standard_charges":[{"minimum":2.6,"maximum":13.99,"gross_charge":17.27,"discounted_cash":5.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.46,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0246-01","type":"NDC"}],"standard_charges":[{"minimum":7.22,"maximum":9.75,"gross_charge":12.03,"discounted_cash":3.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"23155-0246-01","type":"NDC"}],"standard_charges":[{"minimum":1.81,"maximum":9.75,"gross_charge":12.03,"discounted_cash":3.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0008-31","type":"NDC"}],"standard_charges":[{"minimum":16.83,"maximum":22.72,"gross_charge":28.04,"discounted_cash":8.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62332-0008-31","type":"NDC"}],"standard_charges":[{"minimum":4.21,"maximum":22.72,"gross_charge":28.04,"discounted_cash":8.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0896-95","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":0.77,"gross_charge":0.94,"discounted_cash":0.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 25 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0896-95","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.77,"gross_charge":0.94,"discounted_cash":0.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 37.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0799-15","type":"NDC"}],"standard_charges":[{"minimum":9.98,"maximum":13.48,"gross_charge":16.63,"discounted_cash":4.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 37.5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0799-15","type":"NDC"}],"standard_charges":[{"minimum":2.5,"maximum":13.48,"gross_charge":16.63,"discounted_cash":4.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0856-11","type":"NDC"}],"standard_charges":[{"minimum":0.53,"maximum":0.71,"gross_charge":0.87,"discounted_cash":0.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE 75 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68084-0856-11","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":0.71,"gross_charge":0.87,"discounted_cash":0.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0043-01","type":"NDC"}],"standard_charges":[{"minimum":5.75,"maximum":7.76,"gross_charge":9.58,"discounted_cash":2.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0043-01","type":"NDC"}],"standard_charges":[{"minimum":1.44,"maximum":7.76,"gross_charge":9.58,"discounted_cash":2.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.92,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0527-90","type":"NDC"}],"standard_charges":[{"minimum":6.51,"maximum":8.79,"gross_charge":10.84,"discounted_cash":3.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65862-0527-90","type":"NDC"}],"standard_charges":[{"minimum":1.63,"maximum":8.79,"gross_charge":10.84,"discounted_cash":3.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0034-16","type":"NDC"}],"standard_charges":[{"minimum":15.53,"maximum":20.97,"gross_charge":25.88,"discounted_cash":7.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 37.5 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68382-0034-16","type":"NDC"}],"standard_charges":[{"minimum":3.89,"maximum":20.97,"gross_charge":25.88,"discounted_cash":7.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0044-01","type":"NDC"}],"standard_charges":[{"minimum":9.1,"maximum":12.28,"gross_charge":15.16,"discounted_cash":4.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0044-01","type":"NDC"}],"standard_charges":[{"minimum":2.28,"maximum":12.28,"gross_charge":15.16,"discounted_cash":4.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.04,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0818-15","type":"NDC"}],"standard_charges":[{"minimum":13.49,"maximum":18.21,"gross_charge":22.48,"discounted_cash":6.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"50268-0818-15","type":"NDC"}],"standard_charges":[{"minimum":3.38,"maximum":18.21,"gross_charge":22.48,"discounted_cash":6.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.64,"maximum":7.62,"gross_charge":9.4,"discounted_cash":2.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"}]}]},{"description":"VENLAFAXINE ER 75 MG CAPSULEEXTENDED RELEASE 24 HR","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.41,"maximum":7.62,"gross_charge":9.4,"discounted_cash":2.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CTEXT.RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0485-37","type":"NDC"}],"standard_charges":[{"minimum":173.34,"maximum":234.01,"gross_charge":288.89,"discounted_cash":85.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CTEXT.RELEASE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62175-0485-37","type":"NDC"}],"standard_charges":[{"minimum":43.34,"maximum":234.01,"gross_charge":288.89,"discounted_cash":85.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":234.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":173.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.78,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL ER (SR) 240 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":20.73,"maximum":27.98,"gross_charge":34.54,"discounted_cash":10.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"}]}]},{"description":"VERAPAMIL ER (SR) 240 MG TABLETEXTENDED RELEASE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.19,"maximum":27.98,"gross_charge":34.54,"discounted_cash":10.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"}]}]},{"description":"VERICIGUAT 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":172.56,"maximum":232.96,"gross_charge":287.6,"discounted_cash":85.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.56,"methodology":"fee schedule"}]}]},{"description":"VERICIGUAT 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":43.14,"maximum":232.96,"gross_charge":287.6,"discounted_cash":85.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"}]}]},{"description":"VILAZODONE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0981-02","type":"NDC"}],"standard_charges":[{"minimum":50.55,"maximum":68.24,"gross_charge":84.24,"discounted_cash":24.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.55,"methodology":"fee schedule"}]}]},{"description":"VILAZODONE 20 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"69097-0981-02","type":"NDC"}],"standard_charges":[{"minimum":12.64,"maximum":68.24,"gross_charge":84.24,"discounted_cash":24.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"VILAZODONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0354-10","type":"NDC"}],"standard_charges":[{"minimum":136.23,"maximum":183.91,"gross_charge":227.04,"discounted_cash":67.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.23,"methodology":"fee schedule"}]}]},{"description":"VILAZODONE 40 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16729-0354-10","type":"NDC"}],"standard_charges":[{"minimum":34.06,"maximum":183.91,"gross_charge":227.04,"discounted_cash":67.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":183.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"}]}]},{"description":"VILAZODONE 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":190.78,"maximum":257.55,"gross_charge":317.96,"discounted_cash":94.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":257.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.78,"methodology":"fee schedule"}]}]},{"description":"VILAZODONE 40 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":47.7,"maximum":257.55,"gross_charge":317.96,"discounted_cash":94.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":257.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":257.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":257.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":190.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"}]}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0395-04","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":1.85,"gross_charge":2.28,"discounted_cash":0.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"45802-0395-04","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":1.85,"gross_charge":2.28,"discounted_cash":0.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65197-0401-01","type":"NDC"}],"standard_charges":[{"minimum":71.83,"maximum":96.97,"gross_charge":119.71,"discounted_cash":35.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.83,"methodology":"fee schedule"}]}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"65197-0401-01","type":"NDC"}],"standard_charges":[{"minimum":17.96,"maximum":96.97,"gross_charge":119.71,"discounted_cash":35.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.95,"methodology":"fee schedule"}]}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71399-0122-04","type":"NDC"}],"standard_charges":[{"minimum":2.05,"maximum":2.77,"gross_charge":3.41,"discounted_cash":1.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"}]}]},{"description":"VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"71399-0122-04","type":"NDC"}],"standard_charges":[{"minimum":0.52,"maximum":2.77,"gross_charge":3.41,"discounted_cash":1.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0199-01","type":"NDC"}],"standard_charges":[{"minimum":23.97,"maximum":32.36,"gross_charge":39.95,"discounted_cash":11.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.97,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"16714-0199-01","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":32.36,"gross_charge":39.95,"discounted_cash":11.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.99,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0063-03","type":"NDC"}],"standard_charges":[{"minimum":135.11,"maximum":182.4,"gross_charge":225.18,"discounted_cash":66.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.11,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0063-03","type":"NDC"}],"standard_charges":[{"minimum":33.78,"maximum":182.4,"gross_charge":225.18,"discounted_cash":66.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.04,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0378-03","type":"NDC"}],"standard_charges":[{"minimum":24.35,"maximum":32.87,"gross_charge":40.58,"discounted_cash":12.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.35,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"43547-0378-03","type":"NDC"}],"standard_charges":[{"minimum":6.09,"maximum":32.87,"gross_charge":40.58,"discounted_cash":12.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0273-11","type":"NDC"}],"standard_charges":[{"minimum":6.38,"maximum":8.61,"gross_charge":10.62,"discounted_cash":3.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0273-11","type":"NDC"}],"standard_charges":[{"minimum":1.6,"maximum":8.61,"gross_charge":10.62,"discounted_cash":3.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0273-21","type":"NDC"}],"standard_charges":[{"minimum":188.98,"maximum":255.12,"gross_charge":314.96,"discounted_cash":93.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.98,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0273-21","type":"NDC"}],"standard_charges":[{"minimum":47.25,"maximum":255.12,"gross_charge":314.96,"discounted_cash":93.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0573-30","type":"NDC"}],"standard_charges":[{"minimum":48.14,"maximum":64.98,"gross_charge":80.22,"discounted_cash":23.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.14,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0573-30","type":"NDC"}],"standard_charges":[{"minimum":12.04,"maximum":64.98,"gross_charge":80.22,"discounted_cash":23.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.05,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2059.91,"maximum":2780.88,"gross_charge":3433.18,"discounted_cash":1016.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2780.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2780.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2780.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2059.91,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":514.98,"maximum":2780.88,"gross_charge":3433.18,"discounted_cash":1016.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2780.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2780.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2780.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2059.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":652.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":514.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.64,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0062-03","type":"NDC"}],"standard_charges":[{"minimum":35.78,"maximum":48.31,"gross_charge":59.63,"discounted_cash":17.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.78,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"27241-0062-03","type":"NDC"}],"standard_charges":[{"minimum":8.95,"maximum":48.31,"gross_charge":59.63,"discounted_cash":17.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0294-11","type":"NDC"}],"standard_charges":[{"minimum":5.73,"maximum":7.74,"gross_charge":9.55,"discounted_cash":2.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"60687-0294-11","type":"NDC"}],"standard_charges":[{"minimum":1.44,"maximum":7.74,"gross_charge":9.55,"discounted_cash":2.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0572-30","type":"NDC"}],"standard_charges":[{"minimum":20.88,"maximum":28.18,"gross_charge":34.79,"discounted_cash":10.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.88,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 50 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0572-30","type":"NDC"}],"standard_charges":[{"minimum":5.22,"maximum":28.18,"gross_charge":34.79,"discounted_cash":10.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":115.31,"maximum":155.66,"gross_charge":192.17,"discounted_cash":56.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.31,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 1 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.83,"maximum":155.66,"gross_charge":192.17,"discounted_cash":56.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.44,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0984-01","type":"NDC"}],"standard_charges":[{"minimum":18.75,"maximum":25.31,"gross_charge":31.24,"discounted_cash":9.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 2 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0984-01","type":"NDC"}],"standard_charges":[{"minimum":4.69,"maximum":25.31,"gross_charge":31.24,"discounted_cash":9.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.25,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":120.29,"maximum":162.39,"gross_charge":200.47,"discounted_cash":59.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.29,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 2 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":30.08,"maximum":162.39,"gross_charge":200.47,"discounted_cash":59.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":124.13,"maximum":167.57,"gross_charge":206.87,"discounted_cash":61.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.13,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 2.5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":31.04,"maximum":167.57,"gross_charge":206.87,"discounted_cash":61.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0994-11","type":"NDC"}],"standard_charges":[{"minimum":17.01,"maximum":22.96,"gross_charge":28.34,"discounted_cash":8.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 5 MG TABLET","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62584-0994-11","type":"NDC"}],"standard_charges":[{"minimum":4.26,"maximum":22.96,"gross_charge":28.34,"discounted_cash":8.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.67,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":129.35,"maximum":174.62,"gross_charge":215.58,"discounted_cash":63.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.35,"methodology":"fee schedule"}]}]},{"description":"WARFARIN 5 MG TABLET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":32.34,"maximum":174.62,"gross_charge":215.58,"discounted_cash":63.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.23,"maximum":0.3,"gross_charge":0.37,"discounted_cash":0.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM TOPICAL OINTMENT IN PACKET","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.06,"maximum":0.3,"gross_charge":0.37,"discounted_cash":0.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":5.94,"maximum":8.02,"gross_charge":9.89,"discounted_cash":2.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.49,"maximum":8.02,"gross_charge":9.89,"discounted_cash":2.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0062-35","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":5.77,"gross_charge":7.12,"discounted_cash":2.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"17478-0062-35","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":5.77,"gross_charge":7.12,"discounted_cash":2.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":2.09,"maximum":2.82,"gross_charge":3.47,"discounted_cash":1.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":0.53,"maximum":2.82,"gross_charge":3.47,"discounted_cash":1.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":4.37,"maximum":5.9,"gross_charge":7.28,"discounted_cash":2.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"}]}]},{"description":"WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.1,"maximum":5.9,"gross_charge":7.28,"discounted_cash":2.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"}]}]},{"description":"ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":6.68,"maximum":9.02,"gross_charge":11.13,"discounted_cash":3.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.67,"maximum":9.02,"gross_charge":11.13,"discounted_cash":3.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0144-09","type":"NDC"}],"standard_charges":[{"minimum":16.58,"maximum":22.38,"gross_charge":27.62,"discounted_cash":8.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"33342-0144-09","type":"NDC"}],"standard_charges":[{"minimum":4.15,"maximum":22.38,"gross_charge":27.62,"discounted_cash":8.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0256-60","type":"NDC"}],"standard_charges":[{"minimum":13.29,"maximum":17.95,"gross_charge":22.15,"discounted_cash":6.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"55111-0256-60","type":"NDC"}],"standard_charges":[{"minimum":3.33,"maximum":17.95,"gross_charge":22.15,"discounted_cash":6.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":7.32,"maximum":9.88,"gross_charge":12.19,"discounted_cash":3.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":1.83,"maximum":9.88,"gross_charge":12.19,"discounted_cash":3.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":112.02,"maximum":151.22,"gross_charge":186.69,"discounted_cash":55.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.02,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG CAPSULE","code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":28.01,"maximum":151.22,"gross_charge":186.69,"discounted_cash":55.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":151.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":151.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":151.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59212-0680-10","type":"NDC"}],"standard_charges":[{"minimum":1224.04,"maximum":1652.45,"gross_charge":2040.06,"discounted_cash":603.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1652.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1652.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1652.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1224.04,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59212-0680-10","type":"NDC"}],"standard_charges":[{"minimum":306.01,"maximum":1652.45,"gross_charge":2040.06,"discounted_cash":603.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1652.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1652.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1652.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1224.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":387.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.02,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0260-02","type":"NDC"}],"standard_charges":[{"minimum":29.49,"maximum":39.81,"gross_charge":49.14,"discounted_cash":14.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.49,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"62756-0260-02","type":"NDC"}],"standard_charges":[{"minimum":7.38,"maximum":39.81,"gross_charge":49.14,"discounted_cash":14.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0244-00","type":"NDC"}],"standard_charges":[{"minimum":5.9,"maximum":7.97,"gross_charge":9.83,"discounted_cash":2.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68001-0244-00","type":"NDC"}],"standard_charges":[{"minimum":1.48,"maximum":7.97,"gross_charge":9.83,"discounted_cash":2.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0130-01","type":"NDC"}],"standard_charges":[{"minimum":5.12,"maximum":6.91,"gross_charge":8.53,"discounted_cash":2.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"}]}]},{"description":"ZONISAMIDE 100 MG CAPSULE","drug_information": {"unit": 0.033,"type": "GR"},"code_information":[{"code":"HC63700001","type":"CDM"},{"code":"0637","type":"RC"},{"code":"68462-0130-01","type":"NDC"}],"standard_charges":[{"minimum":1.28,"maximum":6.91,"gross_charge":8.53,"discounted_cash":2.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"}]}]},{"description":"ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET","code_information":[{"code":"HC63700010","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":74.09,"maximum":100.02,"gross_charge":123.47,"discounted_cash":36.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.09,"methodology":"fee schedule"}]}]},{"description":"ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET","code_information":[{"code":"HC63700010","type":"CDM"},{"code":"0637","type":"RC"}],"standard_charges":[{"minimum":18.53,"maximum":100.02,"gross_charge":123.47,"discounted_cash":36.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"}]}]},{"description":"DARUNAVIR 800 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFEN 10 MG TABLET (MCT)","drug_information": {"unit": 60,"type": "GR"},"code_information":[{"code":"HC63700010","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59676-0800-30","type":"NDC"}],"standard_charges":[{"minimum":2745.89,"maximum":3706.95,"gross_charge":4576.48,"discounted_cash":1354.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3706.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3706.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3706.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2745.89,"methodology":"fee schedule"}]}]},{"description":"DARUNAVIR 800 MG-COB 150 MG-EMTRICIT 200 MG-TENOFO ALAFEN 10 MG TABLET (MCT)","drug_information": {"unit": 60,"type": "GR"},"code_information":[{"code":"HC63700010","type":"CDM"},{"code":"0637","type":"RC"},{"code":"59676-0800-30","type":"NDC"}],"standard_charges":[{"minimum":686.48,"maximum":3706.95,"gross_charge":4576.48,"discounted_cash":1354.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3706.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3706.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3706.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2745.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.3,"methodology":"fee schedule"}]}]},{"description":"HC PACU 1/4 HOUR CHARGE","code_information":[{"code":"HC71000000","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":146.61,"maximum":146.61,"gross_charge":181,"discounted_cash":53.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.61,"methodology":"fee schedule"}]}]},{"description":"HC PACU 1/4 HOUR CHARGE","code_information":[{"code":"HC71000000","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":27.15,"maximum":146.61,"gross_charge":181,"discounted_cash":53.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"}]}]},{"description":"HC RECOVERY HOURLY","code_information":[{"code":"HC71000001","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":575.91,"maximum":575.91,"gross_charge":711,"discounted_cash":210.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.91,"methodology":"fee schedule"}]}]},{"description":"HC RECOVERY HOURLY","code_information":[{"code":"HC71000001","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":106.65,"maximum":575.91,"gross_charge":711,"discounted_cash":210.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.2,"methodology":"fee schedule"}]}]},{"description":"HC RECOVERY ROOM INITIAL","code_information":[{"code":"HC71000002","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":289.17,"maximum":289.17,"gross_charge":357,"discounted_cash":105.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.17,"methodology":"fee schedule"}]}]},{"description":"HC RECOVERY ROOM INITIAL","code_information":[{"code":"HC71000002","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":53.55,"maximum":289.17,"gross_charge":357,"discounted_cash":105.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.4,"methodology":"fee schedule"}]}]},{"description":"HC GI RECOVERY HOUR CHARGE","code_information":[{"code":"HC71000005","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":141.75,"maximum":141.75,"gross_charge":175,"discounted_cash":51.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.75,"methodology":"fee schedule"}]}]},{"description":"HC GI RECOVERY HOUR CHARGE","code_information":[{"code":"HC71000005","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"minimum":26.25,"maximum":141.75,"gross_charge":175,"discounted_cash":51.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY INCOMPLETE","code_information":[{"code":"HC75000006","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2852.82,"maximum":2852.82,"gross_charge":3522,"discounted_cash":1042.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2852.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2852.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2852.82,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY INCOMPLETE","code_information":[{"code":"HC75000006","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":528.3,"maximum":5079,"gross_charge":3522,"discounted_cash":1042.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2852.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2852.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2852.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":669.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":528.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":704.4,"methodology":"fee schedule"}]}]},{"description":"HC TRACHEOBRONCHOSCOPY","code_information":[{"code":"HC75000010","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2942.73,"maximum":2942.73,"gross_charge":3633,"discounted_cash":1075.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2942.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2942.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2942.73,"methodology":"fee schedule"}]}]},{"description":"HC TRACHEOBRONCHOSCOPY","code_information":[{"code":"HC75000010","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":544.95,"maximum":5079,"gross_charge":3633,"discounted_cash":1075.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2942.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2942.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2942.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":690.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":726.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":544.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":726.6,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/STENT PLCMNT","code_information":[{"code":"HC75000013","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3141.99,"maximum":3141.99,"gross_charge":3879,"discounted_cash":1148.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3141.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3141.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3141.99,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/STENT PLCMNT","code_information":[{"code":"HC75000013","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":581.85,"maximum":5079,"gross_charge":3879,"discounted_cash":1148.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3141.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3141.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3141.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":737.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":581.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":775.8,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY VIA STOMA W/STENT","code_information":[{"code":"HC75000014","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3112.02,"maximum":3112.02,"gross_charge":3842,"discounted_cash":1137.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3112.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3112.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3112.02,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY VIA STOMA W/STENT","code_information":[{"code":"HC75000014","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":576.3,"maximum":5079,"gross_charge":3842,"discounted_cash":1137.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3112.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3112.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3112.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":768.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":576.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":768.4,"methodology":"fee schedule"}]}]},{"description":"HC EGD W/STENT PLACEMENT","code_information":[{"code":"HC75000015","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3464.37,"maximum":3464.37,"gross_charge":4277,"discounted_cash":1266,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3464.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3464.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3464.37,"methodology":"fee schedule"}]}]},{"description":"HC EGD W/STENT PLACEMENT","code_information":[{"code":"HC75000015","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":641.55,"maximum":5079,"gross_charge":4277,"discounted_cash":1266,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3464.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3464.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3464.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":641.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.4,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY W/STENT","code_information":[{"code":"HC75000016","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":166.86,"maximum":166.86,"gross_charge":206,"discounted_cash":60.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY W/STENT","code_information":[{"code":"HC75000016","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":30.9,"maximum":5079,"gross_charge":206,"discounted_cash":60.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"}]}]},{"description":"HC SECRETIN TEST","code_information":[{"code":"HC75000018","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":518.4,"maximum":518.4,"gross_charge":640,"discounted_cash":189.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":518.4,"methodology":"fee schedule"}]}]},{"description":"HC SECRETIN TEST","code_information":[{"code":"HC75000018","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":96,"maximum":5079,"gross_charge":640,"discounted_cash":189.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":518.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL FB PHARYNX","code_information":[{"code":"HC75000019","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":353.97,"maximum":353.97,"gross_charge":437,"discounted_cash":129.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.97,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL FB PHARYNX","code_information":[{"code":"HC75000019","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":65.55,"maximum":5079,"gross_charge":437,"discounted_cash":129.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSOCOPY W/SUBMUSOCAL IN","code_information":[{"code":"HC75000020","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2659.23,"maximum":2659.23,"gross_charge":3283,"discounted_cash":971.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2659.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2659.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2659.23,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSOCOPY W/SUBMUSOCAL IN","code_information":[{"code":"HC75000020","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":492.45,"maximum":5079,"gross_charge":3283,"discounted_cash":971.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2659.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2659.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2659.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":623.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.6,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY W/SUB INJ","code_information":[{"code":"HC75000021","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2331.18,"maximum":2331.18,"gross_charge":2878,"discounted_cash":851.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2331.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2331.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2331.18,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY W/SUB INJ","code_information":[{"code":"HC75000021","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":431.7,"maximum":5079,"gross_charge":2878,"discounted_cash":851.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2331.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2331.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2331.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":431.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.6,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/SUBMUSOCAL INJ","code_information":[{"code":"HC75000022","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6173.82,"maximum":6173.82,"gross_charge":7622,"discounted_cash":2256.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6173.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6173.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6173.82,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/SUBMUSOCAL INJ","code_information":[{"code":"HC75000022","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1143.3,"maximum":6173.82,"gross_charge":7622,"discounted_cash":2256.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6173.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6173.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6173.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1448.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1143.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1524.4,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/DILATATION BALL","code_information":[{"code":"HC75000023","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4864.05,"maximum":4864.05,"gross_charge":6005,"discounted_cash":1777.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4864.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4864.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4864.05,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/DILATATION BALL","code_information":[{"code":"HC75000023","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":900.75,"maximum":5079,"gross_charge":6005,"discounted_cash":1777.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4864.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4864.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4864.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":900.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1201,"methodology":"fee schedule"}]}]},{"description":"HC EGD W/SUBMUCOSAL INJ","code_information":[{"code":"HC75000024","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6039.36,"maximum":6039.36,"gross_charge":7456,"discounted_cash":2206.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6039.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6039.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6039.36,"methodology":"fee schedule"}]}]},{"description":"HC EGD W/SUBMUCOSAL INJ","code_information":[{"code":"HC75000024","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1118.4,"maximum":6039.36,"gross_charge":7456,"discounted_cash":2206.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6039.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6039.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6039.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1416.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1491.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1118.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1491.2,"methodology":"fee schedule"}]}]},{"description":"HC EXCISION TAGS & BANDING","code_information":[{"code":"HC75000026","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5350.05,"maximum":5350.05,"gross_charge":6605,"discounted_cash":1955.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5350.05,"methodology":"fee schedule"}]}]},{"description":"HC EXCISION TAGS & BANDING","code_information":[{"code":"HC75000026","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":990.75,"maximum":5350.05,"gross_charge":6605,"discounted_cash":1955.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5350.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5350.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1254.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1321,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1321,"methodology":"fee schedule"}]}]},{"description":"HC SMALL BOWEL CAPSULE ENDOSCOPY","code_information":[{"code":"HC75000028","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4652.64,"maximum":4652.64,"gross_charge":5744,"discounted_cash":1700.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4652.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4652.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4652.64,"methodology":"fee schedule"}]}]},{"description":"HC SMALL BOWEL CAPSULE ENDOSCOPY","code_information":[{"code":"HC75000028","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":861.6,"maximum":5079,"gross_charge":5744,"discounted_cash":1700.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4652.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4652.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4652.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1091.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":861.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1148.8,"methodology":"fee schedule"}]}]},{"description":"HC SPHINCTEROTOMY","code_information":[{"code":"HC75000029","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5505.57,"maximum":5505.57,"gross_charge":6797,"discounted_cash":2011.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5505.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5505.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5505.57,"methodology":"fee schedule"}]}]},{"description":"HC SPHINCTEROTOMY","code_information":[{"code":"HC75000029","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1019.55,"maximum":5505.57,"gross_charge":6797,"discounted_cash":2011.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5505.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5505.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5505.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1291.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1359.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1019.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1359.4,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGEAL CAPSULE ENDOSCOPY","code_information":[{"code":"HC75000030","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3340.44,"maximum":3340.44,"gross_charge":4124,"discounted_cash":1220.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3340.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3340.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3340.44,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGEAL CAPSULE ENDOSCOPY","code_information":[{"code":"HC75000030","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":618.6,"maximum":5079,"gross_charge":4124,"discounted_cash":1220.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3340.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3340.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3340.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":783.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":618.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":824.8,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOD W/BALLOON DILATION","code_information":[{"code":"HC75000032","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2150.55,"maximum":2150.55,"gross_charge":2655,"discounted_cash":785.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2150.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2150.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2150.55,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOD W/BALLOON DILATION","code_information":[{"code":"HC75000032","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":398.25,"maximum":5079,"gross_charge":2655,"discounted_cash":785.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2150.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2150.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2150.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":504.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":531,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":531,"methodology":"fee schedule"}]}]},{"description":"HC PLCMT OF MARKERS SNG/MULTI","code_information":[{"code":"HC75000037","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3210.84,"maximum":3210.84,"gross_charge":3964,"discounted_cash":1173.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3210.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3210.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3210.84,"methodology":"fee schedule"}]}]},{"description":"HC PLCMT OF MARKERS SNG/MULTI","code_information":[{"code":"HC75000037","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":594.6,"maximum":5079,"gross_charge":3964,"discounted_cash":1173.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3210.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3210.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3210.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":594.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":792.8,"methodology":"fee schedule"}]}]},{"description":"HC BOTEX INJECTIONANAL SPHINCTER","code_information":[{"code":"HC75000038","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5409.99,"maximum":5409.99,"gross_charge":6679,"discounted_cash":1976.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5409.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5409.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5409.99,"methodology":"fee schedule"}]}]},{"description":"HC BOTEX INJECTIONANAL SPHINCTER","code_information":[{"code":"HC75000038","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1001.85,"maximum":5409.99,"gross_charge":6679,"discounted_cash":1976.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5409.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5409.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5409.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1269.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1001.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1335.8,"methodology":"fee schedule"}]}]},{"description":"HC ENDOBRONCHIAL INJ STEROID","code_information":[{"code":"HC75000041","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3735.72,"maximum":3735.72,"gross_charge":4612,"discounted_cash":1365.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3735.72,"methodology":"fee schedule"}]}]},{"description":"HC ENDOBRONCHIAL INJ STEROID","code_information":[{"code":"HC75000041","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":691.8,"maximum":5079,"gross_charge":4612,"discounted_cash":1365.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3735.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":876.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":691.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":922.4,"methodology":"fee schedule"}]}]},{"description":"HC COV RFA PROC/BARNETTA ESOPH","code_information":[{"code":"HC75000044","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4192.56,"maximum":4192.56,"gross_charge":5176,"discounted_cash":1532.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4192.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4192.56,"methodology":"fee schedule"}]}]},{"description":"HC COV RFA PROC/BARNETTA ESOPH","code_information":[{"code":"HC75000044","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":776.4,"maximum":5079,"gross_charge":5176,"discounted_cash":1532.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4192.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4192.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4192.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":983.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1035.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":776.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1035.2,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHOGEAL ULTRASOUND","code_information":[{"code":"HC75000045","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6062.85,"maximum":6062.85,"gross_charge":7485,"discounted_cash":2215.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6062.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6062.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6062.85,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHOGEAL ULTRASOUND","code_information":[{"code":"HC75000045","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1122.75,"maximum":6062.85,"gross_charge":7485,"discounted_cash":2215.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6062.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6062.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6062.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1422.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1497,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1122.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1497,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RETRO CHOLANG W/LITH CALC","code_information":[{"code":"HC75000046","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4353.75,"maximum":4353.75,"gross_charge":5375,"discounted_cash":1591,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4353.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4353.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4353.75,"methodology":"fee schedule"}]}]},{"description":"HC ENDO RETRO CHOLANG W/LITH CALC","code_information":[{"code":"HC75000046","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":806.25,"maximum":5079,"gross_charge":5375,"discounted_cash":1591,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4353.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4353.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4353.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1021.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":806.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1075,"methodology":"fee schedule"}]}]},{"description":"HC ENDO CANN/PAP W/DIR VIS/BILE","code_information":[{"code":"HC75000049","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5051.97,"maximum":5051.97,"gross_charge":6237,"discounted_cash":1846.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5051.97,"methodology":"fee schedule"}]}]},{"description":"HC ENDO CANN/PAP W/DIR VIS/BILE","code_information":[{"code":"HC75000049","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":935.55,"maximum":5079,"gross_charge":6237,"discounted_cash":1846.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5051.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":935.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1247.4,"methodology":"fee schedule"}]}]},{"description":"HC LOWER EUS COLONSCOPY BIOPSY","code_information":[{"code":"HC75000054","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3755.97,"maximum":3755.97,"gross_charge":4637,"discounted_cash":1372.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3755.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3755.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3755.97,"methodology":"fee schedule"}]}]},{"description":"HC LOWER EUS COLONSCOPY BIOPSY","code_information":[{"code":"HC75000054","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":695.55,"maximum":5079,"gross_charge":4637,"discounted_cash":1372.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3755.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3755.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3755.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":881.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":927.4,"methodology":"fee schedule"}]}]},{"description":"HC LOWER EUS FLEX SIG","code_information":[{"code":"HC75000055","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4067.01,"maximum":4067.01,"gross_charge":5021,"discounted_cash":1486.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4067.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4067.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4067.01,"methodology":"fee schedule"}]}]},{"description":"HC LOWER EUS FLEX SIG","code_information":[{"code":"HC75000055","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":753.15,"maximum":5079,"gross_charge":5021,"discounted_cash":1486.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4067.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4067.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4067.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":753.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1004.2,"methodology":"fee schedule"}]}]},{"description":"HC LOWER EUS FLEX SIG BIOP","code_information":[{"code":"HC75000056","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3129.03,"maximum":3129.03,"gross_charge":3863,"discounted_cash":1143.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3129.03,"methodology":"fee schedule"}]}]},{"description":"HC LOWER EUS FLEX SIG BIOP","code_information":[{"code":"HC75000056","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":579.45,"maximum":5079,"gross_charge":3863,"discounted_cash":1143.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3129.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":579.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.6,"methodology":"fee schedule"}]}]},{"description":"HC EGD US TRANSMURAL INJ/MARKERS","code_information":[{"code":"HC75000066","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3888.81,"maximum":3888.81,"gross_charge":4801,"discounted_cash":1421.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3888.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3888.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3888.81,"methodology":"fee schedule"}]}]},{"description":"HC EGD US TRANSMURAL INJ/MARKERS","code_information":[{"code":"HC75000066","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":720.15,"maximum":5079,"gross_charge":4801,"discounted_cash":1421.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3888.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3888.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3888.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":912.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":720.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":960.2,"methodology":"fee schedule"}]}]},{"description":"HC EGD ENDOSCOPIC MUCOSAL-43254","code_information":[{"code":"HC75000067","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4659.93,"maximum":4659.93,"gross_charge":5753,"discounted_cash":1702.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4659.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4659.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4659.93,"methodology":"fee schedule"}]}]},{"description":"HC EGD ENDOSCOPIC MUCOSAL-43254","code_information":[{"code":"HC75000067","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":862.95,"maximum":5079,"gross_charge":5753,"discounted_cash":1702.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4659.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4659.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4659.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.6,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY MUCOSAL RESCTION","code_information":[{"code":"HC75000068","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3167.91,"maximum":3167.91,"gross_charge":3911,"discounted_cash":1157.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3167.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3167.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3167.91,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY MUCOSAL RESCTION","code_information":[{"code":"HC75000068","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":586.65,"maximum":5079,"gross_charge":3911,"discounted_cash":1157.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3167.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3167.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3167.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":743.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":586.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":782.2,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY STENT PLACEMENT","code_information":[{"code":"HC75000069","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4221.72,"maximum":4221.72,"gross_charge":5212,"discounted_cash":1542.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4221.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4221.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4221.72,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY STENT PLACEMENT","code_information":[{"code":"HC75000069","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":781.8,"maximum":5079,"gross_charge":5212,"discounted_cash":1542.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4221.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4221.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4221.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":990.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1042.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1042.4,"methodology":"fee schedule"}]}]},{"description":"HC ERCP REM FORGEIN BODY - 43275","code_information":[{"code":"HC75000070","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3770.55,"maximum":3770.55,"gross_charge":4655,"discounted_cash":1377.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3770.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3770.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3770.55,"methodology":"fee schedule"}]}]},{"description":"HC ERCP REM FORGEIN BODY - 43275","code_information":[{"code":"HC75000070","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":698.25,"maximum":5079,"gross_charge":4655,"discounted_cash":1377.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3770.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3770.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3770.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":884.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":931,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":698.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":931,"methodology":"fee schedule"}]}]},{"description":"HC ERCP W/SPINCTRTMY&STENT-43274","code_information":[{"code":"HC75000072","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5905.71,"maximum":5905.71,"gross_charge":7291,"discounted_cash":2158.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5905.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5905.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5905.71,"methodology":"fee schedule"}]}]},{"description":"HC ERCP W/SPINCTRTMY&STENT-43274","code_information":[{"code":"HC75000072","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1093.65,"maximum":5905.71,"gross_charge":7291,"discounted_cash":2158.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5905.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5905.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5905.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1385.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1458.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1458.2,"methodology":"fee schedule"}]}]},{"description":"HC COLON WITH EMR - 45390","code_information":[{"code":"HC75000073","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2826.9,"maximum":2826.9,"gross_charge":3490,"discounted_cash":1033.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2826.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2826.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2826.9,"methodology":"fee schedule"}]}]},{"description":"HC COLON WITH EMR - 45390","code_information":[{"code":"HC75000073","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":523.5,"maximum":5079,"gross_charge":3490,"discounted_cash":1033.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2826.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2826.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2826.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":663.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":698,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":523.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":698,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSCOPY W/EMR - 45349","code_information":[{"code":"HC75000076","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2962.98,"maximum":2962.98,"gross_charge":3658,"discounted_cash":1082.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2962.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2962.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2962.98,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSCOPY W/EMR - 45349","code_information":[{"code":"HC75000076","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":548.7,"maximum":5079,"gross_charge":3658,"discounted_cash":1082.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2962.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2962.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2962.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":695.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":548.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.6,"methodology":"fee schedule"}]}]},{"description":"HC INSTILT/FECAL MICROBITA-44705","code_information":[{"code":"HC75000078","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":541.89,"maximum":541.89,"gross_charge":669,"discounted_cash":198.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":541.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":541.89,"methodology":"fee schedule"}]}]},{"description":"HC INSTILT/FECAL MICROBITA-44705","code_information":[{"code":"HC75000078","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":100.35,"maximum":5079,"gross_charge":669,"discounted_cash":198.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":541.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":541.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":541.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.8,"methodology":"fee schedule"}]}]},{"description":"HC ERCPSPINCTEROTOMY W/STENT PL","code_information":[{"code":"HC75000080","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":7584.84,"maximum":7584.84,"gross_charge":9364,"discounted_cash":2771.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7584.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7584.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7584.84,"methodology":"fee schedule"}]}]},{"description":"HC ERCPSPINCTEROTOMY W/STENT PL","code_information":[{"code":"HC75000080","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1404.6,"maximum":7584.84,"gross_charge":9364,"discounted_cash":2771.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7584.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7584.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7584.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1779.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1872.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1404.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1872.8,"methodology":"fee schedule"}]}]},{"description":"HC EUS W/INJECTION - 43253","code_information":[{"code":"HC75000081","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3704.94,"maximum":3704.94,"gross_charge":4574,"discounted_cash":1353.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3704.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3704.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3704.94,"methodology":"fee schedule"}]}]},{"description":"HC EUS W/INJECTION - 43253","code_information":[{"code":"HC75000081","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":686.1,"maximum":5079,"gross_charge":4574,"discounted_cash":1353.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3704.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3704.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3704.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":914.8,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL/FECALIMPACTION-45915","code_information":[{"code":"HC75000082","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3913.92,"maximum":3913.92,"gross_charge":4832,"discounted_cash":1430.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3913.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3913.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3913.92,"methodology":"fee schedule"}]}]},{"description":"HC REMOVAL/FECALIMPACTION-45915","code_information":[{"code":"HC75000082","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":724.8,"maximum":5079,"gross_charge":4832,"discounted_cash":1430.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3913.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3913.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3913.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":918.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.4,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSCOPY W/US - 45341","code_information":[{"code":"HC75000083","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1771.47,"maximum":1771.47,"gross_charge":2187,"discounted_cash":647.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1771.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1771.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1771.47,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSCOPY W/US - 45341","code_information":[{"code":"HC75000083","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":328.05,"maximum":5079,"gross_charge":2187,"discounted_cash":647.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1771.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1771.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1771.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.4,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY","code_information":[{"code":"HC75000089","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2538.54,"maximum":2538.54,"gross_charge":3134,"discounted_cash":927.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2538.54,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY","code_information":[{"code":"HC75000089","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":470.1,"maximum":5079,"gross_charge":3134,"discounted_cash":927.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2538.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":595.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":626.8,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY W/BIOPSY","code_information":[{"code":"HC75000090","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2312.55,"maximum":2312.55,"gross_charge":2855,"discounted_cash":845.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2312.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2312.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2312.55,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY W/BIOPSY","code_information":[{"code":"HC75000090","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":428.25,"maximum":5079,"gross_charge":2855,"discounted_cash":845.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2312.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2312.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2312.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":542.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":571,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":428.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":571,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGOSCPY W/SCLERSIS VARCIES","code_information":[{"code":"HC75000091","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2542.59,"maximum":2542.59,"gross_charge":3139,"discounted_cash":929.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2542.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2542.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2542.59,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGOSCPY W/SCLERSIS VARCIES","code_information":[{"code":"HC75000091","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":470.85,"maximum":5079,"gross_charge":3139,"discounted_cash":929.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2542.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2542.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2542.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":470.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":627.8,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY W/BAND LIGATION","code_information":[{"code":"HC75000092","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2543.4,"maximum":2543.4,"gross_charge":3140,"discounted_cash":929.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2543.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2543.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2543.4,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY W/BAND LIGATION","code_information":[{"code":"HC75000092","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":471,"maximum":5079,"gross_charge":3140,"discounted_cash":929.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2543.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2543.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2543.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":628,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":471,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":628,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGSCPY W/REM FOREIGN BODY","code_information":[{"code":"HC75000093","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2286.63,"maximum":2286.63,"gross_charge":2823,"discounted_cash":835.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2286.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2286.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2286.63,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGSCPY W/REM FOREIGN BODY","code_information":[{"code":"HC75000093","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":423.45,"maximum":5079,"gross_charge":2823,"discounted_cash":835.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2286.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2286.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2286.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":536.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":423.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":564.6,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/BALLON DIL <30 MM","code_information":[{"code":"HC75000096","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2608.2,"maximum":2608.2,"gross_charge":3220,"discounted_cash":953.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2608.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2608.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2608.2,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/BALLON DIL <30 MM","code_information":[{"code":"HC75000096","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":483,"maximum":5079,"gross_charge":3220,"discounted_cash":953.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2608.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2608.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2608.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":644,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":483,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":644,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY W/GUIDEWIRE/DIL","code_information":[{"code":"HC75000097","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2792.88,"maximum":2792.88,"gross_charge":3448,"discounted_cash":1020.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2792.88,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY W/GUIDEWIRE/DIL","code_information":[{"code":"HC75000097","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":517.2,"maximum":5079,"gross_charge":3448,"discounted_cash":1020.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2792.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":689.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":517.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":689.6,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/CONTRL BLEEDNG","code_information":[{"code":"HC75000098","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2606.58,"maximum":2606.58,"gross_charge":3218,"discounted_cash":952.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2606.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2606.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2606.58,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/CONTRL BLEEDNG","code_information":[{"code":"HC75000098","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":482.7,"maximum":5079,"gross_charge":3218,"discounted_cash":952.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2606.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2606.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2606.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":611.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":643.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":482.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":643.6,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/ABL POLP/LESONS","code_information":[{"code":"HC75000099","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2243.7,"maximum":2243.7,"gross_charge":2770,"discounted_cash":819.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2243.7,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/ABL POLP/LESONS","code_information":[{"code":"HC75000099","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":415.5,"maximum":5079,"gross_charge":2770,"discounted_cash":819.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2243.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":526.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":554,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":554,"methodology":"fee schedule"}]}]},{"description":"HC EGD - DIAGNOSTIC","code_information":[{"code":"HC75000100","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3752.73,"maximum":3752.73,"gross_charge":4633,"discounted_cash":1371.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3752.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3752.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3752.73,"methodology":"fee schedule"}]}]},{"description":"HC EGD - DIAGNOSTIC","code_information":[{"code":"HC75000100","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":694.95,"maximum":5079,"gross_charge":4633,"discounted_cash":1371.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3752.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3752.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3752.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":880.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":926.6,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ BIOPSY","code_information":[{"code":"HC75000101","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4165.02,"maximum":4165.02,"gross_charge":5142,"discounted_cash":1522.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4165.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4165.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4165.02,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ BIOPSY","code_information":[{"code":"HC75000101","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":771.3,"maximum":5079,"gross_charge":5142,"discounted_cash":1522.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4165.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4165.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4165.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":976.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":771.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1028.4,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ TUBE","code_information":[{"code":"HC75000102","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3326.67,"maximum":3326.67,"gross_charge":4107,"discounted_cash":1215.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3326.67,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ TUBE","code_information":[{"code":"HC75000102","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":616.05,"maximum":5079,"gross_charge":4107,"discounted_cash":1215.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3326.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":780.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.4,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ INJECTION SCLEROSIS","code_information":[{"code":"HC75000103","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3562.38,"maximum":3562.38,"gross_charge":4398,"discounted_cash":1301.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3562.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3562.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3562.38,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ INJECTION SCLEROSIS","code_information":[{"code":"HC75000103","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":659.7,"maximum":5079,"gross_charge":4398,"discounted_cash":1301.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3562.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3562.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3562.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":835.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.6,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ BAND LIGATION","code_information":[{"code":"HC75000104","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4593.51,"maximum":4593.51,"gross_charge":5671,"discounted_cash":1678.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4593.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4593.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4593.51,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ BAND LIGATION","code_information":[{"code":"HC75000104","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":850.65,"maximum":5079,"gross_charge":5671,"discounted_cash":1678.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4593.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4593.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4593.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1077.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1134.2,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ DIL GASTRIC OUTLET OB","code_information":[{"code":"HC75000105","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3800.52,"maximum":3800.52,"gross_charge":4692,"discounted_cash":1388.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3800.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3800.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3800.52,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ DIL GASTRIC OUTLET OB","code_information":[{"code":"HC75000105","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":703.8,"maximum":5079,"gross_charge":4692,"discounted_cash":1388.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3800.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3800.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3800.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":891.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":703.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.4,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ REMOVAL FOREIGN BODY","code_information":[{"code":"HC75000107","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3820.77,"maximum":3820.77,"gross_charge":4717,"discounted_cash":1396.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3820.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3820.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3820.77,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ REMOVAL FOREIGN BODY","code_information":[{"code":"HC75000107","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":707.55,"maximum":5079,"gross_charge":4717,"discounted_cash":1396.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3820.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3820.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3820.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.4,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ GUIDEWIRE/DILATION","code_information":[{"code":"HC75000108","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4908.6,"maximum":4908.6,"gross_charge":6060,"discounted_cash":1793.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4908.6,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ GUIDEWIRE/DILATION","code_information":[{"code":"HC75000108","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":909,"maximum":5079,"gross_charge":6060,"discounted_cash":1793.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4908.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1151.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":909,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1212,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ BALLOON DILATION <30","code_information":[{"code":"HC75000109","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4172.31,"maximum":4172.31,"gross_charge":5151,"discounted_cash":1524.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4172.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4172.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4172.31,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ BALLOON DILATION <30","code_information":[{"code":"HC75000109","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":772.65,"maximum":5079,"gross_charge":5151,"discounted_cash":1524.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4172.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4172.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4172.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1030.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1030.2,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ REMOVAL HOT BX","code_information":[{"code":"HC75000110","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4146.39,"maximum":4146.39,"gross_charge":5119,"discounted_cash":1515.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4146.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4146.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4146.39,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ REMOVAL HOT BX","code_information":[{"code":"HC75000110","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":767.85,"maximum":5079,"gross_charge":5119,"discounted_cash":1515.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4146.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4146.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4146.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":972.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":767.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1023.8,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ CONTROL OF BLEEDING","code_information":[{"code":"HC75000112","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4648.59,"maximum":4648.59,"gross_charge":5739,"discounted_cash":1698.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4648.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4648.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4648.59,"methodology":"fee schedule"}]}]},{"description":"HC EGD - W/ CONTROL OF BLEEDING","code_information":[{"code":"HC75000112","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":860.85,"maximum":5079,"gross_charge":5739,"discounted_cash":1698.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4648.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4648.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4648.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1090.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":860.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1147.8,"methodology":"fee schedule"}]}]},{"description":"HC ERCP","code_information":[{"code":"HC75000114","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3909.06,"maximum":3909.06,"gross_charge":4826,"discounted_cash":1428.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"}]}]},{"description":"HC ERCP","code_information":[{"code":"HC75000114","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":723.9,"maximum":5079,"gross_charge":4826,"discounted_cash":1428.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3909.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":916.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":723.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":965.2,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ BIOPSY","code_information":[{"code":"HC75000115","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4449.33,"maximum":4449.33,"gross_charge":5493,"discounted_cash":1625.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4449.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4449.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4449.33,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ BIOPSY","code_information":[{"code":"HC75000115","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":823.95,"maximum":5079,"gross_charge":5493,"discounted_cash":1625.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4449.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4449.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4449.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1043.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.6,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ SPINCTEROTOMY","code_information":[{"code":"HC75000116","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4468.77,"maximum":4468.77,"gross_charge":5517,"discounted_cash":1633.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4468.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4468.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4468.77,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ SPINCTEROTOMY","code_information":[{"code":"HC75000116","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":827.55,"maximum":5079,"gross_charge":5517,"discounted_cash":1633.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4468.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4468.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4468.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1048.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":827.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1103.4,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ REMOVAL OF STONES","code_information":[{"code":"HC75000117","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5024.43,"maximum":5024.43,"gross_charge":6203,"discounted_cash":1836.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5024.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5024.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5024.43,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ REMOVAL OF STONES","code_information":[{"code":"HC75000117","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":930.45,"maximum":5079,"gross_charge":6203,"discounted_cash":1836.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5024.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5024.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5024.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1178.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":930.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1240.6,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ LITHOTRIPSY OF STONE","code_information":[{"code":"HC75000118","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3977.1,"maximum":3977.1,"gross_charge":4910,"discounted_cash":1453.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3977.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3977.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3977.1,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ LITHOTRIPSY OF STONE","code_information":[{"code":"HC75000118","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":736.5,"maximum":5079,"gross_charge":4910,"discounted_cash":1453.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3977.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3977.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3977.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":932.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":982,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":736.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":982,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/INSERTION STENT/TUBE","code_information":[{"code":"HC75000119","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5210.73,"maximum":5210.73,"gross_charge":6433,"discounted_cash":1904.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5210.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5210.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5210.73,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/INSERTION STENT/TUBE","code_information":[{"code":"HC75000119","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":964.95,"maximum":5210.73,"gross_charge":6433,"discounted_cash":1904.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5210.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5210.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5210.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1222.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1286.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":964.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1286.6,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ ABLATION","code_information":[{"code":"HC75000121","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3470.04,"maximum":3470.04,"gross_charge":4284,"discounted_cash":1268.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3470.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3470.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3470.04,"methodology":"fee schedule"}]}]},{"description":"HC ERCP - W/ ABLATION","code_information":[{"code":"HC75000121","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":642.6,"maximum":5079,"gross_charge":4284,"discounted_cash":1268.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3470.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3470.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3470.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":813.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":642.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":856.8,"methodology":"fee schedule"}]}]},{"description":"HC DILATE ESPHGUS BOUGIE NO SCOPE","code_information":[{"code":"HC75000122","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1725.3,"maximum":1725.3,"gross_charge":2130,"discounted_cash":630.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1725.3,"methodology":"fee schedule"}]}]},{"description":"HC DILATE ESPHGUS BOUGIE NO SCOPE","code_information":[{"code":"HC75000122","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":319.5,"maximum":5079,"gross_charge":2130,"discounted_cash":630.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1725.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":404.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":426,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":319.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":426,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/BALLON DIL >30 MM","code_information":[{"code":"HC75000124","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2847.15,"maximum":2847.15,"gross_charge":3515,"discounted_cash":1040.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2847.15,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHGSCPY W/BALLON DIL >30 MM","code_information":[{"code":"HC75000124","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":527.25,"maximum":5079,"gross_charge":3515,"discounted_cash":1040.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2847.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":667.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":703,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":527.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":703,"methodology":"fee schedule"}]}]},{"description":"HC PEG TUBE CHANGE","code_information":[{"code":"HC75000126","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":978.48,"maximum":978.48,"gross_charge":1208,"discounted_cash":357.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":978.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":978.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":978.48,"methodology":"fee schedule"}]}]},{"description":"HC PEG TUBE CHANGE","code_information":[{"code":"HC75000126","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":181.2,"maximum":5079,"gross_charge":1208,"discounted_cash":357.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":978.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":978.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":978.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.6,"methodology":"fee schedule"}]}]},{"description":"HC SML BOWEL - NOT ILEUM","code_information":[{"code":"HC75000127","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3629.61,"maximum":3629.61,"gross_charge":4481,"discounted_cash":1326.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3629.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3629.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3629.61,"methodology":"fee schedule"}]}]},{"description":"HC SML BOWEL - NOT ILEUM","code_information":[{"code":"HC75000127","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":672.15,"maximum":5079,"gross_charge":4481,"discounted_cash":1326.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3629.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3629.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3629.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":672.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.2,"methodology":"fee schedule"}]}]},{"description":"HC SM BWL-NOT ILUM W/CON BLEEDING","code_information":[{"code":"HC75000132","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3436.83,"maximum":3436.83,"gross_charge":4243,"discounted_cash":1255.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3436.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3436.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3436.83,"methodology":"fee schedule"}]}]},{"description":"HC SM BWL-NOT ILUM W/CON BLEEDING","code_information":[{"code":"HC75000132","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":636.45,"maximum":5079,"gross_charge":4243,"discounted_cash":1255.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3436.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3436.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3436.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":806.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":636.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":848.6,"methodology":"fee schedule"}]}]},{"description":"HC SM BWL-NOT ILUM W/ABL POLYP","code_information":[{"code":"HC75000133","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3258.63,"maximum":3258.63,"gross_charge":4023,"discounted_cash":1190.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3258.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3258.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3258.63,"methodology":"fee schedule"}]}]},{"description":"HC SM BWL-NOT ILUM W/ABL POLYP","code_information":[{"code":"HC75000133","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":603.45,"maximum":5079,"gross_charge":4023,"discounted_cash":1190.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3258.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3258.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3258.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":764.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":804.6,"methodology":"fee schedule"}]}]},{"description":"HC SML BOWEL - INCL ILEUM W/BIOPS","code_information":[{"code":"HC75000137","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4275.18,"maximum":4275.18,"gross_charge":5278,"discounted_cash":1562.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4275.18,"methodology":"fee schedule"}]}]},{"description":"HC SML BOWEL - INCL ILEUM W/BIOPS","code_information":[{"code":"HC75000137","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":791.7,"maximum":5079,"gross_charge":5278,"discounted_cash":1562.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4275.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4275.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1002.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":791.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1055.6,"methodology":"fee schedule"}]}]},{"description":"HC SM BWL-INCL ILEUM W/CONT BLDIN","code_information":[{"code":"HC75000138","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3659.58,"maximum":3659.58,"gross_charge":4518,"discounted_cash":1337.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3659.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3659.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3659.58,"methodology":"fee schedule"}]}]},{"description":"HC SM BWL-INCL ILEUM W/CONT BLDIN","code_information":[{"code":"HC75000138","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":677.7,"maximum":5079,"gross_charge":4518,"discounted_cash":1337.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3659.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3659.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3659.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":858.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":677.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":903.6,"methodology":"fee schedule"}]}]},{"description":"HC ILEOSCOPY VIA STOMA","code_information":[{"code":"HC75000139","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1573.02,"maximum":1573.02,"gross_charge":1942,"discounted_cash":574.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1573.02,"methodology":"fee schedule"}]}]},{"description":"HC ILEOSCOPY VIA STOMA","code_information":[{"code":"HC75000139","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":291.3,"maximum":5079,"gross_charge":1942,"discounted_cash":574.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1573.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":291.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.4,"methodology":"fee schedule"}]}]},{"description":"HC ILEOSCOPY VIA STOMA W/BIOPSY","code_information":[{"code":"HC75000140","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2493.99,"maximum":2493.99,"gross_charge":3079,"discounted_cash":911.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2493.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2493.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2493.99,"methodology":"fee schedule"}]}]},{"description":"HC ILEOSCOPY VIA STOMA W/BIOPSY","code_information":[{"code":"HC75000140","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":461.85,"maximum":5079,"gross_charge":3079,"discounted_cash":911.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2493.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2493.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2493.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":585.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":461.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":615.8,"methodology":"fee schedule"}]}]},{"description":"HC ENDOSCOPY OF BOWEL POUCH","code_information":[{"code":"HC75000141","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1125.09,"maximum":1125.09,"gross_charge":1389,"discounted_cash":411.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1125.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1125.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1125.09,"methodology":"fee schedule"}]}]},{"description":"HC ENDOSCOPY OF BOWEL POUCH","code_information":[{"code":"HC75000141","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":208.35,"maximum":5079,"gross_charge":1389,"discounted_cash":411.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1125.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1125.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1125.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.8,"methodology":"fee schedule"}]}]},{"description":"HC ENDOSCPY BOWEL POUCH W/BIOPSY","code_information":[{"code":"HC75000142","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1391.58,"maximum":1391.58,"gross_charge":1718,"discounted_cash":508.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1391.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1391.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1391.58,"methodology":"fee schedule"}]}]},{"description":"HC ENDOSCPY BOWEL POUCH W/BIOPSY","code_information":[{"code":"HC75000142","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":257.7,"maximum":5079,"gross_charge":1718,"discounted_cash":508.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1391.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1391.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1391.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":326.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":257.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":343.6,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY VIA STOMA","code_information":[{"code":"HC75000143","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3478.95,"maximum":3478.95,"gross_charge":4295,"discounted_cash":1271.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3478.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3478.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3478.95,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY VIA STOMA","code_information":[{"code":"HC75000143","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":644.25,"maximum":5079,"gross_charge":4295,"discounted_cash":1271.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3478.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3478.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3478.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":816.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":859,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":644.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":859,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY VIA STOMA W/BIOPSY","code_information":[{"code":"HC75000144","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3120.12,"maximum":3120.12,"gross_charge":3852,"discounted_cash":1140.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3120.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3120.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3120.12,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY VIA STOMA W/BIOPSY","code_information":[{"code":"HC75000144","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":577.8,"maximum":5079,"gross_charge":3852,"discounted_cash":1140.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3120.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3120.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3120.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":731.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.4,"methodology":"fee schedule"}]}]},{"description":"HC COLNCPY VIA STMA W/REM FRN BDY","code_information":[{"code":"HC75000145","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2861.73,"maximum":2861.73,"gross_charge":3533,"discounted_cash":1045.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2861.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2861.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2861.73,"methodology":"fee schedule"}]}]},{"description":"HC COLNCPY VIA STMA W/REM FRN BDY","code_information":[{"code":"HC75000145","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":529.95,"maximum":5079,"gross_charge":3533,"discounted_cash":1045.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2861.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2861.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2861.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":671.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":529.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":706.6,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY VIA STMA W/CON BLEDNG","code_information":[{"code":"HC75000146","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3089.34,"maximum":3089.34,"gross_charge":3814,"discounted_cash":1128.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3089.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3089.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3089.34,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY VIA STMA W/CON BLEDNG","code_information":[{"code":"HC75000146","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":572.1,"maximum":5079,"gross_charge":3814,"discounted_cash":1128.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3089.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3089.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3089.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":572.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":762.8,"methodology":"fee schedule"}]}]},{"description":"HC COLNCPY STMA W/REM PLYP HOT BX","code_information":[{"code":"HC75000147","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3153.33,"maximum":3153.33,"gross_charge":3893,"discounted_cash":1152.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3153.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3153.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3153.33,"methodology":"fee schedule"}]}]},{"description":"HC COLNCPY STMA W/REM PLYP HOT BX","code_information":[{"code":"HC75000147","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":583.95,"maximum":5079,"gross_charge":3893,"discounted_cash":1152.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3153.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3153.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3153.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":739.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":583.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":778.6,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY VIA STOMA W/ABL PLYP","code_information":[{"code":"HC75000148","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3184.11,"maximum":3184.11,"gross_charge":3931,"discounted_cash":1163.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3184.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3184.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3184.11,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY VIA STOMA W/ABL PLYP","code_information":[{"code":"HC75000148","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":589.65,"maximum":5079,"gross_charge":3931,"discounted_cash":1163.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3184.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3184.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3184.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":746.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":589.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":786.2,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY STOMA W/REM PLYP SNA","code_information":[{"code":"HC75000149","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3501.63,"maximum":3501.63,"gross_charge":4323,"discounted_cash":1279.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3501.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3501.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3501.63,"methodology":"fee schedule"}]}]},{"description":"HC COLNSCPY STOMA W/REM PLYP SNA","code_information":[{"code":"HC75000149","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":648.45,"maximum":5079,"gross_charge":4323,"discounted_cash":1279.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3501.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3501.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3501.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":821.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":864.6,"methodology":"fee schedule"}]}]},{"description":"HC PROCTOSIGMOIDOSCOPY","code_information":[{"code":"HC75000150","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":670.68,"maximum":670.68,"gross_charge":828,"discounted_cash":245.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":670.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":670.68,"methodology":"fee schedule"}]}]},{"description":"HC PROCTOSIGMOIDOSCOPY","code_information":[{"code":"HC75000150","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":124.2,"maximum":5079,"gross_charge":828,"discounted_cash":245.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":670.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":670.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":670.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.6,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY DIAGNOSTIC","code_information":[{"code":"HC75000160","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1603.8,"maximum":1603.8,"gross_charge":1980,"discounted_cash":586.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1603.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1603.8,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY DIAGNOSTIC","code_information":[{"code":"HC75000160","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":297,"maximum":5079,"gross_charge":1980,"discounted_cash":586.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1603.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1603.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1603.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":376.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":396,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":297,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":396,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY W/ BIOPSY","code_information":[{"code":"HC75000161","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1989.36,"maximum":1989.36,"gross_charge":2456,"discounted_cash":726.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1989.36,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMOIDOSCOPY W/ BIOPSY","code_information":[{"code":"HC75000161","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":368.4,"maximum":5079,"gross_charge":2456,"discounted_cash":726.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1989.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":368.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":491.2,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMDSCPY W/REM FORN BODY","code_information":[{"code":"HC75000162","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1645.92,"maximum":1645.92,"gross_charge":2032,"discounted_cash":601.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1645.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1645.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1645.92,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMDSCPY W/REM FORN BODY","code_information":[{"code":"HC75000162","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":304.8,"maximum":5079,"gross_charge":2032,"discounted_cash":601.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1645.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1645.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1645.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":406.4,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMODOSCOPY W/HOT BIOPSY","code_information":[{"code":"HC75000163","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1670.22,"maximum":1670.22,"gross_charge":2062,"discounted_cash":610.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1670.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1670.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1670.22,"methodology":"fee schedule"}]}]},{"description":"HC FLEX SIGMODOSCOPY W/HOT BIOPSY","code_information":[{"code":"HC75000163","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":309.3,"maximum":5079,"gross_charge":2062,"discounted_cash":610.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1670.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1670.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1670.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":391.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":309.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":412.4,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY DX/SCREEN","code_information":[{"code":"HC75000168","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4076.73,"maximum":4076.73,"gross_charge":5033,"discounted_cash":1489.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4076.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4076.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4076.73,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY DX/SCREEN","code_information":[{"code":"HC75000168","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":754.95,"maximum":5079,"gross_charge":5033,"discounted_cash":1489.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4076.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4076.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4076.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":956.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1006.6,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/REM FOREGIN BODY","code_information":[{"code":"HC75000169","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3545.37,"maximum":3545.37,"gross_charge":4377,"discounted_cash":1295.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3545.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3545.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3545.37,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/REM FOREGIN BODY","code_information":[{"code":"HC75000169","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":656.55,"maximum":5079,"gross_charge":4377,"discounted_cash":1295.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3545.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3545.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3545.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":831.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":656.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":875.4,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/BIOPSY","code_information":[{"code":"HC75000170","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4475.25,"maximum":4475.25,"gross_charge":5525,"discounted_cash":1635.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4475.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4475.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4475.25,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/BIOPSY","code_information":[{"code":"HC75000170","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":828.75,"maximum":5079,"gross_charge":5525,"discounted_cash":1635.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4475.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4475.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4475.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1049.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":828.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1105,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/CONTROL BLEEDING","code_information":[{"code":"HC75000171","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4913.46,"maximum":4913.46,"gross_charge":6066,"discounted_cash":1795.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4913.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4913.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4913.46,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/CONTROL BLEEDING","code_information":[{"code":"HC75000171","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":909.9,"maximum":5079,"gross_charge":6066,"discounted_cash":1795.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4913.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4913.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4913.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1152.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":909.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1213.2,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/ABLATION POLYP","code_information":[{"code":"HC75000172","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4617.81,"maximum":4617.81,"gross_charge":5701,"discounted_cash":1687.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4617.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4617.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4617.81,"methodology":"fee schedule"}]}]},{"description":"HC COLONOSCOPY W/ABLATION POLYP","code_information":[{"code":"HC75000172","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":855.15,"maximum":5079,"gross_charge":5701,"discounted_cash":1687.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4617.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4617.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4617.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1083.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":855.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1140.2,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSCOPY W/ANAL FISTULA","code_information":[{"code":"HC75000175","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1788.48,"maximum":1788.48,"gross_charge":2208,"discounted_cash":653.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1788.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1788.48,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSCOPY W/ANAL FISTULA","code_information":[{"code":"HC75000175","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":331.2,"maximum":5079,"gross_charge":2208,"discounted_cash":653.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1788.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1788.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1788.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":441.6,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGEAL MOTILITY INCOMPLET","code_information":[{"code":"HC75000176","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1260.36,"maximum":1260.36,"gross_charge":1556,"discounted_cash":460.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1260.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1260.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1260.36,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGEAL MOTILITY INCOMPLET","code_information":[{"code":"HC75000176","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":233.4,"maximum":5079,"gross_charge":1556,"discounted_cash":460.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1260.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1260.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1260.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.2,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CELIAC PLEXUS - 64680","code_information":[{"code":"HC75000177","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1304.91,"maximum":1304.91,"gross_charge":1611,"discounted_cash":476.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1304.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1304.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1304.91,"methodology":"fee schedule"}]}]},{"description":"HC BLOCK CELIAC PLEXUS - 64680","code_information":[{"code":"HC75000177","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":241.65,"maximum":5079,"gross_charge":1611,"discounted_cash":476.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1304.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1304.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1304.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.2,"methodology":"fee schedule"}]}]},{"description":"HC EGD EUS W/BX AND FNA-43242","code_information":[{"code":"HC75000178","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5930.82,"maximum":5930.82,"gross_charge":7322,"discounted_cash":2167.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5930.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5930.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5930.82,"methodology":"fee schedule"}]}]},{"description":"HC EGD EUS W/BX AND FNA-43242","code_information":[{"code":"HC75000178","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1098.3,"maximum":5930.82,"gross_charge":7322,"discounted_cash":2167.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5930.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5930.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5930.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1391.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1098.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1464.4,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY INCOMPLETE","code_information":[{"code":"HC75000179","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1877.58,"maximum":1877.58,"gross_charge":2318,"discounted_cash":686.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1877.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1877.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1877.58,"methodology":"fee schedule"}]}]},{"description":"HC ESOPHAGOSCOPY INCOMPLETE","code_information":[{"code":"HC75000179","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":347.7,"maximum":5079,"gross_charge":2318,"discounted_cash":686.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1877.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1877.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1877.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.6,"methodology":"fee schedule"}]}]},{"description":"HC EGD. INCOMPLETE","code_information":[{"code":"HC75000180","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2519.91,"maximum":2519.91,"gross_charge":3111,"discounted_cash":920.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2519.91,"methodology":"fee schedule"}]}]},{"description":"HC EGD. INCOMPLETE","code_information":[{"code":"HC75000180","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":466.65,"maximum":5079,"gross_charge":3111,"discounted_cash":920.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2519.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":591.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":466.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":622.2,"methodology":"fee schedule"}]}]},{"description":"HC ERCP INCOMPLETE","code_information":[{"code":"HC75000181","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2626.83,"maximum":2626.83,"gross_charge":3243,"discounted_cash":959.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2626.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2626.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2626.83,"methodology":"fee schedule"}]}]},{"description":"HC ERCP INCOMPLETE","code_information":[{"code":"HC75000181","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":486.45,"maximum":5079,"gross_charge":3243,"discounted_cash":959.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2626.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2626.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2626.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":486.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.6,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPY WASHING","code_information":[{"code":"HC75000183","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1329.21,"maximum":1329.21,"gross_charge":1641,"discounted_cash":485.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1329.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1329.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1329.21,"methodology":"fee schedule"}]}]},{"description":"HC BRONCHOSCOPY WASHING","code_information":[{"code":"HC75000183","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":246.15,"maximum":5079,"gross_charge":1641,"discounted_cash":485.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1329.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1329.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1329.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":246.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.2,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSY W/US FNA-45342","code_information":[{"code":"HC75020001","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3986.01,"maximum":3986.01,"gross_charge":4921,"discounted_cash":1456.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3986.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3986.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3986.01,"methodology":"fee schedule"}]}]},{"description":"HC SIGMOIDOSY W/US FNA-45342","code_information":[{"code":"HC75020001","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":738.15,"maximum":5079,"gross_charge":4921,"discounted_cash":1456.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3986.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3986.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3986.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":738.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":984.2,"methodology":"fee schedule"}]}]},{"description":"EGD INTRAL TUBE/CATH INS 43241","code_information":[{"code":"HC75020003","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6181.11,"maximum":6181.11,"gross_charge":7631,"discounted_cash":2258.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6181.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6181.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6181.11,"methodology":"fee schedule"}]}]},{"description":"EGD INTRAL TUBE/CATH INS 43241","code_information":[{"code":"HC75020003","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1144.65,"maximum":6181.11,"gross_charge":7631,"discounted_cash":2258.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6181.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6181.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6181.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1449.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1526.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1526.2,"methodology":"fee schedule"}]}]},{"description":"EGD TRNS ORL/MRL DRN PSEU -43240","code_information":[{"code":"HC75020004","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":11901.33,"maximum":11901.33,"gross_charge":14693,"discounted_cash":4349.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11901.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11901.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11901.33,"methodology":"fee schedule"}]}]},{"description":"EGD TRNS ORL/MRL DRN PSEU -43240","code_information":[{"code":"HC75020004","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2203.95,"maximum":11901.33,"gross_charge":14693,"discounted_cash":4349.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11901.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11901.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11901.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2791.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2938.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2203.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2938.6,"methodology":"fee schedule"}]}]},{"description":"BRONCH TRN NDL ASPR BX EA-31633","code_information":[{"code":"HC75020008","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5826.33,"maximum":5826.33,"gross_charge":7193,"discounted_cash":2129.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5826.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5826.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5826.33,"methodology":"fee schedule"}]}]},{"description":"BRONCH TRN NDL ASPR BX EA-31633","code_information":[{"code":"HC75020008","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1078.95,"maximum":5826.33,"gross_charge":7193,"discounted_cash":2129.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5826.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5826.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5826.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1366.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1438.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1078.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1438.6,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY TUBE CHANGE 31502","code_information":[{"code":"HC75020012","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":835.92,"maximum":835.92,"gross_charge":1032,"discounted_cash":305.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":835.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":835.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":835.92,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY TUBE CHANGE 31502","code_information":[{"code":"HC75020012","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":154.8,"maximum":5079,"gross_charge":1032,"discounted_cash":305.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":835.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":835.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":835.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.4,"methodology":"fee schedule"}]}]},{"description":"COLONSTOMA W/SUBMUC INJ 44404","code_information":[{"code":"HC75020017","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4088.88,"maximum":4088.88,"gross_charge":5048,"discounted_cash":1494.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4088.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4088.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4088.88,"methodology":"fee schedule"}]}]},{"description":"COLONSTOMA W/SUBMUC INJ 44404","code_information":[{"code":"HC75020017","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":757.2,"maximum":5079,"gross_charge":5048,"discounted_cash":1494.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4088.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4088.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4088.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":959.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1009.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":757.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1009.6,"methodology":"fee schedule"}]}]},{"description":"ILEOSCOPYSTOMA W/BLN DIL 44381","code_information":[{"code":"HC75020018","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6403.86,"maximum":6403.86,"gross_charge":7906,"discounted_cash":2340.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6403.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6403.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6403.86,"methodology":"fee schedule"}]}]},{"description":"ILEOSCOPYSTOMA W/BLN DIL 44381","code_information":[{"code":"HC75020018","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1185.9,"maximum":6403.86,"gross_charge":7906,"discounted_cash":2340.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6403.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6403.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6403.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1502.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1185.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1581.2,"methodology":"fee schedule"}]}]},{"description":"BIOPSY PANCREASPERC NEEDLE 48102","code_information":[{"code":"HC75020019","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":5681.34,"maximum":5681.34,"gross_charge":7014,"discounted_cash":2076.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5681.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5681.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5681.34,"methodology":"fee schedule"}]}]},{"description":"BIOPSY PANCREASPERC NEEDLE 48102","code_information":[{"code":"HC75020019","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1052.1,"maximum":5681.34,"gross_charge":7014,"discounted_cash":2076.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5681.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5681.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5681.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1332.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1052.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1402.8,"methodology":"fee schedule"}]}]},{"description":"NEEDLE ASPIRATION 10021","code_information":[{"code":"HC75020020","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1126.71,"maximum":1126.71,"gross_charge":1391,"discounted_cash":411.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1126.71,"methodology":"fee schedule"}]}]},{"description":"NEEDLE ASPIRATION 10021","code_information":[{"code":"HC75020020","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":208.65,"maximum":5079,"gross_charge":1391,"discounted_cash":411.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1126.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":264.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.2,"methodology":"fee schedule"}]}]},{"description":"ENDSCPY UPPER SMALL INTESTINE 44360","code_information":[{"code":"HC75020021","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6099.3,"maximum":6099.3,"gross_charge":7530,"discounted_cash":2228.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6099.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6099.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6099.3,"methodology":"fee schedule"}]}]},{"description":"ENDSCPY UPPER SMALL INTESTINE 44360","code_information":[{"code":"HC75020021","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1129.5,"maximum":6099.3,"gross_charge":7530,"discounted_cash":2228.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6099.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6099.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6099.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1430.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1506,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1129.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1506,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGEAL MOTILITY 91010","code_information":[{"code":"HC75020023","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1831.41,"maximum":1831.41,"gross_charge":2261,"discounted_cash":669.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1831.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1831.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1831.41,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGEAL MOTILITY 91010","code_information":[{"code":"HC75020023","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":339.15,"maximum":5079,"gross_charge":2261,"discounted_cash":669.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1831.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1831.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1831.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":429.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.2,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGEAL FN/GERD TST 91037","code_information":[{"code":"HC75020024","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":993.87,"maximum":993.87,"gross_charge":1227,"discounted_cash":363.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":993.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":993.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":993.87,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGEAL FN/GERD TST 91037","code_information":[{"code":"HC75020024","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":184.05,"maximum":5079,"gross_charge":1227,"discounted_cash":363.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":993.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":993.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":993.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":233.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":245.4,"methodology":"fee schedule"}]}]},{"description":"COLON SCREEN/HIGH RISK G0105","code_information":[{"code":"HC75020025","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":2979.99,"maximum":2979.99,"gross_charge":3679,"discounted_cash":1088.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2979.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2979.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2979.99,"methodology":"fee schedule"}]}]},{"description":"COLON SCREEN/HIGH RISK G0105","code_information":[{"code":"HC75020025","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":551.85,"maximum":5079,"gross_charge":3679,"discounted_cash":1088.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2979.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2979.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2979.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":699.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":551.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.8,"methodology":"fee schedule"}]}]},{"description":"BRONCH DIL W/TRACH STNT 31631","code_information":[{"code":"HC75020026","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":21862.71,"maximum":21862.71,"gross_charge":26991,"discounted_cash":7989.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21862.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21862.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21862.71,"methodology":"fee schedule"}]}]},{"description":"BRONCH DIL W/TRACH STNT 31631","code_information":[{"code":"HC75020026","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":4048.65,"maximum":21862.71,"gross_charge":26991,"discounted_cash":7989.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21862.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21862.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21862.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5128.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5398.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4048.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5398.2,"methodology":"fee schedule"}]}]},{"description":"SML BOWEL- NOT ILEUM INJECT 44799","code_information":[{"code":"HC75020028","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":3042.36,"maximum":3042.36,"gross_charge":3756,"discounted_cash":1111.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3042.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3042.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3042.36,"methodology":"fee schedule"}]}]},{"description":"SML BOWEL- NOT ILEUM INJECT 44799","code_information":[{"code":"HC75020028","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":563.4,"maximum":5079,"gross_charge":3756,"discounted_cash":1111.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3042.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3042.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3042.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":713.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":563.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":751.2,"methodology":"fee schedule"}]}]},{"description":"SM BWL W/CONV G-J TUBE 44373","code_information":[{"code":"HC75020029","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":6103.35,"maximum":6103.35,"gross_charge":7535,"discounted_cash":2230.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6103.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6103.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6103.35,"methodology":"fee schedule"}]}]},{"description":"SM BWL W/CONV G-J TUBE 44373","code_information":[{"code":"HC75020029","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"minimum":1130.25,"maximum":6103.35,"gross_charge":7535,"discounted_cash":2230.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6103.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6103.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6103.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5079,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1431.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1507,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1130.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1507,"methodology":"fee schedule"}]}]},{"description":"AAA SCREENING - SELF PAY","code_information":[{"code":"HC92120007","type":"CDM"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":20.25,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"AAA SCREENING - SELF PAY","code_information":[{"code":"HC92120007","type":"CDM"},{"code":"0921","type":"RC"}],"standard_charges":[{"minimum":3.75,"maximum":619,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":619,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"HC MULTIDISCIP EDU CLASS *SP","code_information":[{"code":"HC94200012","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":54.27,"maximum":54.27,"gross_charge":67,"discounted_cash":19.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"}]}]},{"description":"HC MULTIDISCIP EDU CLASS *SP","code_information":[{"code":"HC94200012","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":10.05,"maximum":142,"gross_charge":67,"discounted_cash":19.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"HC MULTIDIS TEAM ED & MH EVAL *SP","code_information":[{"code":"HC94200013","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":79.38,"maximum":79.38,"gross_charge":98,"discounted_cash":29.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"}]}]},{"description":"HC MULTIDIS TEAM ED & MH EVAL *SP","code_information":[{"code":"HC94200013","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":14.7,"maximum":142,"gross_charge":98,"discounted_cash":29.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"}]}]},{"description":"HC NON COVERED MED NUT THERAPY","code_information":[{"code":"HC94200015","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":24.3,"maximum":24.3,"gross_charge":30,"discounted_cash":8.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"}]}]},{"description":"HC NON COVERED MED NUT THERAPY","code_information":[{"code":"HC94200015","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"minimum":4.5,"maximum":142,"gross_charge":30,"discounted_cash":8.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":142,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"}]}]},{"description":"US UNI READ ONLY - TRIDENT","code_information":[{"code":"HC99820007","type":"CDM"},{"code":"0998","type":"RC"}],"standard_charges":[{"minimum":16.2,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"}]}]},{"description":"US UNI READ ONLY - TRIDENT","code_information":[{"code":"HC99820007","type":"CDM"},{"code":"0998","type":"RC"}],"standard_charges":[{"minimum":3,"maximum":16.2,"gross_charge":20,"discounted_cash":5.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4,"methodology":"fee schedule"}]}]},{"description":"ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0129","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6198.3,"maximum":8367.7,"gross_charge":10330.49,"discounted_cash":3057.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8367.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8367.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8367.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6714.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7231.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6198.3,"methodology":"fee schedule"}]}]},{"description":"ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0129","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.78,"maximum":8367.7,"gross_charge":10330.49,"discounted_cash":3057.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8367.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8367.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8367.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6611.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":43.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.16,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":66.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.87,"standard_charge_algorithm": "Lesser of $48.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.87,"standard_charge_algorithm": "Lesser of $48.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4648.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7231.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6198.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1962.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2066.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2066.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":41.11,"methodology":"case rate"}]}]},{"description":"ABATACEPT 25 MG/ML INJECTION","code_information":[{"code":"J0129","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3713.03,"maximum":5012.58,"gross_charge":6188.37,"discounted_cash":1831.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5012.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5012.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5012.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4022.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4331.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3713.03,"methodology":"fee schedule"}]}]},{"description":"ABATACEPT 25 MG/ML INJECTION","code_information":[{"code":"J0129","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.78,"maximum":5012.58,"gross_charge":6188.37,"discounted_cash":1831.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5012.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5012.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5012.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3960.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":43.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.16,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":66.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.87,"standard_charge_algorithm": "Lesser of $48.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.87,"standard_charge_algorithm": "Lesser of $48.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2784.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4331.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3713.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1175.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1237.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":928.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1237.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":41.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":40.72,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":42.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":41.11,"methodology":"case rate"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0812-30","type":"NDC"}],"standard_charges":[{"minimum":171.46,"maximum":231.47,"gross_charge":285.76,"discounted_cash":84.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":185.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":200.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.46,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0812-30","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":231.47,"gross_charge":285.76,"discounted_cash":84.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":182.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":128.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":200.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.16,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0259-30","type":"NDC"}],"standard_charges":[{"minimum":105.69,"maximum":142.68,"gross_charge":176.14,"discounted_cash":52.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":114.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":123.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.69,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0259-30","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":142.68,"gross_charge":176.14,"discounted_cash":52.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":79.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":123.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.23,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0963-30","type":"NDC"}],"standard_charges":[{"minimum":117.36,"maximum":158.43,"gross_charge":195.59,"discounted_cash":57.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":158.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":158.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":127.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":136.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.36,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0963-30","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":158.43,"gross_charge":195.59,"discounted_cash":57.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":158.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":158.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":158.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":88.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":136.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":117.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0963-41","type":"NDC"}],"standard_charges":[{"minimum":119.1,"maximum":160.78,"gross_charge":198.49,"discounted_cash":58.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.1,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0963-41","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":160.78,"gross_charge":198.49,"discounted_cash":58.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":127.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.7,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66220-0207-30","type":"NDC"}],"standard_charges":[{"minimum":510.95,"maximum":689.78,"gross_charge":851.57,"discounted_cash":252.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":689.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":689.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":689.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":553.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":596.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":510.95,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66220-0207-30","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":689.78,"gross_charge":851.57,"discounted_cash":252.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":689.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":689.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":689.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":545.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":383.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":596.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":510.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.32,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0860-01","type":"NDC"}],"standard_charges":[{"minimum":119.63,"maximum":161.5,"gross_charge":199.38,"discounted_cash":59.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":139.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.63,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0860-01","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":161.5,"gross_charge":199.38,"discounted_cash":59.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":127.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":139.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.88,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0860-04","type":"NDC"}],"standard_charges":[{"minimum":118.34,"maximum":159.76,"gross_charge":197.23,"discounted_cash":58.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.34,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0860-04","type":"NDC"}],"standard_charges":[{"minimum":1.06,"maximum":159.76,"gross_charge":197.23,"discounted_cash":58.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":126.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":88.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":189.35,"maximum":255.62,"gross_charge":315.57,"discounted_cash":93.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":205.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":220.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.35,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION","code_information":[{"code":"J0132","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.06,"maximum":255.62,"gross_charge":315.57,"discounted_cash":93.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":201.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":142.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":220.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.12,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55390-0613-20","type":"NDC"}],"standard_charges":[{"minimum":33.62,"maximum":45.39,"gross_charge":56.03,"discounted_cash":16.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55390-0613-20","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":45.39,"gross_charge":56.03,"discounted_cash":16.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0154-10","type":"NDC"}],"standard_charges":[{"minimum":38.37,"maximum":51.8,"gross_charge":63.94,"discounted_cash":18.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0154-10","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":51.8,"gross_charge":63.94,"discounted_cash":18.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0155-20","type":"NDC"}],"standard_charges":[{"minimum":43.55,"maximum":58.79,"gross_charge":72.58,"discounted_cash":21.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.55,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0155-20","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":58.79,"gross_charge":72.58,"discounted_cash":21.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0325-09","type":"NDC"}],"standard_charges":[{"minimum":43.2,"maximum":58.32,"gross_charge":71.99,"discounted_cash":21.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0325-09","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":58.32,"gross_charge":71.99,"discounted_cash":21.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0325-14","type":"NDC"}],"standard_charges":[{"minimum":37.11,"maximum":50.1,"gross_charge":61.84,"discounted_cash":18.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0325-14","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":50.1,"gross_charge":61.84,"discounted_cash":18.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55390-0612-10","type":"NDC"}],"standard_charges":[{"minimum":33.2,"maximum":44.81,"gross_charge":55.32,"discounted_cash":16.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"}]}]},{"description":"ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55390-0612-10","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":44.81,"gross_charge":55.32,"discounted_cash":16.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.07,"standard_charge_algorithm": "Lesser of $0.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0972-01","type":"NDC"}],"standard_charges":[{"minimum":324.39,"maximum":437.92,"gross_charge":540.64,"discounted_cash":160.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":351.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":378.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.39,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0972-01","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":437.92,"gross_charge":540.64,"discounted_cash":160.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":437.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":346.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":243.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":378.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":324.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.13,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0997-01","type":"NDC"}],"standard_charges":[{"minimum":302.48,"maximum":408.34,"gross_charge":504.12,"discounted_cash":149.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":327.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":352.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.48,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0997-01","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":408.34,"gross_charge":504.12,"discounted_cash":149.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":322.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":226.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":352.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.83,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0544-30","type":"NDC"}],"standard_charges":[{"minimum":330.09,"maximum":445.62,"gross_charge":550.14,"discounted_cash":162.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":357.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.09,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0544-30","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":445.62,"gross_charge":550.14,"discounted_cash":162.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":352.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":247.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.03,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0258-32","type":"NDC"}],"standard_charges":[{"minimum":312.2,"maximum":421.47,"gross_charge":520.33,"discounted_cash":154.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":338.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":364.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.2,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0258-32","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":421.47,"gross_charge":520.33,"discounted_cash":154.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":421.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":421.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":421.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":333.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":234.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":364.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0193-01","type":"NDC"}],"standard_charges":[{"minimum":284.33,"maximum":383.84,"gross_charge":473.87,"discounted_cash":140.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":308.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":331.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.33,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0193-01","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":383.84,"gross_charge":473.87,"discounted_cash":140.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":303.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":213.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":331.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0651-30","type":"NDC"}],"standard_charges":[{"minimum":381.69,"maximum":515.28,"gross_charge":636.14,"discounted_cash":188.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":515.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":515.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":515.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":413.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":445.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":381.69,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0651-30","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":515.28,"gross_charge":636.14,"discounted_cash":188.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":515.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":515.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":515.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":407.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":286.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":445.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":381.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.23,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":705.68,"maximum":952.66,"gross_charge":1176.12,"discounted_cash":348.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":952.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":952.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":952.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":764.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":823.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":705.68,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.49,"maximum":952.66,"gross_charge":1176.12,"discounted_cash":348.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":952.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":952.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":952.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":752.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":529.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":823.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":705.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.23,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":716.31,"maximum":967.02,"gross_charge":1193.84,"discounted_cash":353.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":967.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":967.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":967.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":776,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":835.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":716.31,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.49,"maximum":967.02,"gross_charge":1193.84,"discounted_cash":353.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":967.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":967.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":967.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":764.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":537.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":835.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":716.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.77,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0542-02","type":"NDC"}],"standard_charges":[{"minimum":36.38,"maximum":49.11,"gross_charge":60.62,"discounted_cash":17.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.38,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0542-02","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":49.11,"gross_charge":60.62,"discounted_cash":17.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0651-00","type":"NDC"}],"standard_charges":[{"minimum":38.36,"maximum":51.79,"gross_charge":63.93,"discounted_cash":18.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0651-00","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":51.79,"gross_charge":63.93,"discounted_cash":18.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0651-02","type":"NDC"}],"standard_charges":[{"minimum":58.1,"maximum":78.43,"gross_charge":96.82,"discounted_cash":28.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.1,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0651-02","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":78.43,"gross_charge":96.82,"discounted_cash":28.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.37,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0855-02","type":"NDC"}],"standard_charges":[{"minimum":46.65,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0855-02","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE CARDIAC IMAGING (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0193-30","type":"NDC"}],"standard_charges":[{"minimum":314.01,"maximum":423.92,"gross_charge":523.35,"discounted_cash":154.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":423.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":423.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":340.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":366.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":314.01,"methodology":"fee schedule"}]}]},{"description":"ADENOSINE CARDIAC IMAGING (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0193-30","type":"NDC"}],"standard_charges":[{"minimum":0.49,"maximum":423.92,"gross_charge":523.35,"discounted_cash":154.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":423.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":423.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":423.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":334.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.49,"standard_charge_algorithm": "Lesser of $0.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":235.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":366.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":314.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.67,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0925-10","type":"NDC"}],"standard_charges":[{"minimum":45.42,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0925-10","type":"NDC"}],"standard_charges":[{"minimum":11.36,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3316-01","type":"NDC"}],"standard_charges":[{"minimum":52.77,"maximum":71.24,"gross_charge":87.94,"discounted_cash":26.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3316-01","type":"NDC"}],"standard_charges":[{"minimum":13.2,"maximum":71.24,"gross_charge":87.94,"discounted_cash":26.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.54,"maximum":60.12,"gross_charge":74.22,"discounted_cash":21.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.14,"maximum":60.12,"gross_charge":74.22,"discounted_cash":21.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.73,"maximum":63.09,"gross_charge":77.88,"discounted_cash":23.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.69,"maximum":63.09,"gross_charge":77.88,"discounted_cash":23.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.58,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.32,"maximum":67.93,"gross_charge":83.86,"discounted_cash":24.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.32,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.58,"maximum":67.93,"gross_charge":83.86,"discounted_cash":24.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.78,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0159-01","type":"NDC"}],"standard_charges":[{"minimum":65.15,"maximum":87.95,"gross_charge":108.57,"discounted_cash":32.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.15,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0159-01","type":"NDC"}],"standard_charges":[{"minimum":16.29,"maximum":87.95,"gross_charge":108.57,"discounted_cash":32.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.29,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.72,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0119-01","type":"NDC"}],"standard_charges":[{"minimum":63.91,"maximum":86.28,"gross_charge":106.51,"discounted_cash":31.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":74.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.91,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0119-01","type":"NDC"}],"standard_charges":[{"minimum":15.98,"maximum":86.28,"gross_charge":106.51,"discounted_cash":31.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":74.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.31,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJ (CONTAINER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0103-01","type":"NDC"}],"standard_charges":[{"minimum":59.18,"maximum":79.9,"gross_charge":98.63,"discounted_cash":29.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.18,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJ (CONTAINER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0103-01","type":"NDC"}],"standard_charges":[{"minimum":14.8,"maximum":79.9,"gross_charge":98.63,"discounted_cash":29.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.73,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJ (CONTAINER)","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.73,"maximum":50.94,"gross_charge":62.88,"discounted_cash":18.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJ (CONTAINER)","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.44,"maximum":50.94,"gross_charge":62.88,"discounted_cash":18.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0168-01","type":"NDC"}],"standard_charges":[{"minimum":425.7,"maximum":574.69,"gross_charge":709.49,"discounted_cash":210.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.7,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0168-01","type":"NDC"}],"standard_charges":[{"minimum":106.43,"maximum":574.69,"gross_charge":709.49,"discounted_cash":210.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":454.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":354.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":354.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.9,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":52.62,"maximum":71.03,"gross_charge":87.69,"discounted_cash":25.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"}]}]},{"description":"EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J0165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.16,"maximum":71.03,"gross_charge":87.69,"discounted_cash":25.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"}]}]},{"description":"LECANEMAB-IRMB 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0174","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0212-01","type":"NDC"}],"standard_charges":[{"minimum":1312.64,"maximum":1772.06,"gross_charge":2187.72,"discounted_cash":647.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1772.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1772.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1772.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1422.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1531.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1312.64,"methodology":"fee schedule"}]}]},{"description":"LECANEMAB-IRMB 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0174","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0212-01","type":"NDC"}],"standard_charges":[{"minimum":328.16,"maximum":1772.06,"gross_charge":2187.72,"discounted_cash":647.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1772.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1772.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1772.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1400.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1093.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1093.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":984.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1531.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1312.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":328.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":437.55,"methodology":"fee schedule"}]}]},{"description":"LECANEMAB-IRMB 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0174","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0215-01","type":"NDC"}],"standard_charges":[{"minimum":2964.36,"maximum":4001.89,"gross_charge":4940.6,"discounted_cash":1462.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3211.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3458.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2964.36,"methodology":"fee schedule"}]}]},{"description":"LECANEMAB-IRMB 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0174","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0215-01","type":"NDC"}],"standard_charges":[{"minimum":741.09,"maximum":4001.89,"gross_charge":4940.6,"discounted_cash":1462.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3161.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2470.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2470.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2223.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3458.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2964.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.12,"methodology":"fee schedule"}]}]},{"description":"DONANEMAB-AZBT 17.5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1789.98,"maximum":2416.47,"gross_charge":2983.29,"discounted_cash":883.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2416.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2416.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2416.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1939.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2088.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1789.98,"methodology":"fee schedule"}]}]},{"description":"DONANEMAB-AZBT 17.5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":447.5,"maximum":2416.47,"gross_charge":2983.29,"discounted_cash":883.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2416.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2416.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2416.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1909.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1491.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1491.65,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1342.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2088.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1789.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":566.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":447.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":596.66,"methodology":"fee schedule"}]}]},{"description":"APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47426-0201-01","type":"NDC"}],"standard_charges":[{"minimum":640.68,"maximum":864.91,"gross_charge":1067.79,"discounted_cash":316.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":864.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":864.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":864.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":694.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":747.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":640.68,"methodology":"fee schedule"}]}]},{"description":"APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47426-0201-01","type":"NDC"}],"standard_charges":[{"minimum":1.53,"maximum":864.91,"gross_charge":1067.79,"discounted_cash":316.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":864.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":864.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":864.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":683.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.91,"standard_charge_algorithm": "Lesser of $1.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.91,"standard_charge_algorithm": "Lesser of $1.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":480.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":747.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":640.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.62,"methodology":"case rate"}]}]},{"description":"SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0209","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60267-0705-50","type":"NDC"}],"standard_charges":[{"minimum":257.6,"maximum":347.75,"gross_charge":429.32,"discounted_cash":127.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":347.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":279.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":300.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":257.6,"methodology":"fee schedule"}]}]},{"description":"SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0209","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60267-0705-50","type":"NDC"}],"standard_charges":[{"minimum":64.4,"maximum":347.75,"gross_charge":429.32,"discounted_cash":127.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":347.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":347.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":274.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":214.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":214.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":193.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":300.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":257.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.87,"methodology":"fee schedule"}]}]},{"description":"SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0211","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60267-0812-00","type":"NDC"}],"standard_charges":[{"minimum":462.15,"maximum":623.9,"gross_charge":770.24,"discounted_cash":228,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":623.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":623.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":623.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":500.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":539.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":462.15,"methodology":"fee schedule"}]}]},{"description":"SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0211","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60267-0812-00","type":"NDC"}],"standard_charges":[{"minimum":115.54,"maximum":623.9,"gross_charge":770.24,"discounted_cash":228,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":623.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":623.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":623.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":492.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":385.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":385.12,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":346.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":539.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":462.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.05,"methodology":"fee schedule"}]}]},{"description":"REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61958-2901-02","type":"NDC"}],"standard_charges":[{"minimum":1547.04,"maximum":2088.5,"gross_charge":2578.39,"discounted_cash":763.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2088.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2088.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2088.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1675.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1804.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1547.04,"methodology":"fee schedule"}]}]},{"description":"REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61958-2901-02","type":"NDC"}],"standard_charges":[{"minimum":386.76,"maximum":2088.5,"gross_charge":2578.39,"discounted_cash":763.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2088.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2088.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2088.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1650.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1289.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1289.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1160.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1804.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1547.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":489.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":386.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":515.68,"methodology":"fee schedule"}]}]},{"description":"REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61958-2902-01","type":"NDC"}],"standard_charges":[{"minimum":1346.27,"maximum":1817.47,"gross_charge":2243.78,"discounted_cash":664.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1817.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1817.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1817.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1458.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1346.27,"methodology":"fee schedule"}]}]},{"description":"REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61958-2902-01","type":"NDC"}],"standard_charges":[{"minimum":336.57,"maximum":1817.47,"gross_charge":2243.78,"discounted_cash":664.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1817.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1817.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1817.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1436.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1121.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1121.89,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1009.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1570.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1346.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":426.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":336.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":448.76,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0290-31","type":"NDC"}],"standard_charges":[{"minimum":42.57,"maximum":57.47,"gross_charge":70.95,"discounted_cash":21.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0290-31","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":57.47,"gross_charge":70.95,"discounted_cash":21.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0173-02","type":"NDC"}],"standard_charges":[{"minimum":43.54,"maximum":58.78,"gross_charge":72.56,"discounted_cash":21.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0173-02","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":58.78,"gross_charge":72.56,"discounted_cash":21.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.19,"maximum":54.25,"gross_charge":66.97,"discounted_cash":19.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.03,"maximum":54.25,"gross_charge":66.97,"discounted_cash":19.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.23,"maximum":62.41,"gross_charge":77.04,"discounted_cash":22.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"}]}]},{"description":"AMIKACIN 500 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J0278","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.03,"maximum":62.41,"gross_charge":77.04,"discounted_cash":22.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":67.62,"maximum":91.29,"gross_charge":112.7,"discounted_cash":33.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.62,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":91.29,"gross_charge":112.7,"discounted_cash":33.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.72,"standard_charge_algorithm": "Lesser of $7.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.72,"standard_charge_algorithm": "Lesser of $7.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.54,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.77,"maximum":73.93,"gross_charge":91.27,"discounted_cash":27.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"}]}]},{"description":"AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.72,"maximum":73.93,"gross_charge":91.27,"discounted_cash":27.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.72,"standard_charge_algorithm": "Lesser of $7.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.72,"standard_charge_algorithm": "Lesser of $7.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0180-03","type":"NDC"}],"standard_charges":[{"minimum":35.39,"maximum":47.77,"gross_charge":58.97,"discounted_cash":17.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.39,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0180-03","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":47.77,"gross_charge":58.97,"discounted_cash":17.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0616-03","type":"NDC"}],"standard_charges":[{"minimum":37.41,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0616-03","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0616-09","type":"NDC"}],"standard_charges":[{"minimum":45.43,"maximum":61.33,"gross_charge":75.71,"discounted_cash":22.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.43,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0616-09","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":61.33,"gross_charge":75.71,"discounted_cash":22.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0153-03","type":"NDC"}],"standard_charges":[{"minimum":40.85,"maximum":55.14,"gross_charge":68.07,"discounted_cash":20.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0153-03","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":55.14,"gross_charge":68.07,"discounted_cash":20.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.62,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0153-09","type":"NDC"}],"standard_charges":[{"minimum":49.07,"maximum":66.24,"gross_charge":81.77,"discounted_cash":24.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.07,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0153-09","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":66.24,"gross_charge":81.77,"discounted_cash":24.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.36,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.52,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"}]}]},{"description":"AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0282","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"}]}]},{"description":"AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0285","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-1055-05","type":"NDC"}],"standard_charges":[{"minimum":120.49,"maximum":162.66,"gross_charge":200.81,"discounted_cash":59.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":130.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":140.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.49,"methodology":"fee schedule"}]}]},{"description":"AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0285","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-1055-05","type":"NDC"}],"standard_charges":[{"minimum":30.13,"maximum":162.66,"gross_charge":200.81,"discounted_cash":59.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.45,"standard_charge_algorithm": "Lesser of $44.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.45,"standard_charge_algorithm": "Lesser of $44.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":140.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"}]}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0233-01","type":"NDC"}],"standard_charges":[{"minimum":217.68,"maximum":293.87,"gross_charge":362.8,"discounted_cash":107.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":235.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":253.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.68,"methodology":"fee schedule"}]}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0233-01","type":"NDC"}],"standard_charges":[{"minimum":20.84,"maximum":293.87,"gross_charge":362.8,"discounted_cash":107.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":232.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":163.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":253.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.09,"methodology":"case rate"}]}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION","code_information":[{"code":"J0289","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":271.64,"maximum":366.72,"gross_charge":452.73,"discounted_cash":134.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":294.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":316.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":271.64,"methodology":"fee schedule"}]}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION","code_information":[{"code":"J0289","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.84,"maximum":366.72,"gross_charge":452.73,"discounted_cash":134.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":289.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":26.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":35.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.28,"standard_charge_algorithm": "Lesser of $29.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":203.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":316.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":271.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":20.84,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":22.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":21.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":21.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":22.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":22.09,"methodology":"case rate"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0113-10","type":"NDC"}],"standard_charges":[{"minimum":36.41,"maximum":49.15,"gross_charge":60.67,"discounted_cash":17.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0113-10","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":49.15,"gross_charge":60.67,"discounted_cash":17.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0351-01","type":"NDC"}],"standard_charges":[{"minimum":36.21,"maximum":48.88,"gross_charge":60.34,"discounted_cash":17.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0351-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":48.88,"gross_charge":60.34,"discounted_cash":17.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0016-01","type":"NDC"}],"standard_charges":[{"minimum":36.86,"maximum":49.76,"gross_charge":61.42,"discounted_cash":18.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0016-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":49.76,"gross_charge":61.42,"discounted_cash":18.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.82,"maximum":48.36,"gross_charge":59.7,"discounted_cash":17.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":48.36,"gross_charge":59.7,"discounted_cash":17.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0103-10","type":"NDC"}],"standard_charges":[{"minimum":42.01,"maximum":56.71,"gross_charge":70.01,"discounted_cash":20.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.01,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0103-10","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":56.71,"gross_charge":70.01,"discounted_cash":20.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0114-20","type":"NDC"}],"standard_charges":[{"minimum":39.65,"maximum":53.53,"gross_charge":66.08,"discounted_cash":19.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0114-20","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":53.53,"gross_charge":66.08,"discounted_cash":19.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.22,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0020-23","type":"NDC"}],"standard_charges":[{"minimum":51.14,"maximum":69.04,"gross_charge":85.23,"discounted_cash":25.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0020-23","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":69.04,"gross_charge":85.23,"discounted_cash":25.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0352-02","type":"NDC"}],"standard_charges":[{"minimum":38.42,"maximum":51.86,"gross_charge":64.02,"discounted_cash":18.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0352-02","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":51.86,"gross_charge":64.02,"discounted_cash":18.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0087-01","type":"NDC"}],"standard_charges":[{"minimum":49.08,"maximum":66.26,"gross_charge":81.8,"discounted_cash":24.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.08,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0087-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":66.26,"gross_charge":81.8,"discounted_cash":24.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.36,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0422-10","type":"NDC"}],"standard_charges":[{"minimum":43.19,"maximum":58.31,"gross_charge":71.98,"discounted_cash":21.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0422-10","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":58.31,"gross_charge":71.98,"discounted_cash":21.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0017-01","type":"NDC"}],"standard_charges":[{"minimum":38.67,"maximum":52.21,"gross_charge":64.45,"discounted_cash":19.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0017-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":52.21,"gross_charge":64.45,"discounted_cash":19.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0454-01","type":"NDC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0454-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.86,"maximum":51.12,"gross_charge":63.1,"discounted_cash":18.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":51.12,"gross_charge":63.1,"discounted_cash":18.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.43,"maximum":51.89,"gross_charge":64.05,"discounted_cash":18.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":51.89,"gross_charge":64.05,"discounted_cash":18.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.75,"maximum":52.31,"gross_charge":64.58,"discounted_cash":19.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":52.31,"gross_charge":64.58,"discounted_cash":19.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0708-00","type":"NDC"}],"standard_charges":[{"minimum":38.48,"maximum":51.94,"gross_charge":64.12,"discounted_cash":18.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN 500 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0708-00","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":51.94,"gross_charge":64.12,"discounted_cash":18.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0210-10","type":"NDC"}],"standard_charges":[{"minimum":51.14,"maximum":69.04,"gross_charge":85.23,"discounted_cash":25.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0210-10","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":69.04,"gross_charge":85.23,"discounted_cash":25.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0116-01","type":"NDC"}],"standard_charges":[{"minimum":36.26,"maximum":48.95,"gross_charge":60.42,"discounted_cash":17.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0116-01","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":48.95,"gross_charge":60.42,"discounted_cash":17.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0081-01","type":"NDC"}],"standard_charges":[{"minimum":44.34,"maximum":59.86,"gross_charge":73.9,"discounted_cash":21.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0081-01","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":59.86,"gross_charge":73.9,"discounted_cash":21.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0005-20","type":"NDC"}],"standard_charges":[{"minimum":44.63,"maximum":60.24,"gross_charge":74.37,"discounted_cash":22.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.63,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0005-20","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":60.24,"gross_charge":74.37,"discounted_cash":22.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0021-10","type":"NDC"}],"standard_charges":[{"minimum":39.63,"maximum":53.51,"gross_charge":66.05,"discounted_cash":19.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0021-10","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":53.51,"gross_charge":66.05,"discounted_cash":19.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0220-01","type":"NDC"}],"standard_charges":[{"minimum":36.44,"maximum":49.19,"gross_charge":60.72,"discounted_cash":17.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.44,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0220-01","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":49.19,"gross_charge":60.72,"discounted_cash":17.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0220-10","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0220-10","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.48,"maximum":49.25,"gross_charge":60.8,"discounted_cash":18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":49.25,"gross_charge":60.8,"discounted_cash":18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.34,"maximum":50.41,"gross_charge":62.23,"discounted_cash":18.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":50.41,"gross_charge":62.23,"discounted_cash":18.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0143-30","type":"NDC"}],"standard_charges":[{"minimum":53.13,"maximum":71.72,"gross_charge":88.54,"discounted_cash":26.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0143-30","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":71.72,"gross_charge":88.54,"discounted_cash":26.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0211-10","type":"NDC"}],"standard_charges":[{"minimum":69.63,"maximum":94,"gross_charge":116.04,"discounted_cash":34.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.63,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0211-10","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":94,"gross_charge":116.04,"discounted_cash":34.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.21,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0117-10","type":"NDC"}],"standard_charges":[{"minimum":39.49,"maximum":53.31,"gross_charge":65.81,"discounted_cash":19.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0117-10","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":53.31,"gross_charge":65.81,"discounted_cash":19.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0349-03","type":"NDC"}],"standard_charges":[{"minimum":39.93,"maximum":53.91,"gross_charge":66.55,"discounted_cash":19.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0349-03","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":53.91,"gross_charge":66.55,"discounted_cash":19.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0082-02","type":"NDC"}],"standard_charges":[{"minimum":53.59,"maximum":72.35,"gross_charge":89.31,"discounted_cash":26.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.59,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0082-02","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":72.35,"gross_charge":89.31,"discounted_cash":26.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0006-31","type":"NDC"}],"standard_charges":[{"minimum":51.65,"maximum":69.73,"gross_charge":86.08,"discounted_cash":25.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.65,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0006-31","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":69.73,"gross_charge":86.08,"discounted_cash":25.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.22,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0417-01","type":"NDC"}],"standard_charges":[{"minimum":41.57,"maximum":56.12,"gross_charge":69.28,"discounted_cash":20.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.57,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0417-01","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":56.12,"gross_charge":69.28,"discounted_cash":20.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0022-01","type":"NDC"}],"standard_charges":[{"minimum":44.38,"maximum":59.91,"gross_charge":73.96,"discounted_cash":21.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0022-01","type":"NDC"}],"standard_charges":[{"minimum":2.97,"maximum":59.91,"gross_charge":73.96,"discounted_cash":21.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.74,"maximum":55,"gross_charge":67.89,"discounted_cash":20.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":55,"gross_charge":67.89,"discounted_cash":20.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.92,"maximum":55.25,"gross_charge":68.2,"discounted_cash":20.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.92,"methodology":"fee schedule"}]}]},{"description":"AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0295","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.97,"maximum":55.25,"gross_charge":68.2,"discounted_cash":20.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.97,"standard_charge_algorithm": "Lesser of $2.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.64,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0250","type":"RC"},{"code":"69918-0700-05","type":"NDC"}],"standard_charges":[{"minimum":45.72,"maximum":45.72,"gross_charge":56.44,"discounted_cash":16.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.72,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0250","type":"RC"},{"code":"69918-0700-05","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":45.72,"gross_charge":56.44,"discounted_cash":16.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0250","type":"RC"},{"code":"69918-0700-25","type":"NDC"}],"standard_charges":[{"minimum":56.98,"maximum":56.98,"gross_charge":70.34,"discounted_cash":20.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.98,"methodology":"fee schedule"}]}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 20,"type": "ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"0250","type":"RC"},{"code":"69918-0700-25","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":56.98,"gross_charge":70.34,"discounted_cash":20.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0934-01","type":"NDC"}],"standard_charges":[{"minimum":38.98,"maximum":52.62,"gross_charge":64.96,"discounted_cash":19.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0934-01","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":52.62,"gross_charge":64.96,"discounted_cash":19.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0400-01","type":"NDC"}],"standard_charges":[{"minimum":39.95,"maximum":53.93,"gross_charge":66.58,"discounted_cash":19.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0400-01","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":53.93,"gross_charge":66.58,"discounted_cash":19.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0614-00","type":"NDC"}],"standard_charges":[{"minimum":39.84,"maximum":53.78,"gross_charge":66.39,"discounted_cash":19.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.84,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0614-00","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":53.78,"gross_charge":66.39,"discounted_cash":19.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0614-21","type":"NDC"}],"standard_charges":[{"minimum":41.02,"maximum":55.38,"gross_charge":68.36,"discounted_cash":20.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0614-21","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":55.38,"gross_charge":68.36,"discounted_cash":20.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0614-55","type":"NDC"}],"standard_charges":[{"minimum":40.29,"maximum":54.39,"gross_charge":67.14,"discounted_cash":19.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0614-55","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":54.39,"gross_charge":67.14,"discounted_cash":19.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0291-00","type":"NDC"}],"standard_charges":[{"minimum":40.11,"maximum":54.15,"gross_charge":66.84,"discounted_cash":19.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0291-00","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":54.15,"gross_charge":66.84,"discounted_cash":19.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0265-25","type":"NDC"}],"standard_charges":[{"minimum":42.51,"maximum":57.39,"gross_charge":70.85,"discounted_cash":20.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"}]}]},{"description":"HYDRALAZINE 20 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0265-25","type":"NDC"}],"standard_charges":[{"minimum":7.51,"maximum":57.39,"gross_charge":70.85,"discounted_cash":20.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.51,"standard_charge_algorithm": "Lesser of $7.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0112-10","type":"NDC"}],"standard_charges":[{"minimum":46.88,"maximum":63.28,"gross_charge":78.12,"discounted_cash":23.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.88,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0112-10","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":63.28,"gross_charge":78.12,"discounted_cash":23.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.63,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0174-10","type":"NDC"}],"standard_charges":[{"minimum":38.18,"maximum":51.54,"gross_charge":63.62,"discounted_cash":18.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0174-10","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":51.54,"gross_charge":63.62,"discounted_cash":18.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6076-04","type":"NDC"}],"standard_charges":[{"minimum":49.76,"maximum":67.18,"gross_charge":82.93,"discounted_cash":24.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6076-04","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":67.18,"gross_charge":82.93,"discounted_cash":24.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0512-44","type":"NDC"}],"standard_charges":[{"minimum":41,"maximum":55.34,"gross_charge":68.32,"discounted_cash":20.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0512-44","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":55.34,"gross_charge":68.32,"discounted_cash":20.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0398-41","type":"NDC"}],"standard_charges":[{"minimum":36.77,"maximum":49.63,"gross_charge":61.27,"discounted_cash":18.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0398-41","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":49.63,"gross_charge":61.27,"discounted_cash":18.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0025-01","type":"NDC"}],"standard_charges":[{"minimum":41.63,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0025-01","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0019-82","type":"NDC"}],"standard_charges":[{"minimum":37.16,"maximum":50.16,"gross_charge":61.92,"discounted_cash":18.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0019-82","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":50.16,"gross_charge":61.92,"discounted_cash":18.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0100-10","type":"NDC"}],"standard_charges":[{"minimum":39.55,"maximum":53.39,"gross_charge":65.91,"discounted_cash":19.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.55,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0100-10","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":53.39,"gross_charge":65.91,"discounted_cash":19.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.49,"maximum":62.76,"gross_charge":77.48,"discounted_cash":22.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"}]}]},{"description":"AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0456","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.53,"maximum":62.76,"gross_charge":77.48,"discounted_cash":22.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.53,"standard_charge_algorithm": "Lesser of $3.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0401-21","type":"NDC"}],"standard_charges":[{"minimum":83.79,"maximum":113.11,"gross_charge":139.64,"discounted_cash":41.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.79,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0401-21","type":"NDC"}],"standard_charges":[{"minimum":20.95,"maximum":113.11,"gross_charge":139.64,"discounted_cash":41.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.93,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0401-26","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0401-26","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":88.26,"maximum":119.15,"gross_charge":147.09,"discounted_cash":43.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.26,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":22.07,"maximum":119.15,"gross_charge":147.09,"discounted_cash":43.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":94.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":73.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":73.55,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.42,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":101.49,"maximum":137.01,"gross_charge":169.14,"discounted_cash":50.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.49,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":25.38,"maximum":137.01,"gross_charge":169.14,"discounted_cash":50.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":84.57,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":118.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0402-30","type":"NDC"}],"standard_charges":[{"minimum":157.78,"maximum":213,"gross_charge":262.96,"discounted_cash":77.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":170.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":184.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.78,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0402-30","type":"NDC"}],"standard_charges":[{"minimum":39.45,"maximum":213,"gross_charge":262.96,"discounted_cash":77.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":213,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":168.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":131.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":131.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":118.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":184.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":157.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":146.04,"maximum":197.15,"gross_charge":243.39,"discounted_cash":72.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":158.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":170.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.04,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.51,"maximum":197.15,"gross_charge":243.39,"discounted_cash":72.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":197.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":197.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":197.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":121.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":121.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":109.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":170.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":146.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.68,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":170.19,"maximum":229.76,"gross_charge":283.65,"discounted_cash":83.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":184.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":198.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.19,"methodology":"fee schedule"}]}]},{"description":"AZTREONAM 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0457","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.55,"maximum":229.76,"gross_charge":283.65,"discounted_cash":83.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":181.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":127.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":198.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.73,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0484-03","type":"NDC"}],"standard_charges":[{"minimum":56.86,"maximum":76.76,"gross_charge":94.76,"discounted_cash":28.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0484-03","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":76.76,"gross_charge":94.76,"discounted_cash":28.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.96,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64253-0400-30","type":"NDC"}],"standard_charges":[{"minimum":53.02,"maximum":71.58,"gross_charge":88.36,"discounted_cash":26.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.02,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64253-0400-30","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":71.58,"gross_charge":88.36,"discounted_cash":26.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3339-01","type":"NDC"}],"standard_charges":[{"minimum":53.2,"maximum":71.82,"gross_charge":88.66,"discounted_cash":26.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.2,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3339-01","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":71.82,"gross_charge":88.66,"discounted_cash":26.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3340-01","type":"NDC"}],"standard_charges":[{"minimum":56.96,"maximum":76.9,"gross_charge":94.93,"discounted_cash":28.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.96,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3340-01","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":76.9,"gross_charge":94.93,"discounted_cash":28.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":67.65,"maximum":91.32,"gross_charge":112.74,"discounted_cash":33.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.65,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.08,"maximum":91.32,"gross_charge":112.74,"discounted_cash":33.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.55,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0525-08","type":"NDC"}],"standard_charges":[{"minimum":40.83,"maximum":55.13,"gross_charge":68.05,"discounted_cash":20.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0525-08","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":55.13,"gross_charge":68.05,"discounted_cash":20.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0525-63","type":"NDC"}],"standard_charges":[{"minimum":40.79,"maximum":55.06,"gross_charge":67.97,"discounted_cash":20.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.79,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0525-63","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":55.06,"gross_charge":67.97,"discounted_cash":20.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.6,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.14,"maximum":56.88,"gross_charge":70.22,"discounted_cash":20.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.14,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.08,"maximum":56.88,"gross_charge":70.22,"discounted_cash":20.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0525-63","type":"NDC"}],"standard_charges":[{"minimum":41.65,"maximum":56.23,"gross_charge":69.41,"discounted_cash":20.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.65,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0525-63","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":56.23,"gross_charge":69.41,"discounted_cash":20.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.89,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0631-01","type":"NDC"}],"standard_charges":[{"minimum":42.96,"maximum":58,"gross_charge":71.6,"discounted_cash":21.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.96,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0631-01","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":58,"gross_charge":71.6,"discounted_cash":21.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.32,"maximum":58.49,"gross_charge":72.2,"discounted_cash":21.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.32,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.08,"maximum":58.49,"gross_charge":72.2,"discounted_cash":21.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.74,"maximum":65.8,"gross_charge":81.23,"discounted_cash":24.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.74,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.08,"maximum":65.8,"gross_charge":81.23,"discounted_cash":24.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0641-25","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0641-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.07,"maximum":67.6,"gross_charge":83.45,"discounted_cash":24.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"}]}]},{"description":"ATROPINE 1 MG/ML INTRAVENOUS SOLUTION (WRAPPER)","code_information":[{"code":"J0461","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.08,"maximum":67.6,"gross_charge":83.45,"discounted_cash":24.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.08,"standard_charge_algorithm": "Lesser of $0.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70257-0560-01","type":"NDC"}],"standard_charges":[{"minimum":411.68,"maximum":555.76,"gross_charge":686.12,"discounted_cash":203.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":555.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":555.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":555.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":445.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":480.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":411.68,"methodology":"fee schedule"}]}]},{"description":"BACLOFEN 10000 MCG/20 ML (500 MCG/ML) INTRATHECAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70257-0560-01","type":"NDC"}],"standard_charges":[{"minimum":102.92,"maximum":555.76,"gross_charge":686.12,"discounted_cash":203.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":555.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":555.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":555.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":439.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":173.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":177.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":180.93,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":181.16,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":267.24,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":205.99,"standard_charge_algorithm": "Lesser of $205.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":205.99,"standard_charge_algorithm": "Lesser of $205.99 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":308.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":480.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":156.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":167.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":160.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":164.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":171.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":165.66,"methodology":"case rate"}]}]},{"description":"BELIMUMAB 120 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"49401-0101-01","type":"NDC"}],"standard_charges":[{"minimum":2861,"maximum":3862.34,"gross_charge":4768.32,"discounted_cash":1411.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3862.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3862.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3862.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3099.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3337.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2861,"methodology":"fee schedule"}]}]},{"description":"BELIMUMAB 120 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"49401-0101-01","type":"NDC"}],"standard_charges":[{"minimum":49.14,"maximum":3862.34,"gross_charge":4768.32,"discounted_cash":1411.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3862.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3862.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3862.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3051.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":54.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":84.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.9,"standard_charge_algorithm": "Lesser of $55.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.9,"standard_charge_algorithm": "Lesser of $55.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2145.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3337.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2861,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":905.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":715.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":953.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":49.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":52.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":50.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":51.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":54.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":52.09,"methodology":"case rate"}]}]},{"description":"BELIMUMAB 400 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"49401-0102-01","type":"NDC"}],"standard_charges":[{"minimum":9042.81,"maximum":12207.8,"gross_charge":15071.35,"discounted_cash":4461.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12207.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12207.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12207.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9796.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10549.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9042.81,"methodology":"fee schedule"}]}]},{"description":"BELIMUMAB 400 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"49401-0102-01","type":"NDC"}],"standard_charges":[{"minimum":49.14,"maximum":12207.8,"gross_charge":15071.35,"discounted_cash":4461.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12207.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12207.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12207.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9645.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":54.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":52,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":84.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.9,"standard_charge_algorithm": "Lesser of $55.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.9,"standard_charge_algorithm": "Lesser of $55.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6782.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10549.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9042.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2863.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3014.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2260.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3014.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":49.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":52.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":50.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":51.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":54.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":52.09,"methodology":"case rate"}]}]},{"description":"ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J0491","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12857.11,"maximum":17357.1,"gross_charge":21428.51,"discounted_cash":6342.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17357.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17357.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17357.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13928.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14999.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12857.11,"methodology":"fee schedule"}]}]},{"description":"ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J0491","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3214.28,"maximum":17357.1,"gross_charge":21428.51,"discounted_cash":6342.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17357.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17357.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17357.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13714.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10714.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10714.26,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9642.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14999.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12857.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4071.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4285.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3214.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4285.71,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0010-07","type":"NDC"}],"standard_charges":[{"minimum":55.9,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0010-07","type":"NDC"}],"standard_charges":[{"minimum":13.98,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58914-0080-52","type":"NDC"}],"standard_charges":[{"minimum":227.07,"maximum":306.54,"gross_charge":378.44,"discounted_cash":112.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":245.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":264.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.07,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58914-0080-52","type":"NDC"}],"standard_charges":[{"minimum":28.96,"maximum":306.54,"gross_charge":378.44,"discounted_cash":112.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":242.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":170.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":264.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":227.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.69,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0842-21","type":"NDC"}],"standard_charges":[{"minimum":51.28,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0842-21","type":"NDC"}],"standard_charges":[{"minimum":12.82,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0147-80","type":"NDC"}],"standard_charges":[{"minimum":67.45,"maximum":91.06,"gross_charge":112.41,"discounted_cash":33.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.45,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0147-80","type":"NDC"}],"standard_charges":[{"minimum":16.87,"maximum":91.06,"gross_charge":112.41,"discounted_cash":33.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0127-01","type":"NDC"}],"standard_charges":[{"minimum":77.25,"maximum":104.29,"gross_charge":128.75,"discounted_cash":38.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0127-01","type":"NDC"}],"standard_charges":[{"minimum":19.32,"maximum":104.29,"gross_charge":128.75,"discounted_cash":38.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.84,"maximum":84.83,"gross_charge":104.72,"discounted_cash":31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.84,"methodology":"fee schedule"}]}]},{"description":"DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION","code_information":[{"code":"J0500","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.71,"maximum":84.83,"gross_charge":104.72,"discounted_cash":31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.96,"standard_charge_algorithm": "Lesser of $28.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0012-02","type":"NDC"}],"standard_charges":[{"minimum":143.34,"maximum":193.51,"gross_charge":238.9,"discounted_cash":70.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":193.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":155.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":167.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.34,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0012-02","type":"NDC"}],"standard_charges":[{"minimum":16.5,"maximum":193.51,"gross_charge":238.9,"discounted_cash":70.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":193.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":152.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.5,"standard_charge_algorithm": "Lesser of $16.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.5,"standard_charge_algorithm": "Lesser of $16.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":107.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":167.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.78,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":98.18,"maximum":132.54,"gross_charge":163.62,"discounted_cash":48.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":106.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":114.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.18,"methodology":"fee schedule"}]}]},{"description":"BENZTROPINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16.5,"maximum":132.54,"gross_charge":163.62,"discounted_cash":48.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":104.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.5,"standard_charge_algorithm": "Lesser of $16.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.5,"standard_charge_algorithm": "Lesser of $16.50 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":114.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.73,"methodology":"fee schedule"}]}]},{"description":"BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J0517","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":21922.49,"maximum":29595.36,"gross_charge":36537.47,"discounted_cash":10815.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29595.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29595.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29595.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":23749.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25576.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21922.49,"methodology":"fee schedule"}]}]},{"description":"BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J0517","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":146,"maximum":29595.36,"gross_charge":36537.47,"discounted_cash":10815.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29595.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29595.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29595.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":23383.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":165.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":169.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":171.4,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":172.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":249.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":191.49,"standard_charge_algorithm": "Lesser of $191.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":191.49,"standard_charge_algorithm": "Lesser of $191.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16441.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25576.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21922.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6942.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5480.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7307.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":146,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":156.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":150.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":153.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":160.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":154.76,"methodology":"case rate"}]}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2 ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60793-0701-02","type":"NDC"}],"standard_charges":[{"minimum":673.55,"maximum":909.29,"gross_charge":1122.57,"discounted_cash":332.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":909.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":909.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":909.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":729.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":785.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":673.55,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2 ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60793-0701-02","type":"NDC"}],"standard_charges":[{"minimum":18.92,"maximum":909.29,"gross_charge":1122.57,"discounted_cash":332.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":909.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":909.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":909.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":718.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":24.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.92,"standard_charge_algorithm": "Lesser of $18.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.92,"standard_charge_algorithm": "Lesser of $18.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":505.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":785.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":673.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":224.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.57,"methodology":"case rate"}]}]},{"description":"BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0565","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16633.11,"maximum":22454.7,"gross_charge":27721.84,"discounted_cash":8205.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22454.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22454.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22454.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18019.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19405.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16633.11,"methodology":"fee schedule"}]}]},{"description":"BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J0565","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.64,"maximum":22454.7,"gross_charge":27721.84,"discounted_cash":8205.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22454.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22454.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22454.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17741.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":39.87,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39.86,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":60.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.09,"standard_charge_algorithm": "Lesser of $45.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.09,"standard_charge_algorithm": "Lesser of $45.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12474.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19405.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16633.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5267.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5544.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4158.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5544.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.64,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.71,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":39.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":37.78,"methodology":"case rate"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0210-10","type":"NDC"}],"standard_charges":[{"minimum":393.66,"maximum":531.44,"gross_charge":656.09,"discounted_cash":194.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":531.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":426.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":393.66,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0210-10","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":531.44,"gross_charge":656.09,"discounted_cash":194.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":531.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":419.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":295.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":459.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":393.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.22,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0562-41","type":"NDC"}],"standard_charges":[{"minimum":408.86,"maximum":551.96,"gross_charge":681.42,"discounted_cash":201.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":551.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":551.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":551.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":442.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":477,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":408.86,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0562-41","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":551.96,"gross_charge":681.42,"discounted_cash":201.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":551.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":551.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":551.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":436.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":306.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":477,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":408.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.29,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0256-00","type":"NDC"}],"standard_charges":[{"minimum":515.61,"maximum":696.08,"gross_charge":859.35,"discounted_cash":254.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":558.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":601.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":515.61,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0256-00","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":696.08,"gross_charge":859.35,"discounted_cash":254.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":696.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":696.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":696.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":549.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":601.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":515.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.87,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0025-82","type":"NDC"}],"standard_charges":[{"minimum":429.81,"maximum":580.25,"gross_charge":716.35,"discounted_cash":212.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":580.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":580.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":465.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":501.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":429.81,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0025-82","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":580.25,"gross_charge":716.35,"discounted_cash":212.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":580.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":580.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":458.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":322.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":501.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":429.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.27,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0402-10","type":"NDC"}],"standard_charges":[{"minimum":784.95,"maximum":1059.68,"gross_charge":1308.24,"discounted_cash":387.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1059.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1059.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":850.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":915.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":784.95,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0402-10","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":1059.68,"gross_charge":1308.24,"discounted_cash":387.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1059.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1059.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":837.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":588.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":915.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":784.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.65,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0427-10","type":"NDC"}],"standard_charges":[{"minimum":425.65,"maximum":574.63,"gross_charge":709.41,"discounted_cash":209.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":461.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.65,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0427-10","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":574.63,"gross_charge":709.41,"discounted_cash":209.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":574.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":574.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":574.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":454.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.89,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0035-01","type":"NDC"}],"standard_charges":[{"minimum":684.54,"maximum":924.13,"gross_charge":1140.9,"discounted_cash":337.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":741.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":798.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":684.54,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0035-01","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":924.13,"gross_charge":1140.9,"discounted_cash":337.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":924.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":924.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":924.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":730.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":513.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":798.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":684.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":216.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":228.18,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83634-0400-41","type":"NDC"}],"standard_charges":[{"minimum":379.83,"maximum":512.78,"gross_charge":633.05,"discounted_cash":187.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":411.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":443.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.83,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83634-0400-41","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":512.78,"gross_charge":633.05,"discounted_cash":187.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":405.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":284.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":443.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.61,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":444.81,"maximum":600.5,"gross_charge":741.35,"discounted_cash":219.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":481.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":518.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":444.81,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.46,"maximum":600.5,"gross_charge":741.35,"discounted_cash":219.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":600.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":474.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":333.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":518.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":444.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.27,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":508.03,"maximum":685.84,"gross_charge":846.71,"discounted_cash":250.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":685.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":685.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":685.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":550.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":592.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":508.03,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.46,"maximum":685.84,"gross_charge":846.71,"discounted_cash":250.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":685.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":685.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":685.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":541.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":381.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":592.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":508.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.35,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG/50 ML (5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0622-01","type":"NDC"}],"standard_charges":[{"minimum":215.03,"maximum":290.28,"gross_charge":358.37,"discounted_cash":106.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":290.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":290.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":232.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.03,"methodology":"fee schedule"}]}]},{"description":"BIVALIRUDIN 250 MG/50 ML (5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0622-01","type":"NDC"}],"standard_charges":[{"minimum":0.46,"maximum":290.28,"gross_charge":358.37,"discounted_cash":106.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":290.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":290.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":290.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":229.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.46,"standard_charge_algorithm": "Lesser of $0.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":161.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.68,"methodology":"fee schedule"}]}]},{"description":"ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J0585","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2899.46,"maximum":3914.27,"gross_charge":4832.42,"discounted_cash":1430.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3914.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3914.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3914.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3141.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3382.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2899.46,"methodology":"fee schedule"}]}]},{"description":"ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J0585","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.79,"maximum":3914.27,"gross_charge":4832.42,"discounted_cash":1430.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3914.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3914.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3914.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3092.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.47,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.78,"standard_charge_algorithm": "Lesser of $6.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.78,"standard_charge_algorithm": "Lesser of $6.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2174.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3382.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2899.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":918.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":724.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":966.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.79,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.14,"methodology":"case rate"}]}]},{"description":"INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION","code_information":[{"code":"J0588","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1250.29,"maximum":1687.89,"gross_charge":2083.81,"discounted_cash":616.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1687.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1687.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1687.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1354.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1458.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.29,"methodology":"fee schedule"}]}]},{"description":"INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION","code_information":[{"code":"J0588","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.77,"maximum":1687.89,"gross_charge":2083.81,"discounted_cash":616.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1687.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1687.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1687.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1333.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.72,"standard_charge_algorithm": "Lesser of $5.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.72,"standard_charge_algorithm": "Lesser of $5.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":937.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1458.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1250.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":395.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":312.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":416.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.06,"methodology":"case rate"}]}]},{"description":"INCOBOTULINUMTOXINA 200 UNIT INTRAMUSCULAR SOLUTION","code_information":[{"code":"J0588","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2467.79,"maximum":3331.51,"gross_charge":4112.97,"discounted_cash":1217.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3331.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3331.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3331.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2673.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2879.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2467.79,"methodology":"fee schedule"}]}]},{"description":"INCOBOTULINUMTOXINA 200 UNIT INTRAMUSCULAR SOLUTION","code_information":[{"code":"J0588","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.77,"maximum":3331.51,"gross_charge":4112.97,"discounted_cash":1217.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3331.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3331.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3331.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2632.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":5.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":8.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.72,"standard_charge_algorithm": "Lesser of $5.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.72,"standard_charge_algorithm": "Lesser of $5.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1850.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2879.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2467.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":781.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":616.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":822.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.01,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":5.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.06,"methodology":"case rate"}]}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0592","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"12496-0757-01","type":"NDC"}],"standard_charges":[{"minimum":67.85,"maximum":91.59,"gross_charge":113.07,"discounted_cash":33.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.85,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0592","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"12496-0757-01","type":"NDC"}],"standard_charges":[{"minimum":4.55,"maximum":91.59,"gross_charge":113.07,"discounted_cash":33.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0592","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0179-01","type":"NDC"}],"standard_charges":[{"minimum":63.21,"maximum":85.33,"gross_charge":105.34,"discounted_cash":31.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0592","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0179-01","type":"NDC"}],"standard_charges":[{"minimum":4.55,"maximum":85.33,"gross_charge":105.34,"discounted_cash":31.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.07,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0592","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.74,"maximum":80.65,"gross_charge":99.56,"discounted_cash":29.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.74,"methodology":"fee schedule"}]}]},{"description":"BUPRENORPHINE HCL 0.3 MG/ML INJECTION SYRINGE","code_information":[{"code":"J0592","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.55,"maximum":80.65,"gross_charge":99.56,"discounted_cash":29.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.55,"standard_charge_algorithm": "Lesser of $4.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.92,"methodology":"fee schedule"}]}]},{"description":"C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0825-02","type":"NDC"}],"standard_charges":[{"minimum":8321.01,"maximum":11233.36,"gross_charge":13868.34,"discounted_cash":4105.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11233.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11233.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11233.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9014.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9707.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8321.01,"methodology":"fee schedule"}]}]},{"description":"C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0825-02","type":"NDC"}],"standard_charges":[{"minimum":64.36,"maximum":11233.36,"gross_charge":13868.34,"discounted_cash":4105.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11233.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11233.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11233.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8875.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":72.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":64.36,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":110.48,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":68.68,"standard_charge_algorithm": "Lesser of $68.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.68,"standard_charge_algorithm": "Lesser of $68.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6240.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9707.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8321.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2634.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2773.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2080.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2773.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":64.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":69.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":66.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":67.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":71.07,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":68.49,"methodology":"case rate"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0162-10","type":"NDC"}],"standard_charges":[{"minimum":67.02,"maximum":90.47,"gross_charge":111.69,"discounted_cash":33.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.02,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0162-10","type":"NDC"}],"standard_charges":[{"minimum":16.76,"maximum":90.47,"gross_charge":111.69,"discounted_cash":33.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.34,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0311-50","type":"NDC"}],"standard_charges":[{"minimum":38.34,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0311-50","type":"NDC"}],"standard_charges":[{"minimum":9.59,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-01","type":"NDC"}],"standard_charges":[{"minimum":53.33,"maximum":71.99,"gross_charge":88.87,"discounted_cash":26.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.33,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-01","type":"NDC"}],"standard_charges":[{"minimum":13.34,"maximum":71.99,"gross_charge":88.87,"discounted_cash":26.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.78,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-05","type":"NDC"}],"standard_charges":[{"minimum":121.7,"maximum":164.3,"gross_charge":202.83,"discounted_cash":60.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.7,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-05","type":"NDC"}],"standard_charges":[{"minimum":30.43,"maximum":164.3,"gross_charge":202.83,"discounted_cash":60.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":101.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":101.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":91.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-59","type":"NDC"}],"standard_charges":[{"minimum":77.25,"maximum":104.28,"gross_charge":128.74,"discounted_cash":38.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0360-59","type":"NDC"}],"standard_charges":[{"minimum":19.32,"maximum":104.28,"gross_charge":128.74,"discounted_cash":38.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0630-01","type":"NDC"}],"standard_charges":[{"minimum":51.28,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0630-01","type":"NDC"}],"standard_charges":[{"minimum":12.82,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0727-01","type":"NDC"}],"standard_charges":[{"minimum":33.39,"maximum":45.08,"gross_charge":55.65,"discounted_cash":16.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0727-01","type":"NDC"}],"standard_charges":[{"minimum":8.35,"maximum":45.08,"gross_charge":55.65,"discounted_cash":16.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0728-01","type":"NDC"}],"standard_charges":[{"minimum":33.43,"maximum":45.13,"gross_charge":55.71,"discounted_cash":16.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.43,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0728-01","type":"NDC"}],"standard_charges":[{"minimum":8.36,"maximum":45.13,"gross_charge":55.71,"discounted_cash":16.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0728-20","type":"NDC"}],"standard_charges":[{"minimum":33.42,"maximum":45.12,"gross_charge":55.7,"discounted_cash":16.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.42,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0728-20","type":"NDC"}],"standard_charges":[{"minimum":8.36,"maximum":45.12,"gross_charge":55.7,"discounted_cash":16.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"75834-0171-01","type":"NDC"}],"standard_charges":[{"minimum":53.37,"maximum":72.05,"gross_charge":88.95,"discounted_cash":26.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"75834-0171-01","type":"NDC"}],"standard_charges":[{"minimum":13.35,"maximum":72.05,"gross_charge":88.95,"discounted_cash":26.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-1673-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-1673-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.41,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION","code_information":[{"code":"J0612","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.61,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0620-01","type":"NDC"}],"standard_charges":[{"minimum":52.62,"maximum":71.03,"gross_charge":87.69,"discounted_cash":25.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0620-01","type":"NDC"}],"standard_charges":[{"minimum":13.16,"maximum":71.03,"gross_charge":87.69,"discounted_cash":25.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-2362-01","type":"NDC"}],"standard_charges":[{"minimum":51.86,"maximum":70.01,"gross_charge":86.43,"discounted_cash":25.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.86,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-2362-01","type":"NDC"}],"standard_charges":[{"minimum":12.97,"maximum":70.01,"gross_charge":86.43,"discounted_cash":25.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-2362-09","type":"NDC"}],"standard_charges":[{"minimum":78.38,"maximum":105.82,"gross_charge":130.63,"discounted_cash":38.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.38,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE ISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-2362-09","type":"NDC"}],"standard_charges":[{"minimum":19.6,"maximum":105.82,"gross_charge":130.63,"discounted_cash":38.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.13,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDEISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0621-02","type":"NDC"}],"standard_charges":[{"minimum":74.46,"maximum":100.53,"gross_charge":124.1,"discounted_cash":36.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDEISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0621-02","type":"NDC"}],"standard_charges":[{"minimum":18.62,"maximum":100.53,"gross_charge":124.1,"discounted_cash":36.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":62.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.05,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDEISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0621-84","type":"NDC"}],"standard_charges":[{"minimum":74.49,"maximum":100.57,"gross_charge":124.15,"discounted_cash":36.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.49,"methodology":"fee schedule"}]}]},{"description":"CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDEISO-OSM IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0613","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0621-84","type":"NDC"}],"standard_charges":[{"minimum":18.63,"maximum":100.57,"gross_charge":124.15,"discounted_cash":36.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":62.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":62.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24201-0400-02","type":"NDC"}],"standard_charges":[{"minimum":2263.14,"maximum":3055.24,"gross_charge":3771.89,"discounted_cash":1116.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3055.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3055.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3055.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2451.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2640.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2263.14,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24201-0400-02","type":"NDC"}],"standard_charges":[{"minimum":565.79,"maximum":3055.24,"gross_charge":3771.89,"discounted_cash":1116.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3055.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3055.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3055.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2414.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1142.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1142.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1069.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1092.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1089.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1374.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2008.38,"standard_charge_algorithm": "Lesser of $2008.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2008.38,"standard_charge_algorithm": "Lesser of $2008.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1697.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2640.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2263.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":716.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":565.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":754.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":803.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":860.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":828.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":844.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":884.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":852.17,"methodology":"case rate"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0205-01","type":"NDC"}],"standard_charges":[{"minimum":2020.44,"maximum":2727.6,"gross_charge":3367.4,"discounted_cash":996.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2727.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2727.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2727.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2188.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2357.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2020.44,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0205-01","type":"NDC"}],"standard_charges":[{"minimum":505.11,"maximum":2727.6,"gross_charge":3367.4,"discounted_cash":996.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2727.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2727.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2727.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2155.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1142.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1142.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1069.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1092.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1089.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1374.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2008.38,"standard_charge_algorithm": "Lesser of $2008.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2008.38,"standard_charge_algorithm": "Lesser of $2008.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1515.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2357.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2020.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":639.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":673.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":803.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":860.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":828.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":844.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":884.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":852.17,"methodology":"case rate"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72078-0039-02","type":"NDC"}],"standard_charges":[{"minimum":2601.33,"maximum":3511.8,"gross_charge":4335.55,"discounted_cash":1283.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3511.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3511.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3511.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2818.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3034.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2601.33,"methodology":"fee schedule"}]}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72078-0039-02","type":"NDC"}],"standard_charges":[{"minimum":650.34,"maximum":3511.8,"gross_charge":4335.55,"discounted_cash":1283.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3511.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3511.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3511.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2774.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1142.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1142.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1069.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1092.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1089.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1374.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2008.38,"standard_charge_algorithm": "Lesser of $2008.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2008.38,"standard_charge_algorithm": "Lesser of $2008.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1951,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3034.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2601.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":823.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":650.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":867.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":803.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":860.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":828.05,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":844.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":884.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":852.17,"methodology":"case rate"}]}]},{"description":"CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0636","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0931-01","type":"NDC"}],"standard_charges":[{"minimum":45.1,"maximum":60.88,"gross_charge":75.16,"discounted_cash":22.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"}]}]},{"description":"CALCITRIOL 1 MCG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0636","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0931-01","type":"NDC"}],"standard_charges":[{"minimum":0.78,"maximum":60.88,"gross_charge":75.16,"discounted_cash":22.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.78,"standard_charge_algorithm": "Lesser of $0.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.78,"standard_charge_algorithm": "Lesser of $0.78 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-1004-69","type":"NDC"}],"standard_charges":[{"minimum":48.25,"maximum":65.14,"gross_charge":80.41,"discounted_cash":23.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.25,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-1004-69","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":65.14,"gross_charge":80.41,"discounted_cash":23.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-2004-69","type":"NDC"}],"standard_charges":[{"minimum":71.43,"maximum":96.44,"gross_charge":119.05,"discounted_cash":35.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.43,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-2004-69","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":96.44,"gross_charge":119.05,"discounted_cash":35.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.81,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0814-30","type":"NDC"}],"standard_charges":[{"minimum":46.65,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0814-30","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0528-10","type":"NDC"}],"standard_charges":[{"minimum":45.32,"maximum":61.18,"gross_charge":75.52,"discounted_cash":22.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0528-10","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":61.18,"gross_charge":75.52,"discounted_cash":22.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0815-30","type":"NDC"}],"standard_charges":[{"minimum":55.44,"maximum":74.85,"gross_charge":92.4,"discounted_cash":27.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0815-30","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":74.85,"gross_charge":92.4,"discounted_cash":27.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.48,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0710-50","type":"NDC"}],"standard_charges":[{"minimum":70.22,"maximum":94.8,"gross_charge":117.03,"discounted_cash":34.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.22,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0710-50","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":94.8,"gross_charge":117.03,"discounted_cash":34.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.41,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0816-30","type":"NDC"}],"standard_charges":[{"minimum":60.65,"maximum":81.88,"gross_charge":101.08,"discounted_cash":29.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.65,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0816-30","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":81.88,"gross_charge":101.08,"discounted_cash":29.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":80.66,"maximum":108.89,"gross_charge":134.42,"discounted_cash":39.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.66,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.54,"maximum":108.89,"gross_charge":134.42,"discounted_cash":39.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":108.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.89,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":92.75,"maximum":125.21,"gross_charge":154.58,"discounted_cash":45.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":100.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":108.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.54,"maximum":125.21,"gross_charge":154.58,"discounted_cash":45.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":98.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":69.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":108.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.92,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0813-10","type":"NDC"}],"standard_charges":[{"minimum":41.11,"maximum":55.5,"gross_charge":68.51,"discounted_cash":20.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0813-10","type":"NDC"}],"standard_charges":[{"minimum":4.54,"maximum":55.5,"gross_charge":68.51,"discounted_cash":20.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.77,"maximum":75.29,"gross_charge":92.95,"discounted_cash":27.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"}]}]},{"description":"LEUCOVORIN CALCIUM 50 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0640","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.54,"maximum":75.29,"gross_charge":92.95,"discounted_cash":27.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.54,"standard_charge_algorithm": "Lesser of $4.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0649-94","type":"NDC"}],"standard_charges":[{"minimum":189.87,"maximum":256.33,"gross_charge":316.45,"discounted_cash":93.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":205.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":221.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.87,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0649-94","type":"NDC"}],"standard_charges":[{"minimum":47.47,"maximum":256.33,"gross_charge":316.45,"discounted_cash":93.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":202.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":158.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":158.23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":142.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":221.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.29,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML (FINAL CONCENTRATION) INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0201-01","type":"NDC"}],"standard_charges":[{"minimum":276.82,"maximum":373.71,"gross_charge":461.36,"discounted_cash":136.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":299.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.82,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML (FINAL CONCENTRATION) INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0201-01","type":"NDC"}],"standard_charges":[{"minimum":69.21,"maximum":373.71,"gross_charge":461.36,"discounted_cash":136.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":373.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":295.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":230.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":230.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":207.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.28,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML (FINAL CONCENTRATION) INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0649-07","type":"NDC"}],"standard_charges":[{"minimum":189.87,"maximum":256.33,"gross_charge":316.45,"discounted_cash":93.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":205.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":221.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.87,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML (FINAL CONCENTRATION) INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0649-07","type":"NDC"}],"standard_charges":[{"minimum":47.47,"maximum":256.33,"gross_charge":316.45,"discounted_cash":93.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":202.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":158.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":158.23,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":142.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":221.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.29,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML (FINAL CONCENTRATION) INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0649-16","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML (FINAL CONCENTRATION) INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0649-16","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0885-10","type":"NDC"}],"standard_charges":[{"minimum":197.7,"maximum":266.9,"gross_charge":329.5,"discounted_cash":97.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":266.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":266.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":214.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":230.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0885-10","type":"NDC"}],"standard_charges":[{"minimum":49.43,"maximum":266.9,"gross_charge":329.5,"discounted_cash":97.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":266.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":266.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":210.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":164.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":164.75,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":148.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":230.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.9,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0885-12","type":"NDC"}],"standard_charges":[{"minimum":201.02,"maximum":271.37,"gross_charge":335.02,"discounted_cash":99.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":271.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":271.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":217.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":234.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.02,"methodology":"fee schedule"}]}]},{"description":"LEVOTHYROXINE 20 MCG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0651","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0885-12","type":"NDC"}],"standard_charges":[{"minimum":50.26,"maximum":271.37,"gross_charge":335.02,"discounted_cash":99.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":271.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":271.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":271.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":214.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":167.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":167.51,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":150.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":234.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.01,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0167-10","type":"NDC"}],"standard_charges":[{"minimum":38.07,"maximum":51.39,"gross_charge":63.44,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0167-10","type":"NDC"}],"standard_charges":[{"minimum":9.52,"maximum":51.39,"gross_charge":63.44,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0464-17","type":"NDC"}],"standard_charges":[{"minimum":35.92,"maximum":48.49,"gross_charge":59.86,"discounted_cash":17.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0464-17","type":"NDC"}],"standard_charges":[{"minimum":8.98,"maximum":48.49,"gross_charge":59.86,"discounted_cash":17.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0464-38","type":"NDC"}],"standard_charges":[{"minimum":33.1,"maximum":44.68,"gross_charge":55.16,"discounted_cash":16.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.1,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0464-38","type":"NDC"}],"standard_charges":[{"minimum":8.28,"maximum":44.68,"gross_charge":55.16,"discounted_cash":16.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0114-02","type":"NDC"}],"standard_charges":[{"minimum":33.08,"maximum":44.65,"gross_charge":55.12,"discounted_cash":16.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.08,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0114-02","type":"NDC"}],"standard_charges":[{"minimum":8.27,"maximum":44.65,"gross_charge":55.12,"discounted_cash":16.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.68,"maximum":49.51,"gross_charge":61.12,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.17,"maximum":49.51,"gross_charge":61.12,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.06,"maximum":50.03,"gross_charge":61.76,"discounted_cash":18.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.27,"maximum":50.03,"gross_charge":61.76,"discounted_cash":18.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.11,"maximum":50.1,"gross_charge":61.84,"discounted_cash":18.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.28,"maximum":50.1,"gross_charge":61.84,"discounted_cash":18.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.32,"maximum":51.73,"gross_charge":63.86,"discounted_cash":18.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.58,"maximum":51.73,"gross_charge":63.86,"discounted_cash":18.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41,"maximum":55.34,"gross_charge":68.32,"discounted_cash":20.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.25,"maximum":55.34,"gross_charge":68.32,"discounted_cash":20.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.49,"maximum":57.36,"gross_charge":70.81,"discounted_cash":20.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.63,"maximum":57.36,"gross_charge":70.81,"discounted_cash":20.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0169-10","type":"NDC"}],"standard_charges":[{"minimum":38.88,"maximum":52.48,"gross_charge":64.79,"discounted_cash":19.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0169-10","type":"NDC"}],"standard_charges":[{"minimum":9.72,"maximum":52.48,"gross_charge":64.79,"discounted_cash":19.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0170-30","type":"NDC"}],"standard_charges":[{"minimum":38.78,"maximum":52.35,"gross_charge":64.62,"discounted_cash":19.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.78,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0170-30","type":"NDC"}],"standard_charges":[{"minimum":9.7,"maximum":52.35,"gross_charge":64.62,"discounted_cash":19.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0466-08","type":"NDC"}],"standard_charges":[{"minimum":33.2,"maximum":44.81,"gross_charge":55.32,"discounted_cash":16.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0466-08","type":"NDC"}],"standard_charges":[{"minimum":8.3,"maximum":44.81,"gross_charge":55.32,"discounted_cash":16.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0466-38","type":"NDC"}],"standard_charges":[{"minimum":36.86,"maximum":49.76,"gross_charge":61.42,"discounted_cash":18.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0466-38","type":"NDC"}],"standard_charges":[{"minimum":9.22,"maximum":49.76,"gross_charge":61.42,"discounted_cash":18.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0466-39","type":"NDC"}],"standard_charges":[{"minimum":37.41,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0466-39","type":"NDC"}],"standard_charges":[{"minimum":9.36,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0117-01","type":"NDC"}],"standard_charges":[{"minimum":36.05,"maximum":48.66,"gross_charge":60.07,"discounted_cash":17.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0117-01","type":"NDC"}],"standard_charges":[{"minimum":9.02,"maximum":48.66,"gross_charge":60.07,"discounted_cash":17.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0506-10","type":"NDC"}],"standard_charges":[{"minimum":40.82,"maximum":55.11,"gross_charge":68.03,"discounted_cash":20.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.82,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0506-10","type":"NDC"}],"standard_charges":[{"minimum":10.21,"maximum":55.11,"gross_charge":68.03,"discounted_cash":20.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.56,"maximum":50.71,"gross_charge":62.6,"discounted_cash":18.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.56,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.39,"maximum":50.71,"gross_charge":62.6,"discounted_cash":18.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.69,"maximum":50.88,"gross_charge":62.81,"discounted_cash":18.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.43,"maximum":50.88,"gross_charge":62.81,"discounted_cash":18.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0092-01","type":"NDC"}],"standard_charges":[{"minimum":36.81,"maximum":49.69,"gross_charge":61.34,"discounted_cash":18.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0092-01","type":"NDC"}],"standard_charges":[{"minimum":9.21,"maximum":49.69,"gross_charge":61.34,"discounted_cash":18.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.98,"maximum":52.62,"gross_charge":64.96,"discounted_cash":19.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.75,"maximum":52.62,"gross_charge":64.96,"discounted_cash":19.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.4,"maximum":57.24,"gross_charge":70.66,"discounted_cash":20.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.6,"maximum":57.24,"gross_charge":70.66,"discounted_cash":20.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0472-01","type":"NDC"}],"standard_charges":[{"minimum":39,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0472-01","type":"NDC"}],"standard_charges":[{"minimum":9.75,"maximum":52.65,"gross_charge":65,"discounted_cash":19.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0800-25","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0800-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.71,"maximum":50.91,"gross_charge":62.85,"discounted_cash":18.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.71,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.43,"maximum":50.91,"gross_charge":62.85,"discounted_cash":18.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.05,"maximum":55.42,"gross_charge":68.41,"discounted_cash":20.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.05,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.27,"maximum":55.42,"gross_charge":68.41,"discounted_cash":20.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.34,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"}]}]},{"description":"BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0665","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.59,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0260-37","type":"NDC"}],"standard_charges":[{"minimum":46.96,"maximum":63.4,"gross_charge":78.26,"discounted_cash":23.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.96,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0260-37","type":"NDC"}],"standard_charges":[{"minimum":3.55,"maximum":63.4,"gross_charge":78.26,"discounted_cash":23.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.7,"maximum":59,"gross_charge":72.83,"discounted_cash":21.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.55,"maximum":59,"gross_charge":72.83,"discounted_cash":21.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0294-01","type":"NDC"}],"standard_charges":[{"minimum":48.5,"maximum":65.48,"gross_charge":80.83,"discounted_cash":23.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.5,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0294-01","type":"NDC"}],"standard_charges":[{"minimum":3.55,"maximum":65.48,"gross_charge":80.83,"discounted_cash":23.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.55,"maximum":58.79,"gross_charge":72.58,"discounted_cash":21.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.55,"methodology":"fee schedule"}]}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J0670","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.55,"maximum":58.79,"gross_charge":72.58,"discounted_cash":21.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0687","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0707-25","type":"NDC"}],"standard_charges":[{"minimum":36.58,"maximum":49.38,"gross_charge":60.96,"discounted_cash":18.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0687","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0707-25","type":"NDC"}],"standard_charges":[{"minimum":9.15,"maximum":49.38,"gross_charge":60.96,"discounted_cash":18.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0688","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0845-01","type":"NDC"}],"standard_charges":[{"minimum":44.38,"maximum":59.91,"gross_charge":73.96,"discounted_cash":21.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0688","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0845-01","type":"NDC"}],"standard_charges":[{"minimum":11.1,"maximum":59.91,"gross_charge":73.96,"discounted_cash":21.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0688","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0845-25","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 3 GRAM INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0688","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0845-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0101-10","type":"NDC"}],"standard_charges":[{"minimum":36.02,"maximum":48.63,"gross_charge":60.03,"discounted_cash":17.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0101-10","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":48.63,"gross_charge":60.03,"discounted_cash":17.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6142-05","type":"NDC"}],"standard_charges":[{"minimum":34.38,"maximum":46.42,"gross_charge":57.3,"discounted_cash":16.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6142-05","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":46.42,"gross_charge":57.3,"discounted_cash":16.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0055-01","type":"NDC"}],"standard_charges":[{"minimum":35.75,"maximum":48.26,"gross_charge":59.57,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.75,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0055-01","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":48.26,"gross_charge":59.57,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.2,"maximum":46.17,"gross_charge":57,"discounted_cash":16.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":46.17,"gross_charge":57,"discounted_cash":16.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.97,"maximum":47.21,"gross_charge":58.28,"discounted_cash":17.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.97,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":47.21,"gross_charge":58.28,"discounted_cash":17.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.63,"maximum":48.1,"gross_charge":59.38,"discounted_cash":17.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.63,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":48.1,"gross_charge":59.38,"discounted_cash":17.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 100 MG/ML INJECTION (PEDIATRIC)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77888-8001-56","type":"NDC"}],"standard_charges":[{"minimum":32.96,"maximum":44.5,"gross_charge":54.93,"discounted_cash":16.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.96,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 100 MG/ML INJECTION (PEDIATRIC)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77888-8001-56","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":44.5,"gross_charge":54.93,"discounted_cash":16.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.99,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 3 G SODIUM CHLORIDE 0.9% (NS) 100 ML IVPB CMPD (PMX)","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.39,"maximum":62.63,"gross_charge":77.31,"discounted_cash":22.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.39,"methodology":"fee schedule"}]}]},{"description":"CEFAZOLIN 3 G SODIUM CHLORIDE 0.9% (NS) 100 ML IVPB CMPD (PMX)","code_information":[{"code":"J0690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":62.63,"gross_charge":77.31,"discounted_cash":22.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.47,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0121-20","type":"NDC"}],"standard_charges":[{"minimum":42.89,"maximum":57.9,"gross_charge":71.47,"discounted_cash":21.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0121-20","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":57.9,"gross_charge":71.47,"discounted_cash":21.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0121-66","type":"NDC"}],"standard_charges":[{"minimum":40.05,"maximum":54.07,"gross_charge":66.75,"discounted_cash":19.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0121-66","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":54.07,"gross_charge":66.75,"discounted_cash":19.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0240-10","type":"NDC"}],"standard_charges":[{"minimum":39.49,"maximum":53.31,"gross_charge":65.81,"discounted_cash":19.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0240-10","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":53.31,"gross_charge":65.81,"discounted_cash":19.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6146-00","type":"NDC"}],"standard_charges":[{"minimum":38.63,"maximum":52.14,"gross_charge":64.37,"discounted_cash":19.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.63,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6146-00","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":52.14,"gross_charge":64.37,"discounted_cash":19.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.88,"maximum":55.19,"gross_charge":68.13,"discounted_cash":20.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.97,"maximum":55.19,"gross_charge":68.13,"discounted_cash":20.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0241-10","type":"NDC"}],"standard_charges":[{"minimum":51.23,"maximum":69.16,"gross_charge":85.38,"discounted_cash":25.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0241-10","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":69.16,"gross_charge":85.38,"discounted_cash":25.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6031-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6031-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6145-04","type":"NDC"}],"standard_charges":[{"minimum":43.72,"maximum":59.02,"gross_charge":72.86,"discounted_cash":21.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.72,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6145-04","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":59.02,"gross_charge":72.86,"discounted_cash":21.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6147-00","type":"NDC"}],"standard_charges":[{"minimum":52.11,"maximum":70.35,"gross_charge":86.85,"discounted_cash":25.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.11,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6147-00","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":70.35,"gross_charge":86.85,"discounted_cash":25.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.37,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6246-00","type":"NDC"}],"standard_charges":[{"minimum":43.73,"maximum":59.04,"gross_charge":72.88,"discounted_cash":21.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6246-00","type":"NDC"}],"standard_charges":[{"minimum":1.97,"maximum":59.04,"gross_charge":72.88,"discounted_cash":21.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.12,"maximum":63.61,"gross_charge":78.52,"discounted_cash":23.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.12,"methodology":"fee schedule"}]}]},{"description":"CEFEPIME 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0692","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.97,"maximum":63.61,"gross_charge":78.52,"discounted_cash":23.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.97,"standard_charge_algorithm": "Lesser of $1.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0109-10","type":"NDC"}],"standard_charges":[{"minimum":41.92,"maximum":56.59,"gross_charge":69.86,"discounted_cash":20.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.92,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0109-10","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":56.59,"gross_charge":69.86,"discounted_cash":20.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0245-25","type":"NDC"}],"standard_charges":[{"minimum":39.72,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0245-25","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0341-29","type":"NDC"}],"standard_charges":[{"minimum":39.26,"maximum":53,"gross_charge":65.43,"discounted_cash":19.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0341-29","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":53,"gross_charge":65.43,"discounted_cash":19.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0110-20","type":"NDC"}],"standard_charges":[{"minimum":50.1,"maximum":67.63,"gross_charge":83.49,"discounted_cash":24.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0110-20","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":67.63,"gross_charge":83.49,"discounted_cash":24.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.7,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0246-25","type":"NDC"}],"standard_charges":[{"minimum":72.6,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0246-25","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":98.01,"gross_charge":121,"discounted_cash":35.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0342-25","type":"NDC"}],"standard_charges":[{"minimum":42.23,"maximum":57.01,"gross_charge":70.38,"discounted_cash":20.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0342-25","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":57.01,"gross_charge":70.38,"discounted_cash":20.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.08,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0342-29","type":"NDC"}],"standard_charges":[{"minimum":46.22,"maximum":62.39,"gross_charge":77.02,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.22,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0342-29","type":"NDC"}],"standard_charges":[{"minimum":6,"maximum":62.39,"gross_charge":77.02,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.73,"maximum":61.74,"gross_charge":76.21,"discounted_cash":22.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.73,"methodology":"fee schedule"}]}]},{"description":"CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0694","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6,"maximum":61.74,"gross_charge":76.21,"discounted_cash":22.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6,"standard_charge_algorithm": "Lesser of $6.00 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.25,"methodology":"fee schedule"}]}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0695","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67919-0030-01","type":"NDC"}],"standard_charges":[{"minimum":399.45,"maximum":539.26,"gross_charge":665.75,"discounted_cash":197.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":539.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":539.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":539.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":432.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":466.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":399.45,"methodology":"fee schedule"}]}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0695","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67919-0030-01","type":"NDC"}],"standard_charges":[{"minimum":7.18,"maximum":539.26,"gross_charge":665.75,"discounted_cash":197.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":539.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":539.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":539.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":426.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8.15,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":12.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.18,"standard_charge_algorithm": "Lesser of $7.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.18,"standard_charge_algorithm": "Lesser of $7.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":299.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":466.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":399.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":7.19,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":7.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.62,"methodology":"case rate"}]}]},{"description":"CEFTRIAXONE 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.09,"maximum":52.77,"gross_charge":65.14,"discounted_cash":19.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.09,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":52.77,"gross_charge":65.14,"discounted_cash":19.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0106-67","type":"NDC"}],"standard_charges":[{"minimum":35.67,"maximum":48.15,"gross_charge":59.44,"discounted_cash":17.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.67,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0106-67","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":48.15,"gross_charge":59.44,"discounted_cash":17.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0701-95","type":"NDC"}],"standard_charges":[{"minimum":35.1,"maximum":47.38,"gross_charge":58.49,"discounted_cash":17.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0701-95","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":47.38,"gross_charge":58.49,"discounted_cash":17.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6148-00","type":"NDC"}],"standard_charges":[{"minimum":35.57,"maximum":48.02,"gross_charge":59.28,"discounted_cash":17.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6148-00","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":48.02,"gross_charge":59.28,"discounted_cash":17.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6148-04","type":"NDC"}],"standard_charges":[{"minimum":36.98,"maximum":49.93,"gross_charge":61.63,"discounted_cash":18.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6148-04","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":49.93,"gross_charge":61.63,"discounted_cash":18.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0061-01","type":"NDC"}],"standard_charges":[{"minimum":36.5,"maximum":49.28,"gross_charge":60.83,"discounted_cash":18.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.5,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0061-01","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":49.28,"gross_charge":60.83,"discounted_cash":18.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.33,"maximum":47.7,"gross_charge":58.88,"discounted_cash":17.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":47.7,"gross_charge":58.88,"discounted_cash":17.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.17,"maximum":48.82,"gross_charge":60.27,"discounted_cash":17.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.17,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":48.82,"gross_charge":60.27,"discounted_cash":17.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6151-01","type":"NDC"}],"standard_charges":[{"minimum":34.9,"maximum":47.11,"gross_charge":58.16,"discounted_cash":17.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.9,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6151-01","type":"NDC"}],"standard_charges":[{"minimum":0.58,"maximum":47.11,"gross_charge":58.16,"discounted_cash":17.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.64,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.47,"maximum":46.54,"gross_charge":57.45,"discounted_cash":17.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"}]}]},{"description":"CEFTRIAXONE 250 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0696","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.58,"maximum":46.54,"gross_charge":57.45,"discounted_cash":17.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.58,"standard_charge_algorithm": "Lesser of $0.58 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24987-0437-00","type":"NDC"}],"standard_charges":[{"minimum":62.76,"maximum":84.73,"gross_charge":104.6,"discounted_cash":30.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.76,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24987-0437-00","type":"NDC"}],"standard_charges":[{"minimum":2.46,"maximum":84.73,"gross_charge":104.6,"discounted_cash":30.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.92,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.73,"maximum":59.03,"gross_charge":72.87,"discounted_cash":21.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 1.5 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.46,"maximum":59.03,"gross_charge":72.87,"discounted_cash":21.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0118-10","type":"NDC"}],"standard_charges":[{"minimum":37.53,"maximum":50.66,"gross_charge":62.54,"discounted_cash":18.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.53,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0118-10","type":"NDC"}],"standard_charges":[{"minimum":2.46,"maximum":50.66,"gross_charge":62.54,"discounted_cash":18.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.87,"maximum":52.47,"gross_charge":64.77,"discounted_cash":19.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"}]}]},{"description":"CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0697","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.46,"maximum":52.47,"gross_charge":64.77,"discounted_cash":19.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.46,"standard_charge_algorithm": "Lesser of $2.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J0702","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":113.69,"maximum":153.48,"gross_charge":189.48,"discounted_cash":56.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"}]}]},{"description":"BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J0702","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.71,"maximum":153.48,"gross_charge":189.48,"discounted_cash":56.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":121.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.71,"standard_charge_algorithm": "Lesser of $7.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.71,"standard_charge_algorithm": "Lesser of $7.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0601-03","type":"NDC"}],"standard_charges":[{"minimum":44.91,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0601-03","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-0500-01","type":"NDC"}],"standard_charges":[{"minimum":60.53,"maximum":81.71,"gross_charge":100.87,"discounted_cash":29.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.53,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-0500-01","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":81.71,"gross_charge":100.87,"discounted_cash":29.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.18,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0187-03","type":"NDC"}],"standard_charges":[{"minimum":46.53,"maximum":62.81,"gross_charge":77.54,"discounted_cash":22.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0187-03","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":62.81,"gross_charge":77.54,"discounted_cash":22.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0407-04","type":"NDC"}],"standard_charges":[{"minimum":44.4,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0407-04","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":59.94,"gross_charge":74,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0406-03","type":"NDC"}],"standard_charges":[{"minimum":4.33,"maximum":5.85,"gross_charge":7.21,"discounted_cash":2.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"}]}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0406-03","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":5.85,"gross_charge":7.21,"discounted_cash":2.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.45,"methodology":"fee schedule"}]}]},{"description":"CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0712","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":486.16,"maximum":656.32,"gross_charge":810.26,"discounted_cash":239.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":656.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":656.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":526.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":567.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":486.16,"methodology":"fee schedule"}]}]},{"description":"CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0712","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.57,"maximum":656.32,"gross_charge":810.26,"discounted_cash":239.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":656.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":656.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":656.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":518.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.84,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.23,"standard_charge_algorithm": "Lesser of $4.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.23,"standard_charge_algorithm": "Lesser of $4.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":364.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":567.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":486.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":153.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.93,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.78,"methodology":"case rate"}]}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.72,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.19,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0128-67","type":"NDC"}],"standard_charges":[{"minimum":46.67,"maximum":63.01,"gross_charge":77.78,"discounted_cash":23.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.67,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0128-67","type":"NDC"}],"standard_charges":[{"minimum":2.19,"maximum":63.01,"gross_charge":77.78,"discounted_cash":23.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0236-10","type":"NDC"}],"standard_charges":[{"minimum":46.01,"maximum":62.12,"gross_charge":76.68,"discounted_cash":22.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.01,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0236-10","type":"NDC"}],"standard_charges":[{"minimum":2.19,"maximum":62.12,"gross_charge":76.68,"discounted_cash":22.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.34,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.47,"maximum":57.34,"gross_charge":70.78,"discounted_cash":20.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0713","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.19,"maximum":57.34,"gross_charge":70.78,"discounted_cash":20.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.16,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0714","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":946.62,"maximum":1277.94,"gross_charge":1577.7,"discounted_cash":467,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1277.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1277.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1277.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1025.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1104.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"}]}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0714","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":89.85,"maximum":1277.94,"gross_charge":1577.7,"discounted_cash":467,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1277.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1277.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1277.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1009.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":100.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":95.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":97.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":153.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":103.55,"standard_charge_algorithm": "Lesser of $103.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":103.55,"standard_charge_algorithm": "Lesser of $103.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":709.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1104.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":946.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":299.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":236.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":315.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":89.85,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":96.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":92.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":94.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":98.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":95.24,"methodology":"case rate"}]}]},{"description":"CLONIDINE (PF) 1000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0735","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-2000-01","type":"NDC"}],"standard_charges":[{"minimum":72.09,"maximum":97.33,"gross_charge":120.15,"discounted_cash":35.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE (PF) 1000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0735","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-2000-01","type":"NDC"}],"standard_charges":[{"minimum":18.03,"maximum":97.33,"gross_charge":120.15,"discounted_cash":35.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.3,"standard_charge_algorithm": "Lesser of $25.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.3,"standard_charge_algorithm": "Lesser of $25.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE (PF) 1000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION","code_information":[{"code":"J0735","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.15,"maximum":87.95,"gross_charge":108.57,"discounted_cash":32.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.15,"methodology":"fee schedule"}]}]},{"description":"CLONIDINE (PF) 1000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION","code_information":[{"code":"J0735","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16.29,"maximum":87.95,"gross_charge":108.57,"discounted_cash":32.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.3,"standard_charge_algorithm": "Lesser of $25.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.3,"standard_charge_algorithm": "Lesser of $25.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.72,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0115-06","type":"NDC"}],"standard_charges":[{"minimum":43.76,"maximum":59.08,"gross_charge":72.93,"discounted_cash":21.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.76,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0115-06","type":"NDC"}],"standard_charges":[{"minimum":10.94,"maximum":59.08,"gross_charge":72.93,"discounted_cash":21.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.47,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0460-68","type":"NDC"}],"standard_charges":[{"minimum":39.69,"maximum":53.58,"gross_charge":66.14,"discounted_cash":19.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0460-68","type":"NDC"}],"standard_charges":[{"minimum":9.93,"maximum":53.58,"gross_charge":66.14,"discounted_cash":19.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0815-00","type":"NDC"}],"standard_charges":[{"minimum":38.58,"maximum":52.08,"gross_charge":64.29,"discounted_cash":19.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.58,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0815-00","type":"NDC"}],"standard_charges":[{"minimum":9.65,"maximum":52.08,"gross_charge":64.29,"discounted_cash":19.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0816-00","type":"NDC"}],"standard_charges":[{"minimum":41.17,"maximum":55.58,"gross_charge":68.61,"discounted_cash":20.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0816-00","type":"NDC"}],"standard_charges":[{"minimum":10.3,"maximum":55.58,"gross_charge":68.61,"discounted_cash":20.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0639-01","type":"NDC"}],"standard_charges":[{"minimum":42.03,"maximum":56.75,"gross_charge":70.05,"discounted_cash":20.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0639-01","type":"NDC"}],"standard_charges":[{"minimum":10.51,"maximum":56.75,"gross_charge":70.05,"discounted_cash":20.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38,"maximum":51.29,"gross_charge":63.32,"discounted_cash":18.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.5,"maximum":51.29,"gross_charge":63.32,"discounted_cash":18.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.59,"maximum":53.44,"gross_charge":65.97,"discounted_cash":19.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.9,"maximum":53.44,"gross_charge":65.97,"discounted_cash":19.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.99,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.64,"maximum":57.56,"gross_charge":71.06,"discounted_cash":21.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 150 MG/ML INJECTION SOLUTION","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.66,"maximum":57.56,"gross_charge":71.06,"discounted_cash":21.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0074-01","type":"NDC"}],"standard_charges":[{"minimum":42.89,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0074-01","type":"NDC"}],"standard_charges":[{"minimum":10.73,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.05,"maximum":62.16,"gross_charge":76.74,"discounted_cash":22.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.52,"maximum":62.16,"gross_charge":76.74,"discounted_cash":22.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0076-01","type":"NDC"}],"standard_charges":[{"minimum":45.42,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0076-01","type":"NDC"}],"standard_charges":[{"minimum":11.36,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0076-24","type":"NDC"}],"standard_charges":[{"minimum":57.14,"maximum":77.13,"gross_charge":95.22,"discounted_cash":28.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0076-24","type":"NDC"}],"standard_charges":[{"minimum":14.29,"maximum":77.13,"gross_charge":95.22,"discounted_cash":28.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.05,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.54,"maximum":61.48,"gross_charge":75.9,"discounted_cash":22.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.54,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.39,"maximum":61.48,"gross_charge":75.9,"discounted_cash":22.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.21,"maximum":66.43,"gross_charge":82.01,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0736","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.31,"maximum":66.43,"gross_charge":82.01,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.02,"maximum":58.07,"gross_charge":71.69,"discounted_cash":21.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.76,"maximum":58.07,"gross_charge":71.69,"discounted_cash":21.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.17,"maximum":60.97,"gross_charge":75.27,"discounted_cash":22.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.17,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.3,"maximum":60.97,"gross_charge":75.27,"discounted_cash":22.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.06,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.07,"maximum":64.89,"gross_charge":80.11,"discounted_cash":23.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"}]}]},{"description":"CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0737","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.02,"maximum":64.89,"gross_charge":80.11,"discounted_cash":23.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"}]}]},{"description":"CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0740","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0216-31","type":"NDC"}],"standard_charges":[{"minimum":1122.12,"maximum":1514.87,"gross_charge":1870.2,"discounted_cash":553.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1215.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1309.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1122.12,"methodology":"fee schedule"}]}]},{"description":"CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0740","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0216-31","type":"NDC"}],"standard_charges":[{"minimum":280.53,"maximum":1514.87,"gross_charge":1870.2,"discounted_cash":553.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1514.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1196.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":301.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":301.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":554.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":555.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":564.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":797.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":697.85,"standard_charge_algorithm": "Lesser of $697.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":697.85,"standard_charge_algorithm": "Lesser of $697.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":841.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1309.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1122.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":466.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":499.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":480.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":489.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":513.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":494.52,"methodology":"case rate"}]}]},{"description":"IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0742","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":784.81,"maximum":1059.49,"gross_charge":1308.01,"discounted_cash":387.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1059.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1059.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":850.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":915.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":784.81,"methodology":"fee schedule"}]}]},{"description":"IMIPENEM-CILASTATIN-RELEBACTAM 1.25 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J0742","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.23,"maximum":1059.49,"gross_charge":1308.01,"discounted_cash":387.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1059.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1059.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1059.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":837.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.7,"standard_charge_algorithm": "Lesser of $2.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.7,"standard_charge_algorithm": "Lesser of $2.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":588.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":915.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":784.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":248.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":196.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.34,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.36,"methodology":"case rate"}]}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0322-25","type":"NDC"}],"standard_charges":[{"minimum":57.47,"maximum":77.59,"gross_charge":95.78,"discounted_cash":28.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"}]}]},{"description":"IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0322-25","type":"NDC"}],"standard_charges":[{"minimum":9.24,"maximum":77.59,"gross_charge":95.78,"discounted_cash":28.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.24,"standard_charge_algorithm": "Lesser of $9.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.24,"standard_charge_algorithm": "Lesser of $9.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.16,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0114-87","type":"NDC"}],"standard_charges":[{"minimum":39.86,"maximum":53.81,"gross_charge":66.43,"discounted_cash":19.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0114-87","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":53.81,"gross_charge":66.43,"discounted_cash":19.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0192-87","type":"NDC"}],"standard_charges":[{"minimum":39.36,"maximum":53.13,"gross_charge":65.59,"discounted_cash":19.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0192-87","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":53.13,"gross_charge":65.59,"discounted_cash":19.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0009-24","type":"NDC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0009-24","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.34,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.45,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.37,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"}]}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J0744","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.45,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"COLISTIMETHATE FOR INHALATION 75 MG/ML SOLN (RESPIRATORY)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0393-06","type":"NDC"}],"standard_charges":[{"minimum":56.25,"maximum":75.94,"gross_charge":93.75,"discounted_cash":27.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.25,"methodology":"fee schedule"}]}]},{"description":"COLISTIMETHATE FOR INHALATION 75 MG/ML SOLN (RESPIRATORY)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0393-06","type":"NDC"}],"standard_charges":[{"minimum":14.07,"maximum":75.94,"gross_charge":93.75,"discounted_cash":27.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.75,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0159-10","type":"NDC"}],"standard_charges":[{"minimum":89.14,"maximum":120.34,"gross_charge":148.56,"discounted_cash":43.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.14,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0159-10","type":"NDC"}],"standard_charges":[{"minimum":16.55,"maximum":120.34,"gross_charge":148.56,"discounted_cash":43.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.72,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0131-01","type":"NDC"}],"standard_charges":[{"minimum":98.79,"maximum":133.37,"gross_charge":164.65,"discounted_cash":48.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":107.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":115.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.79,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0131-01","type":"NDC"}],"standard_charges":[{"minimum":16.55,"maximum":133.37,"gross_charge":164.65,"discounted_cash":48.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":74.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":115.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.93,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0023-01","type":"NDC"}],"standard_charges":[{"minimum":97.5,"maximum":131.63,"gross_charge":162.5,"discounted_cash":48.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.5,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0023-01","type":"NDC"}],"standard_charges":[{"minimum":16.55,"maximum":131.63,"gross_charge":162.5,"discounted_cash":48.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":104,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.5,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0023-04","type":"NDC"}],"standard_charges":[{"minimum":59.37,"maximum":80.15,"gross_charge":98.94,"discounted_cash":29.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.37,"methodology":"fee schedule"}]}]},{"description":"COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0023-04","type":"NDC"}],"standard_charges":[{"minimum":14.85,"maximum":80.15,"gross_charge":98.94,"discounted_cash":29.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.55,"standard_charge_algorithm": "Lesser of $16.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0700-02","type":"NDC"}],"standard_charges":[{"minimum":40.07,"maximum":54.09,"gross_charge":66.77,"discounted_cash":19.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0700-02","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":54.09,"gross_charge":66.77,"discounted_cash":19.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.36,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0294-31","type":"NDC"}],"standard_charges":[{"minimum":38.67,"maximum":52.2,"gross_charge":64.44,"discounted_cash":19.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0294-31","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":52.2,"gross_charge":64.44,"discounted_cash":19.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0523-31","type":"NDC"}],"standard_charges":[{"minimum":42.66,"maximum":57.6,"gross_charge":71.1,"discounted_cash":21.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.66,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0523-31","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":57.6,"gross_charge":71.1,"discounted_cash":21.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0090-01","type":"NDC"}],"standard_charges":[{"minimum":38.85,"maximum":52.44,"gross_charge":64.74,"discounted_cash":19.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.85,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0090-01","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":52.44,"gross_charge":64.74,"discounted_cash":19.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0360-25","type":"NDC"}],"standard_charges":[{"minimum":37.29,"maximum":50.35,"gross_charge":62.15,"discounted_cash":18.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.29,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0360-25","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":50.35,"gross_charge":62.15,"discounted_cash":18.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0640-00","type":"NDC"}],"standard_charges":[{"minimum":75.55,"maximum":101.99,"gross_charge":125.91,"discounted_cash":37.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":88.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.55,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0640-00","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":101.99,"gross_charge":125.91,"discounted_cash":37.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":88.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0778-41","type":"NDC"}],"standard_charges":[{"minimum":39.45,"maximum":53.25,"gross_charge":65.74,"discounted_cash":19.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0778-41","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":53.25,"gross_charge":65.74,"discounted_cash":19.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0204-10","type":"NDC"}],"standard_charges":[{"minimum":39.72,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0204-10","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0580-01","type":"NDC"}],"standard_charges":[{"minimum":48.02,"maximum":64.83,"gross_charge":80.03,"discounted_cash":23.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.02,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0580-01","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":64.83,"gross_charge":80.03,"discounted_cash":23.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0580-25","type":"NDC"}],"standard_charges":[{"minimum":48.05,"maximum":64.86,"gross_charge":80.07,"discounted_cash":23.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0580-25","type":"NDC"}],"standard_charges":[{"minimum":4.75,"maximum":64.86,"gross_charge":80.07,"discounted_cash":23.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.02,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.53,"maximum":53.37,"gross_charge":65.88,"discounted_cash":19.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.75,"maximum":53.37,"gross_charge":65.88,"discounted_cash":19.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40,"maximum":54,"gross_charge":66.66,"discounted_cash":19.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.75,"maximum":54,"gross_charge":66.66,"discounted_cash":19.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.48,"maximum":54.65,"gross_charge":67.46,"discounted_cash":19.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J0780","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.75,"maximum":54.65,"gross_charge":67.46,"discounted_cash":19.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.75,"standard_charge_algorithm": "Lesser of $4.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"}]}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0834","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":79.01,"maximum":106.67,"gross_charge":131.68,"discounted_cash":38.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.01,"methodology":"fee schedule"}]}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0834","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.76,"maximum":106.67,"gross_charge":131.68,"discounted_cash":38.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.1,"standard_charge_algorithm": "Lesser of $35.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.1,"standard_charge_algorithm": "Lesser of $35.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"}]}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0834","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":96.35,"maximum":130.07,"gross_charge":160.57,"discounted_cash":47.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":104.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":112.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.35,"methodology":"fee schedule"}]}]},{"description":"COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0834","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":24.09,"maximum":130.07,"gross_charge":160.57,"discounted_cash":47.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":130.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":102.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.1,"standard_charge_algorithm": "Lesser of $35.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.1,"standard_charge_algorithm": "Lesser of $35.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":112.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":96.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.12,"methodology":"fee schedule"}]}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0840","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0110-12","type":"NDC"}],"standard_charges":[{"minimum":5850.89,"maximum":7898.7,"gross_charge":9751.47,"discounted_cash":2886.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7898.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7898.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7898.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6338.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6826.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5850.89,"methodology":"fee schedule"}]}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0840","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0110-12","type":"NDC"}],"standard_charges":[{"minimum":1462.73,"maximum":7898.7,"gross_charge":9751.47,"discounted_cash":2886.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7898.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7898.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7898.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6240.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1779.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1779.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1949.92,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1929.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1986.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2684.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2823.08,"standard_charge_algorithm": "Lesser of $2823.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2823.08,"standard_charge_algorithm": "Lesser of $2823.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4388.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6826.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5850.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1852.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1462.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1950.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1569.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1679.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1616.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1648.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1726.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1663.96,"methodology":"case rate"}]}]},{"description":"ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0841","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66621-0790-01","type":"NDC"}],"standard_charges":[{"minimum":2965.17,"maximum":4002.98,"gross_charge":4941.94,"discounted_cash":1462.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4002.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4002.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4002.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3212.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3459.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.17,"methodology":"fee schedule"}]}]},{"description":"ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0841","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66621-0790-01","type":"NDC"}],"standard_charges":[{"minimum":741.3,"maximum":4002.98,"gross_charge":4941.94,"discounted_cash":1462.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4002.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4002.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4002.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3162.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1027.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1027.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":912.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1076.32,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":929.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1595.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1224.1,"standard_charge_algorithm": "Lesser of $1224.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1224.1,"standard_charge_algorithm": "Lesser of $1224.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2223.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3459.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2965.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":932.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":998.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":960.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":979.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1026.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":988.95,"methodology":"case rate"}]}]},{"description":"DALBAVANCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0875","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57970-0100-01","type":"NDC"}],"standard_charges":[{"minimum":6894.75,"maximum":9307.92,"gross_charge":11491.25,"discounted_cash":3401.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9307.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9307.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9307.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7469.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8043.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6894.75,"methodology":"fee schedule"}]}]},{"description":"DALBAVANCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0875","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57970-0100-01","type":"NDC"}],"standard_charges":[{"minimum":13.92,"maximum":9307.92,"gross_charge":11491.25,"discounted_cash":3401.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9307.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9307.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9307.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7354.4,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":15.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":23.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.13,"standard_charge_algorithm": "Lesser of $17.13 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.13,"standard_charge_algorithm": "Lesser of $17.13 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5171.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8043.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6894.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2183.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2298.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1723.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2298.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":13.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":14.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":14.76,"methodology":"case rate"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0892-01","type":"NDC"}],"standard_charges":[{"minimum":1831.95,"maximum":2473.14,"gross_charge":3053.25,"discounted_cash":903.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2473.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2473.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2473.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1984.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2137.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1831.95,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0892-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":2473.14,"gross_charge":3053.25,"discounted_cash":903.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2473.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2473.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2473.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1954.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1373.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2137.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1831.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":457.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":610.65,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0344-01","type":"NDC"}],"standard_charges":[{"minimum":274.77,"maximum":370.94,"gross_charge":457.95,"discounted_cash":135.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":297.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":320.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.77,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0344-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":370.94,"gross_charge":457.95,"discounted_cash":135.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":293.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":206.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":320.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.59,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0813-50","type":"NDC"}],"standard_charges":[{"minimum":334.07,"maximum":450.99,"gross_charge":556.77,"discounted_cash":164.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":361.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":389.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.07,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0813-50","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":450.99,"gross_charge":556.77,"discounted_cash":164.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":356.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":250.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":389.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":334.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.36,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67919-0011-01","type":"NDC"}],"standard_charges":[{"minimum":1973.01,"maximum":2663.56,"gross_charge":3288.34,"discounted_cash":973.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2663.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2663.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2663.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2137.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2301.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1973.01,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67919-0011-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":2663.56,"gross_charge":3288.34,"discounted_cash":973.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2663.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2663.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2663.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2104.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1479.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2301.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1973.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":624.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":493.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":657.67,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0034-02","type":"NDC"}],"standard_charges":[{"minimum":274.73,"maximum":370.89,"gross_charge":457.88,"discounted_cash":135.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":297.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":320.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.73,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0034-02","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":370.89,"gross_charge":457.88,"discounted_cash":135.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":293.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":206.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":320.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.58,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0102-01","type":"NDC"}],"standard_charges":[{"minimum":557.19,"maximum":752.2,"gross_charge":928.64,"discounted_cash":274.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":752.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":752.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":752.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":603.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":650.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":557.19,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0102-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":752.2,"gross_charge":928.64,"discounted_cash":274.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":752.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":752.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":752.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":594.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":417.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":650.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":557.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.73,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0152-01","type":"NDC"}],"standard_charges":[{"minimum":266.18,"maximum":359.34,"gross_charge":443.62,"discounted_cash":131.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.18,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0152-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":359.34,"gross_charge":443.62,"discounted_cash":131.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":283.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":199.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83090-0011-01","type":"NDC"}],"standard_charges":[{"minimum":330.09,"maximum":445.62,"gross_charge":550.14,"discounted_cash":162.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":357.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.09,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83090-0011-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":445.62,"gross_charge":550.14,"discounted_cash":162.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":352.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":247.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.03,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":398.49,"maximum":537.96,"gross_charge":664.14,"discounted_cash":196.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":537.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":537.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":537.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":431.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":464.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":398.49,"methodology":"fee schedule"}]}]},{"description":"DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J0878","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.05,"maximum":537.96,"gross_charge":664.14,"discounted_cash":196.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":537.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":537.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":537.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":425.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":298.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":464.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":398.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.83,"methodology":"fee schedule"}]}]},{"description":"DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0025-04","type":"NDC"}],"standard_charges":[{"minimum":3451.79,"maximum":4659.92,"gross_charge":5752.98,"discounted_cash":1702.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4659.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4659.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4659.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3739.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4027.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3451.79,"methodology":"fee schedule"}]}]},{"description":"DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0025-04","type":"NDC"}],"standard_charges":[{"minimum":2.61,"maximum":4659.92,"gross_charge":5752.98,"discounted_cash":1702.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4659.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4659.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4659.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3681.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.47,"standard_charge_algorithm": "Lesser of $3.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.47,"standard_charge_algorithm": "Lesser of $3.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2588.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4027.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3451.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":862.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1150.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.77,"methodology":"case rate"}]}]},{"description":"DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0028-01","type":"NDC"}],"standard_charges":[{"minimum":6692.12,"maximum":9034.36,"gross_charge":11153.52,"discounted_cash":3301.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9034.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9034.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9034.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7249.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7807.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6692.12,"methodology":"fee schedule"}]}]},{"description":"DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0028-01","type":"NDC"}],"standard_charges":[{"minimum":2.61,"maximum":9034.36,"gross_charge":11153.52,"discounted_cash":3301.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9034.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9034.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9034.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7138.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.47,"standard_charge_algorithm": "Lesser of $3.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.47,"standard_charge_algorithm": "Lesser of $3.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5019.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7807.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6692.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2119.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2230.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1673.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2230.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.77,"methodology":"case rate"}]}]},{"description":"DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0032-01","type":"NDC"}],"standard_charges":[{"minimum":16413.09,"maximum":22157.68,"gross_charge":27355.15,"discounted_cash":8097.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22157.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22157.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22157.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17780.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19148.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16413.09,"methodology":"fee schedule"}]}]},{"description":"DARBEPOETIN ALFA 500 MCG/ML IN POLYSORBATE INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0032-01","type":"NDC"}],"standard_charges":[{"minimum":2.61,"maximum":22157.68,"gross_charge":27355.15,"discounted_cash":8097.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22157.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22157.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22157.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17507.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.93,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.47,"standard_charge_algorithm": "Lesser of $3.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.47,"standard_charge_algorithm": "Lesser of $3.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12309.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19148.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16413.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5197.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5471.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4103.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5471.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.61,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.69,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.77,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA 10000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0310-00","type":"NDC"}],"standard_charges":[{"minimum":386.38,"maximum":521.61,"gross_charge":643.96,"discounted_cash":190.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":418.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":450.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":386.38,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA 10000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0310-00","type":"NDC"}],"standard_charges":[{"minimum":6.33,"maximum":521.61,"gross_charge":643.96,"discounted_cash":190.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":412.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":289.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":450.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":386.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.71,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA 10000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0310-02","type":"NDC"}],"standard_charges":[{"minimum":386.37,"maximum":521.6,"gross_charge":643.94,"discounted_cash":190.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":418.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":450.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA 10000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0310-02","type":"NDC"}],"standard_charges":[{"minimum":6.33,"maximum":521.6,"gross_charge":643.94,"discounted_cash":190.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":521.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":521.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":521.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":412.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":289.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":450.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":386.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.71,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA 2000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0126-01","type":"NDC"}],"standard_charges":[{"minimum":113.22,"maximum":152.85,"gross_charge":188.7,"discounted_cash":55.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":122.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.22,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA 2000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0126-01","type":"NDC"}],"standard_charges":[{"minimum":6.33,"maximum":152.85,"gross_charge":188.7,"discounted_cash":55.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":84.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.71,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA 4000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0304-00","type":"NDC"}],"standard_charges":[{"minimum":290.76,"maximum":392.52,"gross_charge":484.59,"discounted_cash":143.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":392.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":392.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":392.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":314.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":339.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":290.76,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA 4000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0304-00","type":"NDC"}],"standard_charges":[{"minimum":6.33,"maximum":392.52,"gross_charge":484.59,"discounted_cash":143.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":392.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":392.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":392.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":310.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":218.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":339.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":290.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.71,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA 4000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0304-01","type":"NDC"}],"standard_charges":[{"minimum":292.1,"maximum":394.33,"gross_charge":486.82,"discounted_cash":144.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":316.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":340.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.1,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA 4000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0304-01","type":"NDC"}],"standard_charges":[{"minimum":6.33,"maximum":394.33,"gross_charge":486.82,"discounted_cash":144.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":311.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.46,"standard_charge_algorithm": "Lesser of $9.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":219.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":340.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.71,"methodology":"case rate"}]}]},{"description":"DECITABINE 5 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0556-10","type":"NDC"}],"standard_charges":[{"minimum":442.73,"maximum":597.69,"gross_charge":737.88,"discounted_cash":218.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":597.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":597.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":597.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":479.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":516.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":442.73,"methodology":"fee schedule"}]}]},{"description":"DECITABINE 5 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0556-10","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":597.69,"gross_charge":737.88,"discounted_cash":218.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":597.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":597.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":597.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":472.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":332.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":516.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":442.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.58,"methodology":"fee schedule"}]}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0224-05","type":"NDC"}],"standard_charges":[{"minimum":631.49,"maximum":852.51,"gross_charge":1052.47,"discounted_cash":311.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":852.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":852.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":852.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":684.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":736.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":631.49,"methodology":"fee schedule"}]}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0224-05","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":852.51,"gross_charge":1052.47,"discounted_cash":311.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":852.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":852.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":852.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":673.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":473.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":736.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":631.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":199.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.5,"methodology":"fee schedule"}]}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0427-37","type":"NDC"}],"standard_charges":[{"minimum":373.91,"maximum":504.77,"gross_charge":623.17,"discounted_cash":184.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":405.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":436.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.91,"methodology":"fee schedule"}]}]},{"description":"DECITABINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0427-37","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":504.77,"gross_charge":623.17,"discounted_cash":184.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":398.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":280.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":436.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":373.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.64,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0624-07","type":"NDC"}],"standard_charges":[{"minimum":111.09,"maximum":149.98,"gross_charge":185.15,"discounted_cash":54.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.09,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0624-07","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":149.98,"gross_charge":185.15,"discounted_cash":54.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.03,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6237-00","type":"NDC"}],"standard_charges":[{"minimum":128.03,"maximum":172.83,"gross_charge":213.37,"discounted_cash":63.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":138.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":149.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6237-00","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":172.83,"gross_charge":213.37,"discounted_cash":63.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":136.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":96.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":149.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0599-30","type":"NDC"}],"standard_charges":[{"minimum":87.95,"maximum":118.73,"gross_charge":146.58,"discounted_cash":43.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.95,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0599-30","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":118.73,"gross_charge":146.58,"discounted_cash":43.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.32,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":102.12,"maximum":137.87,"gross_charge":170.2,"discounted_cash":50.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.12,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.96,"maximum":137.87,"gross_charge":170.2,"discounted_cash":50.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 213 MG/ML IM INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0597-10","type":"NDC"}],"standard_charges":[{"minimum":58.63,"maximum":79.15,"gross_charge":97.71,"discounted_cash":28.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.63,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 213 MG/ML IM INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0597-10","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":79.15,"gross_charge":97.71,"discounted_cash":28.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0623-07","type":"NDC"}],"standard_charges":[{"minimum":62.14,"maximum":83.89,"gross_charge":103.56,"discounted_cash":30.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0623-07","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":83.89,"gross_charge":103.56,"discounted_cash":30.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6236-00","type":"NDC"}],"standard_charges":[{"minimum":59.37,"maximum":80.15,"gross_charge":98.94,"discounted_cash":29.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.37,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6236-00","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":80.15,"gross_charge":98.94,"discounted_cash":29.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.79,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.65,"maximum":73.77,"gross_charge":91.07,"discounted_cash":26.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.96,"maximum":73.77,"gross_charge":91.07,"discounted_cash":26.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.22,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.65,"maximum":73.78,"gross_charge":91.08,"discounted_cash":26.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"}]}]},{"description":"DEFEROXAMINE 500 MG SOLUTION FOR INJECTION","code_information":[{"code":"J0895","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.96,"maximum":73.78,"gross_charge":91.08,"discounted_cash":26.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.96,"standard_charge_algorithm": "Lesser of $8.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.22,"methodology":"fee schedule"}]}]},{"description":"DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0897","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0730-01","type":"NDC"}],"standard_charges":[{"minimum":13600.82,"maximum":18361.11,"gross_charge":22668.03,"discounted_cash":6709.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18361.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18361.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18361.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14734.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15867.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13600.82,"methodology":"fee schedule"}]}]},{"description":"DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0897","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0730-01","type":"NDC"}],"standard_charges":[{"minimum":24.86,"maximum":18361.11,"gross_charge":22668.03,"discounted_cash":6709.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18361.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18361.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18361.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14507.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.44,"standard_charge_algorithm": "Lesser of $25.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.44,"standard_charge_algorithm": "Lesser of $25.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10200.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15867.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13600.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4306.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4533.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3400.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4533.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.35,"methodology":"case rate"}]}]},{"description":"DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0897","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0710-21","type":"NDC"}],"standard_charges":[{"minimum":7491.21,"maximum":10113.14,"gross_charge":12485.35,"discounted_cash":3695.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10113.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10113.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10113.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8115.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8739.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7491.21,"methodology":"fee schedule"}]}]},{"description":"DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J0897","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0710-21","type":"NDC"}],"standard_charges":[{"minimum":24.86,"maximum":10113.14,"gross_charge":12485.35,"discounted_cash":3695.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10113.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10113.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10113.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7990.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.44,"standard_charge_algorithm": "Lesser of $25.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.44,"standard_charge_algorithm": "Lesser of $25.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5618.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8739.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7491.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2372.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2497.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1872.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2497.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.1,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.35,"methodology":"case rate"}]}]},{"description":"ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL","code_information":[{"code":"J1000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":99.6,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":107.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":116.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL","code_information":[{"code":"J1000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":24.9,"maximum":134.46,"gross_charge":166,"discounted_cash":49.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":106.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.9,"standard_charge_algorithm": "Lesser of $29.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.9,"standard_charge_algorithm": "Lesser of $29.90 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":74.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":116.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.2,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-1573-05","type":"NDC"}],"standard_charges":[{"minimum":42.45,"maximum":57.3,"gross_charge":70.74,"discounted_cash":20.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.45,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-1573-05","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":57.3,"gross_charge":70.74,"discounted_cash":20.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1573-01","type":"NDC"}],"standard_charges":[{"minimum":42.44,"maximum":57.29,"gross_charge":70.72,"discounted_cash":20.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1573-01","type":"NDC"}],"standard_charges":[{"minimum":10.61,"maximum":57.29,"gross_charge":70.72,"discounted_cash":20.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.36,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.15,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.5,"maximum":61.42,"gross_charge":75.82,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.38,"maximum":61.42,"gross_charge":75.82,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.5,"maximum":61.43,"gross_charge":75.83,"discounted_cash":22.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.38,"maximum":61.43,"gross_charge":75.83,"discounted_cash":22.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.77,"maximum":73.93,"gross_charge":91.27,"discounted_cash":27.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.7,"maximum":73.93,"gross_charge":91.27,"discounted_cash":27.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.26,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-1574-01","type":"NDC"}],"standard_charges":[{"minimum":47.36,"maximum":63.94,"gross_charge":78.93,"discounted_cash":23.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.36,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-1574-01","type":"NDC"}],"standard_charges":[{"minimum":11.84,"maximum":63.94,"gross_charge":78.93,"discounted_cash":23.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-1574-05","type":"NDC"}],"standard_charges":[{"minimum":47.37,"maximum":63.95,"gross_charge":78.94,"discounted_cash":23.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-1574-05","type":"NDC"}],"standard_charges":[{"minimum":11.85,"maximum":63.95,"gross_charge":78.94,"discounted_cash":23.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":52.44,"maximum":70.79,"gross_charge":87.39,"discounted_cash":25.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.44,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.11,"maximum":70.79,"gross_charge":87.39,"discounted_cash":25.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.09,"maximum":79.77,"gross_charge":98.47,"discounted_cash":29.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.09,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":14.78,"maximum":79.77,"gross_charge":98.47,"discounted_cash":29.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":68.91,"maximum":93.03,"gross_charge":114.84,"discounted_cash":34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.91,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J1010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17.23,"maximum":93.03,"gross_charge":114.84,"discounted_cash":34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.97,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0981-02","type":"NDC"}],"standard_charges":[{"minimum":68.45,"maximum":92.41,"gross_charge":114.08,"discounted_cash":33.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.45,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0981-02","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":92.41,"gross_charge":114.08,"discounted_cash":33.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.82,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0887-00","type":"NDC"}],"standard_charges":[{"minimum":53.19,"maximum":71.8,"gross_charge":88.64,"discounted_cash":26.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0887-00","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":71.8,"gross_charge":88.64,"discounted_cash":26.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0887-99","type":"NDC"}],"standard_charges":[{"minimum":53.04,"maximum":71.61,"gross_charge":88.4,"discounted_cash":26.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.04,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0887-99","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":71.61,"gross_charge":88.4,"discounted_cash":26.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.68,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":75.42,"maximum":101.82,"gross_charge":125.7,"discounted_cash":37.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":87.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.42,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.16,"maximum":101.82,"gross_charge":125.7,"discounted_cash":37.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":87.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.14,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":76.41,"maximum":103.16,"gross_charge":127.35,"discounted_cash":37.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"}]}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION","code_information":[{"code":"J1050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.16,"maximum":103.16,"gross_charge":127.35,"discounted_cash":37.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE FOR INHALATION 4 MG/ML SOLN (RESPIRATORY)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0237-01","type":"NDC"}],"standard_charges":[{"minimum":33.95,"maximum":45.83,"gross_charge":56.58,"discounted_cash":16.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.95,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE FOR INHALATION 4 MG/ML SOLN (RESPIRATORY)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0237-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":45.83,"gross_charge":56.58,"discounted_cash":16.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE FOR INHALATION 4 MG/ML SOLN (RESPIRATORY)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0165-02","type":"NDC"}],"standard_charges":[{"minimum":34.29,"maximum":46.3,"gross_charge":57.15,"discounted_cash":16.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE FOR INHALATION 4 MG/ML SOLN (RESPIRATORY)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0165-02","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":46.3,"gross_charge":57.15,"discounted_cash":16.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE FOR INHALATION 4 MG/ML SOLN (RESPIRATORY)","code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":46.98,"gross_charge":57.99,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE FOR INHALATION 4 MG/ML SOLN (RESPIRATORY)","code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":46.98,"gross_charge":57.99,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0053-01","type":"NDC"}],"standard_charges":[{"minimum":35.56,"maximum":48.01,"gross_charge":59.26,"discounted_cash":17.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0053-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":48.01,"gross_charge":59.26,"discounted_cash":17.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0304-25","type":"NDC"}],"standard_charges":[{"minimum":36.83,"maximum":49.71,"gross_charge":61.37,"discounted_cash":18.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0304-25","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":49.71,"gross_charge":61.37,"discounted_cash":18.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0506-01","type":"NDC"}],"standard_charges":[{"minimum":36.18,"maximum":48.85,"gross_charge":60.3,"discounted_cash":17.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.18,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0506-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":48.85,"gross_charge":60.3,"discounted_cash":17.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0021-01","type":"NDC"}],"standard_charges":[{"minimum":43.09,"maximum":58.17,"gross_charge":71.81,"discounted_cash":21.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0021-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":58.17,"gross_charge":71.81,"discounted_cash":21.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.76,"maximum":48.28,"gross_charge":59.6,"discounted_cash":17.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":48.28,"gross_charge":59.6,"discounted_cash":17.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0165-05","type":"NDC"}],"standard_charges":[{"minimum":34.49,"maximum":46.56,"gross_charge":57.48,"discounted_cash":17.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.49,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0165-05","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":46.56,"gross_charge":57.48,"discounted_cash":17.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0418-00","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0418-00","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0419-01","type":"NDC"}],"standard_charges":[{"minimum":33.92,"maximum":45.79,"gross_charge":56.53,"discounted_cash":16.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0419-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":45.79,"gross_charge":56.53,"discounted_cash":16.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.31,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0423-00","type":"NDC"}],"standard_charges":[{"minimum":34.58,"maximum":46.69,"gross_charge":57.63,"discounted_cash":17.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.58,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0423-00","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":46.69,"gross_charge":57.63,"discounted_cash":17.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0120-01","type":"NDC"}],"standard_charges":[{"minimum":35.06,"maximum":47.33,"gross_charge":58.43,"discounted_cash":17.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0120-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":47.33,"gross_charge":58.43,"discounted_cash":17.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.07,"maximum":47.35,"gross_charge":58.45,"discounted_cash":17.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":47.35,"gross_charge":58.45,"discounted_cash":17.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.15,"standard_charge_algorithm": "Lesser of $0.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81284-0411-00","type":"NDC"}],"standard_charges":[{"minimum":160.83,"maximum":217.13,"gross_charge":268.05,"discounted_cash":79.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":174.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":187.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.83,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81284-0411-00","type":"NDC"}],"standard_charges":[{"minimum":40.21,"maximum":217.13,"gross_charge":268.05,"discounted_cash":79.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":217.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":217.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":217.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":171.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.65,"standard_charge_algorithm": "Lesser of $65.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.65,"standard_charge_algorithm": "Lesser of $65.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":120.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":187.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":160.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.61,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":233.65,"maximum":315.43,"gross_charge":389.41,"discounted_cash":115.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":253.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":272.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58.42,"maximum":315.43,"gross_charge":389.41,"discounted_cash":115.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":315.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":315.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":315.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":249.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.65,"standard_charge_algorithm": "Lesser of $65.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.65,"standard_charge_algorithm": "Lesser of $65.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":175.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":272.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":233.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.89,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":277.88,"maximum":375.14,"gross_charge":463.13,"discounted_cash":137.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":301.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":324.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.88,"methodology":"fee schedule"}]}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.65,"maximum":375.14,"gross_charge":463.13,"discounted_cash":137.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":375.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":375.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":375.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":296.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":65.65,"standard_charge_algorithm": "Lesser of $65.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":65.65,"standard_charge_algorithm": "Lesser of $65.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":208.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":324.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.63,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION","code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION","code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0313-31","type":"NDC"}],"standard_charges":[{"minimum":58.55,"maximum":79.04,"gross_charge":97.58,"discounted_cash":28.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.55,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0313-31","type":"NDC"}],"standard_charges":[{"minimum":14.64,"maximum":79.04,"gross_charge":97.58,"discounted_cash":28.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.52,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0190-01","type":"NDC"}],"standard_charges":[{"minimum":100.38,"maximum":135.52,"gross_charge":167.3,"discounted_cash":49.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":117.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0190-01","type":"NDC"}],"standard_charges":[{"minimum":25.1,"maximum":135.52,"gross_charge":167.3,"discounted_cash":49.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":135.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":135.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":107.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":117.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":100.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0853-50","type":"NDC"}],"standard_charges":[{"minimum":125.21,"maximum":169.04,"gross_charge":208.68,"discounted_cash":61.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":135.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":146.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.21,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0853-50","type":"NDC"}],"standard_charges":[{"minimum":25.4,"maximum":169.04,"gross_charge":208.68,"discounted_cash":61.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":133.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":146.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.74,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":133.37,"maximum":180.05,"gross_charge":222.28,"discounted_cash":65.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":144.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.37,"methodology":"fee schedule"}]}]},{"description":"ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION (MCT)","code_information":[{"code":"J1120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":25.4,"maximum":180.05,"gross_charge":222.28,"discounted_cash":65.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":142.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.4,"standard_charge_algorithm": "Lesser of $25.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":100.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.04,"maximum":54.05,"gross_charge":66.72,"discounted_cash":19.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.01,"maximum":54.05,"gross_charge":66.72,"discounted_cash":19.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.27,"standard_charge_algorithm": "Lesser of $23.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.27,"standard_charge_algorithm": "Lesser of $23.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.05,"maximum":54.06,"gross_charge":66.74,"discounted_cash":19.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.02,"maximum":54.06,"gross_charge":66.74,"discounted_cash":19.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.27,"standard_charge_algorithm": "Lesser of $23.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.27,"standard_charge_algorithm": "Lesser of $23.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":45.92,"maximum":61.99,"gross_charge":76.52,"discounted_cash":22.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION","code_information":[{"code":"J1160","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.48,"maximum":61.99,"gross_charge":76.52,"discounted_cash":22.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.27,"standard_charge_algorithm": "Lesser of $23.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.27,"standard_charge_algorithm": "Lesser of $23.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0121-11","type":"NDC"}],"standard_charges":[{"minimum":18396.85,"maximum":24835.75,"gross_charge":30661.41,"discounted_cash":9075.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24835.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24835.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24835.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19929.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21462.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18396.85,"methodology":"fee schedule"}]}]},{"description":"DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50633-0121-11","type":"NDC"}],"standard_charges":[{"minimum":4442.11,"maximum":24835.75,"gross_charge":30661.41,"discounted_cash":9075.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24835.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24835.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24835.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19623.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5069.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5069.98,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4777.44,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4867.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4867.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7596.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4852.31,"standard_charge_algorithm": "Lesser of $4852.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4852.31,"standard_charge_algorithm": "Lesser of $4852.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13797.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21462.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18396.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5825.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4599.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6132.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4442.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4753.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4575.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4664.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4886.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4708.64,"methodology":"case rate"}]}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.68,"maximum":48.17,"gross_charge":59.46,"discounted_cash":17.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"}]}]},{"description":"PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1165","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.52,"maximum":48.17,"gross_charge":59.46,"discounted_cash":17.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.52,"standard_charge_algorithm": "Lesser of $0.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.52,"standard_charge_algorithm": "Lesser of $0.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1170","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0009-01","type":"NDC"}],"standard_charges":[{"minimum":38.5,"maximum":51.97,"gross_charge":64.16,"discounted_cash":19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1170","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0009-01","type":"NDC"}],"standard_charges":[{"minimum":3.92,"maximum":51.97,"gross_charge":64.16,"discounted_cash":19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.92,"standard_charge_algorithm": "Lesser of $3.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.92,"standard_charge_algorithm": "Lesser of $3.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1170","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0009-11","type":"NDC"}],"standard_charges":[{"minimum":36.58,"maximum":49.38,"gross_charge":60.96,"discounted_cash":18.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1170","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0009-11","type":"NDC"}],"standard_charges":[{"minimum":3.92,"maximum":49.38,"gross_charge":60.96,"discounted_cash":18.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.92,"standard_charge_algorithm": "Lesser of $3.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.92,"standard_charge_algorithm": "Lesser of $3.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0852-25","type":"NDC"}],"standard_charges":[{"minimum":39.98,"maximum":53.97,"gross_charge":66.62,"discounted_cash":19.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0852-25","type":"NDC"}],"standard_charges":[{"minimum":10,"maximum":53.97,"gross_charge":66.62,"discounted_cash":19.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.33,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0540-05","type":"NDC"}],"standard_charges":[{"minimum":47.92,"maximum":64.69,"gross_charge":79.86,"discounted_cash":23.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0540-05","type":"NDC"}],"standard_charges":[{"minimum":11.98,"maximum":64.69,"gross_charge":79.86,"discounted_cash":23.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0540-50","type":"NDC"}],"standard_charges":[{"minimum":172.47,"maximum":232.84,"gross_charge":287.45,"discounted_cash":85.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":186.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":201.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.47,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0540-50","type":"NDC"}],"standard_charges":[{"minimum":43.12,"maximum":232.84,"gross_charge":287.45,"discounted_cash":85.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":232.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":232.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":232.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":183.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":143.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":143.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":129.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":201.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":172.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.49,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0851-07","type":"NDC"}],"standard_charges":[{"minimum":60.8,"maximum":82.08,"gross_charge":101.33,"discounted_cash":30,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0851-07","type":"NDC"}],"standard_charges":[{"minimum":15.2,"maximum":82.08,"gross_charge":101.33,"discounted_cash":30,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.27,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0851-50","type":"NDC"}],"standard_charges":[{"minimum":318.22,"maximum":429.6,"gross_charge":530.36,"discounted_cash":156.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":344.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":371.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":318.22,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0851-50","type":"NDC"}],"standard_charges":[{"minimum":79.56,"maximum":429.6,"gross_charge":530.36,"discounted_cash":156.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":339.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":265.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":238.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":371.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":318.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.08,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.64,"maximum":54.87,"gross_charge":67.73,"discounted_cash":20.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.64,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":54.87,"gross_charge":67.73,"discounted_cash":20.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.87,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.79,"maximum":56.42,"gross_charge":69.65,"discounted_cash":20.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.45,"maximum":56.42,"gross_charge":69.65,"discounted_cash":20.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.22,"maximum":71.85,"gross_charge":88.7,"discounted_cash":26.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.22,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.31,"maximum":71.85,"gross_charge":88.7,"discounted_cash":26.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":250.14,"maximum":337.69,"gross_charge":416.9,"discounted_cash":123.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":270.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":291.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.14,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.54,"maximum":337.69,"gross_charge":416.9,"discounted_cash":123.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":266.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":208.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":208.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":187.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":291.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.38,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":269.97,"maximum":364.46,"gross_charge":449.95,"discounted_cash":133.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":292.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":314.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.97,"methodology":"fee schedule"}]}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":67.5,"maximum":364.46,"gross_charge":449.95,"discounted_cash":133.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":287.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":224.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":224.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":202.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":314.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.99,"methodology":"fee schedule"}]}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0716-01","type":"NDC"}],"standard_charges":[{"minimum":366.18,"maximum":494.35,"gross_charge":610.3,"discounted_cash":180.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":494.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":494.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":494.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":396.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":427.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":366.18,"methodology":"fee schedule"}]}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0716-01","type":"NDC"}],"standard_charges":[{"minimum":72.38,"maximum":494.35,"gross_charge":610.3,"discounted_cash":180.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":494.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":494.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":494.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":390.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":80.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":108.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":123.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":177.07,"standard_charge_algorithm": "Lesser of $177.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":177.07,"standard_charge_algorithm": "Lesser of $177.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":274.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":427.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":366.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":72.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":77.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":74.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":79.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":76.72,"methodology":"case rate"}]}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1190","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":379.47,"maximum":512.29,"gross_charge":632.45,"discounted_cash":187.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":411.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.47,"methodology":"fee schedule"}]}]},{"description":"DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1190","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":72.38,"maximum":512.29,"gross_charge":632.45,"discounted_cash":187.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":404.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":80.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":108.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":102.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":110.04,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":123.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":177.07,"standard_charge_algorithm": "Lesser of $177.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":177.07,"standard_charge_algorithm": "Lesser of $177.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":284.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":72.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":77.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":74.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":79.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":76.72,"methodology":"case rate"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0481-01","type":"NDC"}],"standard_charges":[{"minimum":33.99,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0481-01","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0664-16","type":"NDC"}],"standard_charges":[{"minimum":34.17,"maximum":46.13,"gross_charge":56.95,"discounted_cash":16.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.17,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0664-16","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":46.13,"gross_charge":56.95,"discounted_cash":16.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0101-01","type":"NDC"}],"standard_charges":[{"minimum":35.1,"maximum":47.38,"gross_charge":58.49,"discounted_cash":17.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0101-01","type":"NDC"}],"standard_charges":[{"minimum":1.32,"maximum":47.38,"gross_charge":58.49,"discounted_cash":17.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.02,"maximum":45.92,"gross_charge":56.69,"discounted_cash":16.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.02,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.32,"maximum":45.92,"gross_charge":56.69,"discounted_cash":16.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.22,"maximum":47.55,"gross_charge":58.7,"discounted_cash":17.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1200","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.32,"maximum":47.55,"gross_charge":58.7,"discounted_cash":17.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.32,"standard_charge_algorithm": "Lesser of $1.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0305-66","type":"NDC"}],"standard_charges":[{"minimum":105.81,"maximum":142.85,"gross_charge":176.35,"discounted_cash":52.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":114.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":123.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.81,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0305-66","type":"NDC"}],"standard_charges":[{"minimum":26.46,"maximum":142.85,"gross_charge":176.35,"discounted_cash":52.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":123.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.27,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":133.1,"maximum":179.68,"gross_charge":221.82,"discounted_cash":65.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":144.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":155.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.1,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.28,"maximum":179.68,"gross_charge":221.82,"discounted_cash":65.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":179.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":179.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":179.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":141.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":99.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":155.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":133.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0305-20","type":"NDC"}],"standard_charges":[{"minimum":113.69,"maximum":153.48,"gross_charge":189.48,"discounted_cash":56.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0305-20","type":"NDC"}],"standard_charges":[{"minimum":28.43,"maximum":153.48,"gross_charge":189.48,"discounted_cash":56.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":121.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0658-20","type":"NDC"}],"standard_charges":[{"minimum":94.27,"maximum":127.26,"gross_charge":157.11,"discounted_cash":46.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":102.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":109.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.27,"methodology":"fee schedule"}]}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0658-20","type":"NDC"}],"standard_charges":[{"minimum":23.57,"maximum":127.26,"gross_charge":157.11,"discounted_cash":46.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":127.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":100.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":84.09,"standard_charge_algorithm": "Lesser of $84.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":70.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":109.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":94.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.43,"methodology":"fee schedule"}]}]},{"description":"DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1212","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0177-50","type":"NDC"}],"standard_charges":[{"minimum":1639.03,"maximum":2212.69,"gross_charge":2731.71,"discounted_cash":808.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2212.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2212.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2212.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1775.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1912.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1639.03,"methodology":"fee schedule"}]}]},{"description":"DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1212","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0177-50","type":"NDC"}],"standard_charges":[{"minimum":409.76,"maximum":2212.69,"gross_charge":2731.71,"discounted_cash":808.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2212.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2212.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2212.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1748.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":715.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":715.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":680.82,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":719.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":693.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1092.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":719.29,"standard_charge_algorithm": "Lesser of $719.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":719.29,"standard_charge_algorithm": "Lesser of $719.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1229.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1912.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1639.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":519.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":546.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":638.99,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":683.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":658.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":670.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":702.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":677.33,"methodology":"case rate"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0203-80","type":"NDC"}],"standard_charges":[{"minimum":33.36,"maximum":45.03,"gross_charge":55.59,"discounted_cash":16.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.36,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0203-80","type":"NDC"}],"standard_charges":[{"minimum":7.39,"maximum":45.03,"gross_charge":55.59,"discounted_cash":16.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0203-82","type":"NDC"}],"standard_charges":[{"minimum":33.27,"maximum":44.92,"gross_charge":55.45,"discounted_cash":16.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.27,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0203-82","type":"NDC"}],"standard_charges":[{"minimum":7.39,"maximum":44.92,"gross_charge":55.45,"discounted_cash":16.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.31,"maximum":44.97,"gross_charge":55.51,"discounted_cash":16.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.31,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":44.97,"gross_charge":55.51,"discounted_cash":16.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.9,"maximum":64.66,"gross_charge":79.82,"discounted_cash":23.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.9,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":64.66,"gross_charge":79.82,"discounted_cash":23.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.97,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.5,"maximum":65.48,"gross_charge":80.83,"discounted_cash":23.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.5,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":65.48,"gross_charge":80.83,"discounted_cash":23.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.17,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.63,"maximum":72.39,"gross_charge":89.37,"discounted_cash":26.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":72.39,"gross_charge":89.37,"discounted_cash":26.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":83.31,"maximum":112.47,"gross_charge":138.84,"discounted_cash":41.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.31,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":112.47,"gross_charge":138.84,"discounted_cash":41.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 500 MG/250 ML (2000 MCG/ML) IN 5 % DEXTROSE IV","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65,"maximum":87.74,"gross_charge":108.32,"discounted_cash":32.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 500 MG/250 ML (2000 MCG/ML) IN 5 % DEXTROSE IV","code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.39,"maximum":87.74,"gross_charge":108.32,"discounted_cash":32.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.67,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 50MG/50ML (1MG/ML) IN 5% DEXTROSE INTRAVENOUS MCT RIS CONTRASTS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"88888-2294-64","type":"NDC"}],"standard_charges":[{"minimum":36.45,"maximum":49.21,"gross_charge":60.75,"discounted_cash":17.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"DOBUTAMINE 50MG/50ML (1MG/ML) IN 5% DEXTROSE INTRAVENOUS MCT RIS CONTRASTS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"88888-2294-64","type":"NDC"}],"standard_charges":[{"minimum":7.39,"maximum":49.21,"gross_charge":60.75,"discounted_cash":17.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.39,"standard_charge_algorithm": "Lesser of $7.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.88,"maximum":52.48,"gross_charge":64.79,"discounted_cash":19.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":52.48,"gross_charge":64.79,"discounted_cash":19.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.96,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.59,"maximum":54.8,"gross_charge":67.65,"discounted_cash":20.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.59,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":54.8,"gross_charge":67.65,"discounted_cash":20.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.3,"maximum":53.06,"gross_charge":65.5,"discounted_cash":19.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.3,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":53.06,"gross_charge":65.5,"discounted_cash":19.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400 MG/250 ML (1600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":52.37,"maximum":70.69,"gross_charge":87.27,"discounted_cash":25.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.37,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400 MG/250 ML (1600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":70.69,"gross_charge":87.27,"discounted_cash":25.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400 MG/250 ML (1600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":64.36,"maximum":86.89,"gross_charge":107.26,"discounted_cash":31.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.36,"methodology":"fee schedule"}]}]},{"description":"DOPAMINE 400 MG/250 ML (1600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN","code_information":[{"code":"J1265","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":86.89,"gross_charge":107.26,"discounted_cash":31.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":86.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":86.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":86.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.8,"standard_charge_algorithm": "Lesser of $0.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.46,"methodology":"fee schedule"}]}]},{"description":"INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1306","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8468.6,"maximum":11432.6,"gross_charge":14114.32,"discounted_cash":4177.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11432.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11432.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11432.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9174.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9880.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8468.6,"methodology":"fee schedule"}]}]},{"description":"INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1306","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2117.15,"maximum":11432.6,"gross_charge":14114.32,"discounted_cash":4177.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11432.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11432.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11432.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9033.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7057.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7057.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6351.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9880.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8468.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2681.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2822.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2117.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2822.87,"methodology":"fee schedule"}]}]},{"description":"ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J1323","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34136.99,"maximum":46084.93,"gross_charge":56894.97,"discounted_cash":16840.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46084.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46084.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46084.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36981.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39826.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34136.99,"methodology":"fee schedule"}]}]},{"description":"ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J1323","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8534.25,"maximum":46084.93,"gross_charge":56894.97,"discounted_cash":16840.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46084.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46084.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46084.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36412.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28447.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28447.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25602.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39826.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34136.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10810.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11379,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8534.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11379,"methodology":"fee schedule"}]}]},{"description":"ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J1323","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58810.1,"maximum":79393.63,"gross_charge":98016.82,"discounted_cash":29012.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79393.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79393.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79393.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63710.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68611.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58810.1,"methodology":"fee schedule"}]}]},{"description":"ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J1323","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":14702.53,"maximum":79393.63,"gross_charge":98016.82,"discounted_cash":29012.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79393.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79393.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79393.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62730.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49008.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49008.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44107.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68611.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58810.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18623.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19603.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14702.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19603.37,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL (ARGININE) 1.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66215-0402-01","type":"NDC"}],"standard_charges":[{"minimum":175.25,"maximum":236.59,"gross_charge":292.08,"discounted_cash":86.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":189.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":204.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":175.25,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL (ARGININE) 1.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66215-0402-01","type":"NDC"}],"standard_charges":[{"minimum":17.92,"maximum":236.59,"gross_charge":292.08,"discounted_cash":86.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":186.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":131.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":204.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":175.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.42,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":91.79,"maximum":123.92,"gross_charge":152.98,"discounted_cash":45.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.79,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17.92,"maximum":123.92,"gross_charge":152.98,"discounted_cash":45.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":97.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.6,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":175.33,"maximum":236.7,"gross_charge":292.21,"discounted_cash":86.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":189.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":204.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":175.33,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL (GLYCINE) 1.5 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17.92,"maximum":236.7,"gross_charge":292.21,"discounted_cash":86.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":187.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":131.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":204.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":175.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66215-0403-01","type":"NDC"}],"standard_charges":[{"minimum":104.02,"maximum":140.43,"gross_charge":173.36,"discounted_cash":51.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":121.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.02,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66215-0403-01","type":"NDC"}],"standard_charges":[{"minimum":17.92,"maximum":140.43,"gross_charge":173.36,"discounted_cash":51.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":140.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":78.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":121.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":104.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.68,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0060-40","type":"NDC"}],"standard_charges":[{"minimum":124.63,"maximum":168.25,"gross_charge":207.71,"discounted_cash":61.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":135.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":145.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.63,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0060-40","type":"NDC"}],"standard_charges":[{"minimum":17.92,"maximum":168.25,"gross_charge":207.71,"discounted_cash":61.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":132.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":145.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0588-10","type":"NDC"}],"standard_charges":[{"minimum":174.77,"maximum":235.94,"gross_charge":291.28,"discounted_cash":86.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":189.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":203.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.77,"methodology":"fee schedule"}]}]},{"description":"EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0588-10","type":"NDC"}],"standard_charges":[{"minimum":17.92,"maximum":235.94,"gross_charge":291.28,"discounted_cash":86.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":186.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.92,"standard_charge_algorithm": "Lesser of $17.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":131.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":203.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.26,"methodology":"fee schedule"}]}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1327","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0163-80","type":"NDC"}],"standard_charges":[{"minimum":162.37,"maximum":219.2,"gross_charge":270.61,"discounted_cash":80.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":175.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":189.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.37,"methodology":"fee schedule"}]}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1327","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0163-80","type":"NDC"}],"standard_charges":[{"minimum":3.35,"maximum":219.2,"gross_charge":270.61,"discounted_cash":80.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":219.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":173.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.17,"standard_charge_algorithm": "Lesser of $31.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.17,"standard_charge_algorithm": "Lesser of $31.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":121.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":189.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":162.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.13,"methodology":"fee schedule"}]}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1327","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0305-51","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1327","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0305-51","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":3.35,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $31.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $31.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1327","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0026-80","type":"NDC"}],"standard_charges":[{"minimum":77.85,"maximum":105.1,"gross_charge":129.75,"discounted_cash":38.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.85,"methodology":"fee schedule"}]}]},{"description":"EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1327","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0026-80","type":"NDC"}],"standard_charges":[{"minimum":3.35,"maximum":105.1,"gross_charge":129.75,"discounted_cash":38.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.04,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.17,"standard_charge_algorithm": "Lesser of $31.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.17,"standard_charge_algorithm": "Lesser of $31.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.95,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0221-10","type":"NDC"}],"standard_charges":[{"minimum":86.46,"maximum":116.72,"gross_charge":144.09,"discounted_cash":42.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":100.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.46,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0221-10","type":"NDC"}],"standard_charges":[{"minimum":17.22,"maximum":116.72,"gross_charge":144.09,"discounted_cash":42.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":92.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":100.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0820-01","type":"NDC"}],"standard_charges":[{"minimum":102.12,"maximum":137.87,"gross_charge":170.2,"discounted_cash":50.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.12,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0820-01","type":"NDC"}],"standard_charges":[{"minimum":17.22,"maximum":137.87,"gross_charge":170.2,"discounted_cash":50.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0282-20","type":"NDC"}],"standard_charges":[{"minimum":235.12,"maximum":317.41,"gross_charge":391.86,"discounted_cash":116,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":254.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":274.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.12,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0282-20","type":"NDC"}],"standard_charges":[{"minimum":17.22,"maximum":317.41,"gross_charge":391.86,"discounted_cash":116,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":317.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":317.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":317.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":250.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":176.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":274.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":235.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.38,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0159-01","type":"NDC"}],"standard_charges":[{"minimum":81.33,"maximum":109.79,"gross_charge":135.54,"discounted_cash":40.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.33,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0159-01","type":"NDC"}],"standard_charges":[{"minimum":17.22,"maximum":109.79,"gross_charge":135.54,"discounted_cash":40.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":330.14,"maximum":445.69,"gross_charge":550.23,"discounted_cash":162.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":357.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.14,"methodology":"fee schedule"}]}]},{"description":"ERTAPENEM 1 GRAM SOLUTION FOR INJECTION","code_information":[{"code":"J1335","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17.22,"maximum":445.69,"gross_charge":550.23,"discounted_cash":162.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":352.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.22,"standard_charge_algorithm": "Lesser of $17.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":247.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.05,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1380","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0111-01","type":"NDC"}],"standard_charges":[{"minimum":102.81,"maximum":138.79,"gross_charge":171.34,"discounted_cash":50.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":111.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.81,"methodology":"fee schedule"}]}]},{"description":"ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1380","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0111-01","type":"NDC"}],"standard_charges":[{"minimum":11.71,"maximum":138.79,"gross_charge":171.34,"discounted_cash":50.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11.71,"standard_charge_algorithm": "Lesser of $11.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11.71,"standard_charge_algorithm": "Lesser of $11.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"}]}]},{"description":"CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION","code_information":[{"code":"J1410","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":883.45,"maximum":1192.66,"gross_charge":1472.41,"discounted_cash":435.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1192.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1192.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1192.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":957.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1030.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":883.45,"methodology":"fee schedule"}]}]},{"description":"CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION","code_information":[{"code":"J1410","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":220.87,"maximum":1192.66,"gross_charge":1472.41,"discounted_cash":435.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1192.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1192.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1192.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":942.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":382.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":372.15,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":391.27,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":379.17,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":585.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":401.7,"standard_charge_algorithm": "Lesser of $401.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":401.7,"standard_charge_algorithm": "Lesser of $401.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":662.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1030.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":883.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":279.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":294.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":342.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":366.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":352.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":359.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":376.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":362.86,"methodology":"case rate"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0113-82","type":"NDC"}],"standard_charges":[{"minimum":42.14,"maximum":56.88,"gross_charge":70.22,"discounted_cash":20.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.14,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0113-82","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":56.88,"gross_charge":70.22,"discounted_cash":20.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-82","type":"NDC"}],"standard_charges":[{"minimum":54,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-82","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0002-06","type":"NDC"}],"standard_charges":[{"minimum":40.11,"maximum":54.15,"gross_charge":66.85,"discounted_cash":19.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0002-06","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":54.15,"gross_charge":66.85,"discounted_cash":19.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70655-0002-06","type":"NDC"}],"standard_charges":[{"minimum":41.88,"maximum":56.54,"gross_charge":69.8,"discounted_cash":20.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.88,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70655-0002-06","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":56.54,"gross_charge":69.8,"discounted_cash":20.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.37,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.4,"maximum":58.58,"gross_charge":72.32,"discounted_cash":21.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":58.58,"gross_charge":72.32,"discounted_cash":21.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0113-87","type":"NDC"}],"standard_charges":[{"minimum":65.63,"maximum":88.59,"gross_charge":109.37,"discounted_cash":32.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.63,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0113-87","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":88.59,"gross_charge":109.37,"discounted_cash":32.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.88,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-67","type":"NDC"}],"standard_charges":[{"minimum":42.89,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-67","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-87","type":"NDC"}],"standard_charges":[{"minimum":66.13,"maximum":89.28,"gross_charge":110.21,"discounted_cash":32.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.13,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0184-87","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":89.28,"gross_charge":110.21,"discounted_cash":32.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.05,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69784-0003-06","type":"NDC"}],"standard_charges":[{"minimum":32.84,"maximum":44.34,"gross_charge":54.73,"discounted_cash":16.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.84,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69784-0003-06","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":44.34,"gross_charge":54.73,"discounted_cash":16.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70655-0088-06","type":"NDC"}],"standard_charges":[{"minimum":43.9,"maximum":59.26,"gross_charge":73.16,"discounted_cash":21.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.9,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70655-0088-06","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":59.26,"gross_charge":73.16,"discounted_cash":21.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.39,"maximum":57.22,"gross_charge":70.64,"discounted_cash":20.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.39,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":57.22,"gross_charge":70.64,"discounted_cash":20.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":78.76,"maximum":106.33,"gross_charge":131.26,"discounted_cash":38.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.76,"methodology":"fee schedule"}]}]},{"description":"FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1450","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":106.33,"gross_charge":131.26,"discounted_cash":38.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.26,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0829-02","type":"NDC"}],"standard_charges":[{"minimum":1595.45,"maximum":2153.85,"gross_charge":2659.07,"discounted_cash":787.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2153.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2153.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2153.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1728.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1861.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1595.45,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0829-02","type":"NDC"}],"standard_charges":[{"minimum":5.5,"maximum":2153.85,"gross_charge":2659.07,"discounted_cash":787.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2153.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2153.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2153.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1701.81,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1196.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1861.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1595.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":505.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":398.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"methodology":"case rate"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0710-01","type":"NDC"}],"standard_charges":[{"minimum":4493.84,"maximum":6066.69,"gross_charge":7489.73,"discounted_cash":2216.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6066.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6066.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6066.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4868.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5242.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4493.84,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0710-01","type":"NDC"}],"standard_charges":[{"minimum":5.5,"maximum":6066.69,"gross_charge":7489.73,"discounted_cash":2216.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6066.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6066.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6066.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4793.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3370.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5242.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4493.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1423.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1497.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1497.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"methodology":"case rate"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0211-02","type":"NDC"}],"standard_charges":[{"minimum":1827.93,"maximum":2467.71,"gross_charge":3046.55,"discounted_cash":901.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2467.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2467.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2467.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1980.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2132.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1827.93,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0211-02","type":"NDC"}],"standard_charges":[{"minimum":5.5,"maximum":2467.71,"gross_charge":3046.55,"discounted_cash":901.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2467.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2467.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2467.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1949.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1370.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2132.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1827.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":578.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"methodology":"case rate"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70710-1478-01","type":"NDC"}],"standard_charges":[{"minimum":2188.56,"maximum":2954.56,"gross_charge":3647.6,"discounted_cash":1079.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2954.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2954.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2954.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2370.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2553.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2188.56,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70710-1478-01","type":"NDC"}],"standard_charges":[{"minimum":5.5,"maximum":2954.56,"gross_charge":3647.6,"discounted_cash":1079.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2954.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2954.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2954.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2334.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1641.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2553.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2188.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":693.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":547.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":729.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"methodology":"case rate"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5449.68,"maximum":7357.06,"gross_charge":9082.79,"discounted_cash":2688.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7357.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7357.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7357.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5903.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6357.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5449.68,"methodology":"fee schedule"}]}]},{"description":"FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1451","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.5,"maximum":7357.06,"gross_charge":9082.79,"discounted_cash":2688.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7357.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7357.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7357.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5812.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":9.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.57,"standard_charge_algorithm": "Lesser of $7.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4087.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6357.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5449.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1725.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1816.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":5.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":5.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":5.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":5.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":5.83,"methodology":"case rate"}]}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0859-11","type":"NDC"}],"standard_charges":[{"minimum":538.5,"maximum":726.98,"gross_charge":897.5,"discounted_cash":265.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":726.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":726.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":583.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":628.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":538.5,"methodology":"fee schedule"}]}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0859-11","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":726.98,"gross_charge":897.5,"discounted_cash":265.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":726.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":726.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":726.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":574.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":403.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":628.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":538.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.5,"methodology":"fee schedule"}]}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0889-10","type":"NDC"}],"standard_charges":[{"minimum":136.78,"maximum":184.65,"gross_charge":227.96,"discounted_cash":67.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":148.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":159.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.78,"methodology":"fee schedule"}]}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0889-10","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":184.65,"gross_charge":227.96,"discounted_cash":67.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":145.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":102.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":159.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":136.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.6,"methodology":"fee schedule"}]}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72205-0083-01","type":"NDC"}],"standard_charges":[{"minimum":76.36,"maximum":103.09,"gross_charge":127.26,"discounted_cash":37.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.36,"methodology":"fee schedule"}]}]},{"description":"FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72205-0083-01","type":"NDC"}],"standard_charges":[{"minimum":0.16,"maximum":103.09,"gross_charge":127.26,"discounted_cash":37.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.16,"standard_charge_algorithm": "Lesser of $0.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.46,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 10 G/100 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0437-91","type":"NDC"}],"standard_charges":[{"minimum":4821.24,"maximum":6508.67,"gross_charge":8035.39,"discounted_cash":2378.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6508.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6508.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6508.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5223.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5624.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4821.24,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 10 G/100 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0437-91","type":"NDC"}],"standard_charges":[{"minimum":43.97,"maximum":6508.67,"gross_charge":8035.39,"discounted_cash":2378.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6508.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6508.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6508.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5142.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":75.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3615.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5624.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4821.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1526.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1607.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1205.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1607.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":47.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":46.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46.61,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 20 G/200 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0438-92","type":"NDC"}],"standard_charges":[{"minimum":9431.01,"maximum":12731.87,"gross_charge":15718.35,"discounted_cash":4652.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12731.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12731.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12731.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10216.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11002.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9431.01,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 20 G/200 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0438-92","type":"NDC"}],"standard_charges":[{"minimum":43.97,"maximum":12731.87,"gross_charge":15718.35,"discounted_cash":4652.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12731.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12731.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12731.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10059.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":75.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7073.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11002.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9431.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2986.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3143.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2357.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3143.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":47.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":46.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46.61,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 40 G/400 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0439-93","type":"NDC"}],"standard_charges":[{"minimum":15455.27,"maximum":20864.62,"gross_charge":25758.78,"discounted_cash":7624.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20864.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20864.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20864.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16743.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18031.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15455.27,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 40 G/400 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0439-93","type":"NDC"}],"standard_charges":[{"minimum":43.97,"maximum":20864.62,"gross_charge":25758.78,"discounted_cash":7624.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20864.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20864.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20864.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16485.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":75.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11591.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18031.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15455.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4894.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5151.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3863.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5151.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":47.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":46.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46.61,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 5 G/50 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0436-90","type":"NDC"}],"standard_charges":[{"minimum":2516.35,"maximum":3397.07,"gross_charge":4193.91,"discounted_cash":1241.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3397.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3397.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3397.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2726.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2935.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2516.35,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (PRIVIGEN) 5 G/50 ML (10%) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0436-90","type":"NDC"}],"standard_charges":[{"minimum":43.97,"maximum":3397.07,"gross_charge":4193.91,"discounted_cash":1241.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3397.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3397.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3397.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2684.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":48.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":75.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.77,"standard_charge_algorithm": "Lesser of $52.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1887.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2935.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2516.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":796.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":629.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":838.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.97,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":47.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":45.29,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":46.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":48.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":46.61,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOB G 10 GRAM/100 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0800-71","type":"NDC"}],"standard_charges":[{"minimum":3577.94,"maximum":4830.21,"gross_charge":5963.22,"discounted_cash":1765.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4830.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4830.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4830.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3876.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4174.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3577.94,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOB G 10 GRAM/100 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0800-71","type":"NDC"}],"standard_charges":[{"minimum":43.22,"maximum":4830.21,"gross_charge":5963.22,"discounted_cash":1765.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4830.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4830.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4830.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3816.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":49.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.48,"standard_charge_algorithm": "Lesser of $50.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.48,"standard_charge_algorithm": "Lesser of $50.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2683.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4174.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3577.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":894.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1192.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":46.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.81,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0800-24","type":"NDC"}],"standard_charges":[{"minimum":6944.41,"maximum":9374.95,"gross_charge":11574.01,"discounted_cash":3425.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9374.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9374.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9374.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7523.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8101.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6944.41,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0800-24","type":"NDC"}],"standard_charges":[{"minimum":43.22,"maximum":9374.95,"gross_charge":11574.01,"discounted_cash":3425.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9374.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9374.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9374.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7407.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":49.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.48,"standard_charge_algorithm": "Lesser of $50.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.48,"standard_charge_algorithm": "Lesser of $50.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5208.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8101.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6944.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2199.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2314.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1736.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2314.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":46.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.81,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0800-20","type":"NDC"}],"standard_charges":[{"minimum":1894.7,"maximum":2557.85,"gross_charge":3157.83,"discounted_cash":934.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2557.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2557.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2557.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2052.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2210.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1894.7,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBU G 5 GRAM/50 ML(10 %)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0800-20","type":"NDC"}],"standard_charges":[{"minimum":43.22,"maximum":2557.85,"gross_charge":3157.83,"discounted_cash":934.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2557.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2557.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2557.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2021.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":49.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.48,"standard_charge_algorithm": "Lesser of $50.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.48,"standard_charge_algorithm": "Lesser of $50.48 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1421.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2210.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1894.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":599.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":473.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":43.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":46.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.81,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (100 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-03","type":"NDC"}],"standard_charges":[{"minimum":3089.87,"maximum":4171.32,"gross_charge":5149.77,"discounted_cash":1524.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4171.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4171.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4171.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3347.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3604.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3089.87,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (100 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-03","type":"NDC"}],"standard_charges":[{"minimum":42.96,"maximum":4171.32,"gross_charge":5149.77,"discounted_cash":1524.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4171.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4171.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4171.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3295.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2317.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3604.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3089.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":978.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1029.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.54,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (20 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-01","type":"NDC"}],"standard_charges":[{"minimum":766.71,"maximum":1035.06,"gross_charge":1277.84,"discounted_cash":378.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1035.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1035.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1035.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":830.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":894.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":766.71,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (20 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-01","type":"NDC"}],"standard_charges":[{"minimum":42.96,"maximum":1035.06,"gross_charge":1277.84,"discounted_cash":378.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1035.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1035.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1035.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":817.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":575.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":894.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":766.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":255.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.54,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (200 ML )","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-04","type":"NDC"}],"standard_charges":[{"minimum":5993.82,"maximum":8091.65,"gross_charge":9989.69,"discounted_cash":2956.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8091.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8091.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8091.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6493.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6992.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5993.82,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (200 ML )","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-04","type":"NDC"}],"standard_charges":[{"minimum":42.96,"maximum":8091.65,"gross_charge":9989.69,"discounted_cash":2956.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8091.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8091.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8091.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6393.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4495.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6992.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5993.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1898.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1997.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1498.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1997.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.54,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (300 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-05","type":"NDC"}],"standard_charges":[{"minimum":8897.76,"maximum":12011.98,"gross_charge":14829.6,"discounted_cash":4389.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12011.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12011.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12011.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9639.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10380.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8897.76,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (300 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-05","type":"NDC"}],"standard_charges":[{"minimum":42.96,"maximum":12011.98,"gross_charge":14829.6,"discounted_cash":4389.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12011.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12011.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12011.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9490.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6673.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10380.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8897.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2817.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2965.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2224.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2965.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.54,"methodology":"case rate"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (50 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-02","type":"NDC"}],"standard_charges":[{"minimum":1637.89,"maximum":2211.15,"gross_charge":2729.81,"discounted_cash":808.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2211.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2211.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2211.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1774.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1910.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.89,"methodology":"fee schedule"}]}]},{"description":"IMMUNE GLOBULIN (IGG) (HUMAN) 10 % AND MALTOSE IV SOLUTION (50 ML)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1568","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0850-02","type":"NDC"}],"standard_charges":[{"minimum":42.96,"maximum":2211.15,"gross_charge":2729.81,"discounted_cash":808.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2211.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2211.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2211.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1747.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":49.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.82,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":73.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.57,"standard_charge_algorithm": "Lesser of $47.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1228.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1910.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1637.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":518.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":409.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":545.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":42.96,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":45.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":44.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":45.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":47.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":45.54,"methodology":"case rate"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0185-10","type":"NDC"}],"standard_charges":[{"minimum":124.56,"maximum":168.16,"gross_charge":207.6,"discounted_cash":61.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":134.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":145.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.56,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0185-10","type":"NDC"}],"standard_charges":[{"minimum":31.14,"maximum":168.16,"gross_charge":207.6,"discounted_cash":61.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":168.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":168.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":132.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":145.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0173-01","type":"NDC"}],"standard_charges":[{"minimum":148.35,"maximum":200.27,"gross_charge":247.24,"discounted_cash":73.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":160.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":173.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.35,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0173-01","type":"NDC"}],"standard_charges":[{"minimum":37.09,"maximum":200.27,"gross_charge":247.24,"discounted_cash":73.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":158.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":111.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":173.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0315-41","type":"NDC"}],"standard_charges":[{"minimum":127.64,"maximum":172.32,"gross_charge":212.73,"discounted_cash":62.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":138.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":148.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.64,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0315-41","type":"NDC"}],"standard_charges":[{"minimum":31.91,"maximum":172.32,"gross_charge":212.73,"discounted_cash":62.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":136.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":95.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":148.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.55,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0315-94","type":"NDC"}],"standard_charges":[{"minimum":127.62,"maximum":172.28,"gross_charge":212.69,"discounted_cash":62.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":138.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":148.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.62,"methodology":"fee schedule"}]}]},{"description":"GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0315-94","type":"NDC"}],"standard_charges":[{"minimum":31.91,"maximum":172.28,"gross_charge":212.69,"discounted_cash":62.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":172.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":172.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":172.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":136.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.39,"standard_charge_algorithm": "Lesser of $49.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":95.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":148.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":127.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.54,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0010-01","type":"NDC"}],"standard_charges":[{"minimum":35.47,"maximum":47.88,"gross_charge":59.11,"discounted_cash":17.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0010-01","type":"NDC"}],"standard_charges":[{"minimum":3.01,"maximum":47.88,"gross_charge":59.11,"discounted_cash":17.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.01,"standard_charge_algorithm": "Lesser of $3.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.01,"standard_charge_algorithm": "Lesser of $3.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0010-95","type":"NDC"}],"standard_charges":[{"minimum":90.48,"maximum":122.14,"gross_charge":150.79,"discounted_cash":44.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":98.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0010-95","type":"NDC"}],"standard_charges":[{"minimum":3.01,"maximum":122.14,"gross_charge":150.79,"discounted_cash":44.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.01,"standard_charge_algorithm": "Lesser of $3.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.01,"standard_charge_algorithm": "Lesser of $3.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.16,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.63,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"}]}]},{"description":"GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1580","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.01,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.01,"standard_charge_algorithm": "Lesser of $3.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.01,"standard_charge_algorithm": "Lesser of $3.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE (PF) 1 MG/5 ML (0.2 MG/ML) IN STERILE WATER IV SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62295-3326-05","type":"NDC"}],"standard_charges":[{"minimum":50.47,"maximum":68.13,"gross_charge":84.11,"discounted_cash":24.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"}]}]},{"description":"GLYCOPYRROLATE (PF) 1 MG/5 ML (0.2 MG/ML) IN STERILE WATER IV SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62295-3326-05","type":"NDC"}],"standard_charges":[{"minimum":12.62,"maximum":68.13,"gross_charge":84.11,"discounted_cash":24.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"}]}]},{"description":"GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1602","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0350-01","type":"NDC"}],"standard_charges":[{"minimum":8587.62,"maximum":11593.29,"gross_charge":14312.7,"discounted_cash":4236.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11593.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11593.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11593.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9303.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10018.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8587.62,"methodology":"fee schedule"}]}]},{"description":"GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1602","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0350-01","type":"NDC"}],"standard_charges":[{"minimum":9.63,"maximum":11593.29,"gross_charge":14312.7,"discounted_cash":4236.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11593.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11593.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11593.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9160.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":10.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":12.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":16.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":15.91,"standard_charge_algorithm": "Lesser of $15.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":15.91,"standard_charge_algorithm": "Lesser of $15.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6440.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10018.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8587.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2719.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2862.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2146.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2862.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":10.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.92,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":10.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":10.21,"methodology":"case rate"}]}]},{"description":"GLUCAGON 1 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J1610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":261.92,"maximum":353.59,"gross_charge":436.53,"discounted_cash":129.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":283.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":305.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.92,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON 1 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J1610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.48,"maximum":353.59,"gross_charge":436.53,"discounted_cash":129.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":279.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":184.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":193.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":191.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":291.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":192.47,"standard_charge_algorithm": "Lesser of $192.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":192.47,"standard_charge_algorithm": "Lesser of $192.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":196.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":305.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":170.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":182.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":175.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":179.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":187.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":180.78,"methodology":"case rate"}]}]},{"description":"GLUCAGON 1 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J1610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":261.96,"maximum":353.65,"gross_charge":436.6,"discounted_cash":129.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":283.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":305.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.96,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON 1 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J1610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.49,"maximum":353.65,"gross_charge":436.6,"discounted_cash":129.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":353.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":353.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":353.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":279.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":184.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":188.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":193.04,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":191.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":291.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":192.47,"standard_charge_algorithm": "Lesser of $192.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":192.47,"standard_charge_algorithm": "Lesser of $192.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":196.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":305.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":170.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":182.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":175.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":179.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":187.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":180.78,"methodology":"case rate"}]}]},{"description":"GLUCAGON HCL 1 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0583-13","type":"NDC"}],"standard_charges":[{"minimum":529.71,"maximum":715.11,"gross_charge":882.85,"discounted_cash":261.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":715.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":715.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":715.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":573.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":529.71,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0583-13","type":"NDC"}],"standard_charges":[{"minimum":132.43,"maximum":715.11,"gross_charge":882.85,"discounted_cash":261.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":715.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":715.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":715.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":565.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":441.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":441.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":397.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":618,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":529.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.57,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0593-03","type":"NDC"}],"standard_charges":[{"minimum":377.1,"maximum":509.08,"gross_charge":628.49,"discounted_cash":186.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":509.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":408.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":439.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.1,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0593-03","type":"NDC"}],"standard_charges":[{"minimum":94.28,"maximum":509.08,"gross_charge":628.49,"discounted_cash":186.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":509.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":402.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":314.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":314.25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":282.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":439.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.7,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0594-03","type":"NDC"}],"standard_charges":[{"minimum":317.79,"maximum":429.01,"gross_charge":529.64,"discounted_cash":156.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":344.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":370.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317.79,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0594-03","type":"NDC"}],"standard_charges":[{"minimum":79.45,"maximum":429.01,"gross_charge":529.64,"discounted_cash":156.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":429.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":429.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":429.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":338.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":264.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":264.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":238.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":370.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.93,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0596-03","type":"NDC"}],"standard_charges":[{"minimum":376.01,"maximum":507.62,"gross_charge":626.68,"discounted_cash":185.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":407.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":438.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.01,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0596-03","type":"NDC"}],"standard_charges":[{"minimum":94.01,"maximum":507.62,"gross_charge":626.68,"discounted_cash":185.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":401.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":313.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":313.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":282.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":438.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.34,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0596-11","type":"NDC"}],"standard_charges":[{"minimum":376.01,"maximum":507.61,"gross_charge":626.67,"discounted_cash":185.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":407.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":438.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.01,"methodology":"fee schedule"}]}]},{"description":"GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0596-11","type":"NDC"}],"standard_charges":[{"minimum":94.01,"maximum":507.61,"gross_charge":626.67,"discounted_cash":185.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":401.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":313.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":313.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":282.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":438.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.34,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1626","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0546-02","type":"NDC"}],"standard_charges":[{"minimum":41.81,"maximum":56.44,"gross_charge":69.67,"discounted_cash":20.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1626","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0546-02","type":"NDC"}],"standard_charges":[{"minimum":0.43,"maximum":56.44,"gross_charge":69.67,"discounted_cash":20.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.43,"standard_charge_algorithm": "Lesser of $0.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.43,"standard_charge_algorithm": "Lesser of $0.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1626","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.48,"maximum":51.94,"gross_charge":64.12,"discounted_cash":18.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J1626","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.43,"maximum":51.94,"gross_charge":64.12,"discounted_cash":18.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.43,"standard_charge_algorithm": "Lesser of $0.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.43,"standard_charge_algorithm": "Lesser of $0.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10147-0911-01","type":"NDC"}],"standard_charges":[{"minimum":45.96,"maximum":62.04,"gross_charge":76.59,"discounted_cash":22.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.96,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10147-0911-01","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":62.04,"gross_charge":76.59,"discounted_cash":22.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0806-01","type":"NDC"}],"standard_charges":[{"minimum":37.18,"maximum":50.19,"gross_charge":61.96,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0806-01","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":50.19,"gross_charge":61.96,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0474-01","type":"NDC"}],"standard_charges":[{"minimum":34.61,"maximum":46.73,"gross_charge":57.68,"discounted_cash":17.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.61,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0474-01","type":"NDC"}],"standard_charges":[{"minimum":1.82,"maximum":46.73,"gross_charge":57.68,"discounted_cash":17.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.71,"maximum":45.51,"gross_charge":56.18,"discounted_cash":16.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.82,"maximum":45.51,"gross_charge":56.18,"discounted_cash":16.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.3,"maximum":49.01,"gross_charge":60.5,"discounted_cash":17.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1630","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.82,"maximum":49.01,"gross_charge":60.5,"discounted_cash":17.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.82,"standard_charge_algorithm": "Lesser of $1.82 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0469-01","type":"NDC"}],"standard_charges":[{"minimum":50.12,"maximum":67.66,"gross_charge":83.52,"discounted_cash":24.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0469-01","type":"NDC"}],"standard_charges":[{"minimum":8.79,"maximum":67.66,"gross_charge":83.52,"discounted_cash":24.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.79,"standard_charge_algorithm": "Lesser of $8.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.79,"standard_charge_algorithm": "Lesser of $8.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0410-13","type":"NDC"}],"standard_charges":[{"minimum":61.74,"maximum":83.35,"gross_charge":102.89,"discounted_cash":30.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.74,"methodology":"fee schedule"}]}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0410-13","type":"NDC"}],"standard_charges":[{"minimum":8.79,"maximum":83.35,"gross_charge":102.89,"discounted_cash":30.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.79,"standard_charge_algorithm": "Lesser of $8.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.79,"standard_charge_algorithm": "Lesser of $8.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.58,"methodology":"fee schedule"}]}]},{"description":"HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55292-0702-55","type":"NDC"}],"standard_charges":[{"minimum":23747.55,"maximum":32059.19,"gross_charge":39579.24,"discounted_cash":11715.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32059.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32059.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32059.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":25726.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":27705.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23747.55,"methodology":"fee schedule"}]}]},{"description":"HEMIN 350 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1640","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55292-0702-55","type":"NDC"}],"standard_charges":[{"minimum":29.57,"maximum":32059.19,"gross_charge":39579.24,"discounted_cash":11715.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32059.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32059.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32059.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":25330.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":33.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":50.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.79,"standard_charge_algorithm": "Lesser of $32.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.79,"standard_charge_algorithm": "Lesser of $32.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17810.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":27705.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23747.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7520.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7915.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5936.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7915.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":29.57,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":31.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":30.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":31.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":32.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":31.34,"methodology":"case rate"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63807-0600-55","type":"NDC"}],"standard_charges":[{"minimum":33.83,"maximum":45.66,"gross_charge":56.37,"discounted_cash":16.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63807-0600-55","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":45.66,"gross_charge":56.37,"discounted_cash":16.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64253-0333-35","type":"NDC"}],"standard_charges":[{"minimum":34.08,"maximum":46,"gross_charge":56.79,"discounted_cash":16.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.08,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64253-0333-35","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":46,"gross_charge":56.79,"discounted_cash":16.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.22,"maximum":51.59,"gross_charge":63.69,"discounted_cash":18.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.02,"maximum":51.59,"gross_charge":63.69,"discounted_cash":18.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.43,"maximum":66.73,"gross_charge":82.38,"discounted_cash":24.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.43,"methodology":"fee schedule"}]}]},{"description":"HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE","code_information":[{"code":"J1642","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.02,"maximum":66.73,"gross_charge":82.38,"discounted_cash":24.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.48,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) (PF) 1000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV","code_information":[{"code":"J1643","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.63,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) (PF) 1000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV","code_information":[{"code":"J1643","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.41,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) (PF) 2000 UNIT/1000 ML IN 0.9 % SODIUM CHLORIDE IV","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.89,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) (PF) 2000 UNIT/1000 ML IN 0.9 % SODIUM CHLORIDE IV","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0400-10","type":"NDC"}],"standard_charges":[{"minimum":40.97,"maximum":55.31,"gross_charge":68.28,"discounted_cash":20.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0400-10","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":55.31,"gross_charge":68.28,"discounted_cash":20.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0400-30","type":"NDC"}],"standard_charges":[{"minimum":48.09,"maximum":64.93,"gross_charge":80.15,"discounted_cash":23.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0400-30","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":64.93,"gross_charge":80.15,"discounted_cash":23.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0400-67","type":"NDC"}],"standard_charges":[{"minimum":36.96,"maximum":49.89,"gross_charge":61.59,"discounted_cash":18.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.96,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0400-67","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":49.89,"gross_charge":61.59,"discounted_cash":18.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0540-11","type":"NDC"}],"standard_charges":[{"minimum":40.37,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0540-11","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0540-31","type":"NDC"}],"standard_charges":[{"minimum":47.57,"maximum":64.21,"gross_charge":79.27,"discounted_cash":23.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0540-31","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":64.21,"gross_charge":79.27,"discounted_cash":23.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0540-33","type":"NDC"}],"standard_charges":[{"minimum":45.06,"maximum":60.84,"gross_charge":75.1,"discounted_cash":22.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0540-33","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":60.84,"gross_charge":75.1,"discounted_cash":22.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63739-0931-14","type":"NDC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63739-0931-14","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0384-99","type":"NDC"}],"standard_charges":[{"minimum":50.9,"maximum":68.72,"gross_charge":84.83,"discounted_cash":25.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.9,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0384-99","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":68.72,"gross_charge":84.83,"discounted_cash":25.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0420-95","type":"NDC"}],"standard_charges":[{"minimum":36.1,"maximum":48.73,"gross_charge":60.16,"discounted_cash":17.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.1,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0420-95","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":48.73,"gross_charge":60.16,"discounted_cash":17.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0179-25","type":"NDC"}],"standard_charges":[{"minimum":36.05,"maximum":48.66,"gross_charge":60.07,"discounted_cash":17.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0179-25","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":48.66,"gross_charge":60.07,"discounted_cash":17.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.57,"maximum":54.77,"gross_charge":67.61,"discounted_cash":20.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":54.77,"gross_charge":67.61,"discounted_cash":20.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.35,"maximum":55.82,"gross_charge":68.91,"discounted_cash":20.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 1000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":55.82,"gross_charge":68.91,"discounted_cash":20.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 25000 UNIT/500 ML (50 UNIT/ML) IN DEXTROSE 5 % IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0522-77","type":"NDC"}],"standard_charges":[{"minimum":53,"maximum":71.54,"gross_charge":88.32,"discounted_cash":26.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 25000 UNIT/500 ML (50 UNIT/ML) IN DEXTROSE 5 % IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0522-77","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":71.54,"gross_charge":88.32,"discounted_cash":26.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 25000 UNIT/500 ML (50 UNIT/ML) IN DEXTROSE 5 % IV","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":74.46,"maximum":100.53,"gross_charge":124.1,"discounted_cash":36.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 25000 UNIT/500 ML (50 UNIT/ML) IN DEXTROSE 5 % IV","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":100.53,"gross_charge":124.1,"discounted_cash":36.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0402-01","type":"NDC"}],"standard_charges":[{"minimum":35.69,"maximum":48.18,"gross_charge":59.47,"discounted_cash":17.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0402-01","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":48.18,"gross_charge":59.47,"discounted_cash":17.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.9,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0402-66","type":"NDC"}],"standard_charges":[{"minimum":35.84,"maximum":48.39,"gross_charge":59.73,"discounted_cash":17.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0402-66","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":48.39,"gross_charge":59.73,"discounted_cash":17.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"37300-0101-81","type":"NDC"}],"standard_charges":[{"minimum":37.09,"maximum":50.07,"gross_charge":61.81,"discounted_cash":18.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.09,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"37300-0101-81","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":50.07,"gross_charge":61.81,"discounted_cash":18.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0262-01","type":"NDC"}],"standard_charges":[{"minimum":36.56,"maximum":49.35,"gross_charge":60.92,"discounted_cash":18.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0262-01","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":49.35,"gross_charge":60.92,"discounted_cash":18.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0262-06","type":"NDC"}],"standard_charges":[{"minimum":35.79,"maximum":48.32,"gross_charge":59.65,"discounted_cash":17.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0262-06","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":48.32,"gross_charge":59.65,"discounted_cash":17.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0403-02","type":"NDC"}],"standard_charges":[{"minimum":34.41,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0403-02","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":46.45,"gross_charge":57.34,"discounted_cash":16.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0255-01","type":"NDC"}],"standard_charges":[{"minimum":36.25,"maximum":48.94,"gross_charge":60.41,"discounted_cash":17.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0255-01","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":48.94,"gross_charge":60.41,"discounted_cash":17.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0255-25","type":"NDC"}],"standard_charges":[{"minimum":37.19,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0255-25","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0412-01","type":"NDC"}],"standard_charges":[{"minimum":34.34,"maximum":46.36,"gross_charge":57.23,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0412-01","type":"NDC"}],"standard_charges":[{"minimum":0.28,"maximum":46.36,"gross_charge":57.23,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.06,"maximum":47.33,"gross_charge":58.42,"discounted_cash":17.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":47.33,"gross_charge":58.42,"discounted_cash":17.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.07,"maximum":48.69,"gross_charge":60.11,"discounted_cash":17.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"}]}]},{"description":"HEPARIN (PORCINE) 5000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1644","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.28,"maximum":48.69,"gross_charge":60.11,"discounted_cash":17.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.28,"standard_charge_algorithm": "Lesser of $0.28 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0046-10","type":"NDC"}],"standard_charges":[{"minimum":46.71,"maximum":63.06,"gross_charge":77.84,"discounted_cash":23.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.71,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0046-10","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":63.06,"gross_charge":77.84,"discounted_cash":23.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.57,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-71","type":"NDC"}],"standard_charges":[{"minimum":45.2,"maximum":61.02,"gross_charge":75.33,"discounted_cash":22.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.2,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-71","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":61.02,"gross_charge":75.33,"discounted_cash":22.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.07,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-84","type":"NDC"}],"standard_charges":[{"minimum":54.48,"maximum":73.54,"gross_charge":90.79,"discounted_cash":26.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.48,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-84","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":73.54,"gross_charge":90.79,"discounted_cash":26.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.16,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0586-96","type":"NDC"}],"standard_charges":[{"minimum":52.39,"maximum":70.73,"gross_charge":87.31,"discounted_cash":25.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.39,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0586-96","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":70.73,"gross_charge":87.31,"discounted_cash":25.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0605-84","type":"NDC"}],"standard_charges":[{"minimum":78.74,"maximum":106.29,"gross_charge":131.22,"discounted_cash":38.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.74,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0605-84","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":106.29,"gross_charge":131.22,"discounted_cash":38.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.25,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-88","type":"NDC"}],"standard_charges":[{"minimum":50.82,"maximum":68.61,"gross_charge":84.7,"discounted_cash":25.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-88","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":68.61,"gross_charge":84.7,"discounted_cash":25.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.25,"maximum":67.83,"gross_charge":83.74,"discounted_cash":24.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":67.83,"gross_charge":83.74,"discounted_cash":24.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.98,"maximum":70.17,"gross_charge":86.62,"discounted_cash":25.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":70.17,"gross_charge":86.62,"discounted_cash":25.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.38,"maximum":74.76,"gross_charge":92.29,"discounted_cash":27.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":74.76,"gross_charge":92.29,"discounted_cash":27.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.46,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0056-10","type":"NDC"}],"standard_charges":[{"minimum":49.41,"maximum":66.7,"gross_charge":82.34,"discounted_cash":24.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0056-10","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":66.7,"gross_charge":82.34,"discounted_cash":24.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.47,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0411-70","type":"NDC"}],"standard_charges":[{"minimum":38.11,"maximum":51.45,"gross_charge":63.51,"discounted_cash":18.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0411-70","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":51.45,"gross_charge":63.51,"discounted_cash":18.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0569-90","type":"NDC"}],"standard_charges":[{"minimum":88.89,"maximum":120,"gross_charge":148.14,"discounted_cash":43.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":103.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.89,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0569-90","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":120,"gross_charge":148.14,"discounted_cash":43.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":94.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":103.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.63,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0411-81","type":"NDC"}],"standard_charges":[{"minimum":74.39,"maximum":100.43,"gross_charge":123.98,"discounted_cash":36.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.39,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0411-81","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":100.43,"gross_charge":123.98,"discounted_cash":36.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.8,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.85,"maximum":72.7,"gross_charge":89.75,"discounted_cash":26.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.85,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":72.7,"gross_charge":89.75,"discounted_cash":26.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.95,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.71,"maximum":73.86,"gross_charge":91.18,"discounted_cash":26.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":73.86,"gross_charge":91.18,"discounted_cash":26.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.24,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.94,"maximum":75.52,"gross_charge":93.23,"discounted_cash":27.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.94,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":75.52,"gross_charge":93.23,"discounted_cash":27.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":61.03,"maximum":82.39,"gross_charge":101.71,"discounted_cash":30.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.03,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":82.39,"gross_charge":101.71,"discounted_cash":30.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.35,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":78.26,"maximum":105.65,"gross_charge":130.42,"discounted_cash":38.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.26,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":105.65,"gross_charge":130.42,"discounted_cash":38.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0066-10","type":"NDC"}],"standard_charges":[{"minimum":53.55,"maximum":72.3,"gross_charge":89.25,"discounted_cash":26.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0066-10","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":72.3,"gross_charge":89.25,"discounted_cash":26.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0798-04","type":"NDC"}],"standard_charges":[{"minimum":89.62,"maximum":120.99,"gross_charge":149.36,"discounted_cash":44.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":97.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":104.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.62,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0798-04","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":120.99,"gross_charge":149.36,"discounted_cash":44.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":120.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":120.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":120.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":104.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":89.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.88,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0537-84","type":"NDC"}],"standard_charges":[{"minimum":101.69,"maximum":137.28,"gross_charge":169.47,"discounted_cash":50.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":118.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.69,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0537-84","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":137.28,"gross_charge":169.47,"discounted_cash":50.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":118.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0569-84","type":"NDC"}],"standard_charges":[{"minimum":102.91,"maximum":138.93,"gross_charge":171.51,"discounted_cash":50.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":111.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.91,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0569-84","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":138.93,"gross_charge":171.51,"discounted_cash":50.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.31,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0411-83","type":"NDC"}],"standard_charges":[{"minimum":68.05,"maximum":91.87,"gross_charge":113.41,"discounted_cash":33.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.05,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0411-83","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":91.87,"gross_charge":113.41,"discounted_cash":33.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.69,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.08,"maximum":79.76,"gross_charge":98.46,"discounted_cash":29.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.08,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":79.76,"gross_charge":98.46,"discounted_cash":29.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":61.68,"maximum":83.26,"gross_charge":102.79,"discounted_cash":30.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.68,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":83.26,"gross_charge":102.79,"discounted_cash":30.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.06,"maximum":87.83,"gross_charge":108.42,"discounted_cash":32.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.06,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":87.83,"gross_charge":108.42,"discounted_cash":32.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.69,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0006-01","type":"NDC"}],"standard_charges":[{"minimum":37.65,"maximum":50.82,"gross_charge":62.74,"discounted_cash":18.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0006-01","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":50.82,"gross_charge":62.74,"discounted_cash":18.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-70","type":"NDC"}],"standard_charges":[{"minimum":37.05,"maximum":50.01,"gross_charge":61.74,"discounted_cash":18.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.05,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-70","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":50.01,"gross_charge":61.74,"discounted_cash":18.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0791-00","type":"NDC"}],"standard_charges":[{"minimum":44.16,"maximum":59.61,"gross_charge":73.59,"discounted_cash":21.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.16,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0791-00","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":59.61,"gross_charge":73.59,"discounted_cash":21.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.72,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0533-83","type":"NDC"}],"standard_charges":[{"minimum":46.59,"maximum":62.89,"gross_charge":77.64,"discounted_cash":22.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0533-83","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":62.89,"gross_charge":77.64,"discounted_cash":22.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.68,"maximum":50.87,"gross_charge":62.8,"discounted_cash":18.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.68,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":50.87,"gross_charge":62.8,"discounted_cash":18.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.21,"maximum":51.58,"gross_charge":63.67,"discounted_cash":18.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":51.58,"gross_charge":63.67,"discounted_cash":18.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.48,"maximum":51.95,"gross_charge":64.13,"discounted_cash":18.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":51.95,"gross_charge":64.13,"discounted_cash":18.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.97,"maximum":55.3,"gross_charge":68.27,"discounted_cash":20.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":55.3,"gross_charge":68.27,"discounted_cash":20.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0016-10","type":"NDC"}],"standard_charges":[{"minimum":38.41,"maximum":51.85,"gross_charge":64.01,"discounted_cash":18.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.41,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0016-10","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":51.85,"gross_charge":64.01,"discounted_cash":18.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-76","type":"NDC"}],"standard_charges":[{"minimum":46.16,"maximum":62.32,"gross_charge":76.93,"discounted_cash":22.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.16,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-76","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":62.32,"gross_charge":76.93,"discounted_cash":22.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.39,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0535-98","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0535-98","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-87","type":"NDC"}],"standard_charges":[{"minimum":51.14,"maximum":69.04,"gross_charge":85.23,"discounted_cash":25.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-87","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":69.04,"gross_charge":85.23,"discounted_cash":25.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.05,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-82","type":"NDC"}],"standard_charges":[{"minimum":40.1,"maximum":54.13,"gross_charge":66.82,"discounted_cash":19.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-82","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":54.13,"gross_charge":66.82,"discounted_cash":19.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.19,"maximum":51.56,"gross_charge":63.65,"discounted_cash":18.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":51.56,"gross_charge":63.65,"discounted_cash":18.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.08,"maximum":52.75,"gross_charge":65.12,"discounted_cash":19.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":52.75,"gross_charge":65.12,"discounted_cash":19.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.44,"maximum":53.24,"gross_charge":65.72,"discounted_cash":19.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":53.24,"gross_charge":65.72,"discounted_cash":19.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.94,"maximum":64.72,"gross_charge":79.9,"discounted_cash":23.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":64.72,"gross_charge":79.9,"discounted_cash":23.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-77","type":"NDC"}],"standard_charges":[{"minimum":40.28,"maximum":54.37,"gross_charge":67.12,"discounted_cash":19.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-77","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":54.37,"gross_charge":67.12,"discounted_cash":19.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0566-21","type":"NDC"}],"standard_charges":[{"minimum":44,"maximum":59.4,"gross_charge":73.33,"discounted_cash":21.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0566-21","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":59.4,"gross_charge":73.33,"discounted_cash":21.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-88","type":"NDC"}],"standard_charges":[{"minimum":60.36,"maximum":81.49,"gross_charge":100.6,"discounted_cash":29.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.36,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-88","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":81.49,"gross_charge":100.6,"discounted_cash":29.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.12,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0607-88","type":"NDC"}],"standard_charges":[{"minimum":60.37,"maximum":81.5,"gross_charge":100.61,"discounted_cash":29.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.37,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0607-88","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":81.5,"gross_charge":100.61,"discounted_cash":29.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.13,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-85","type":"NDC"}],"standard_charges":[{"minimum":43.31,"maximum":58.46,"gross_charge":72.17,"discounted_cash":21.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-85","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":58.46,"gross_charge":72.17,"discounted_cash":21.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.44,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.1,"maximum":58.18,"gross_charge":71.82,"discounted_cash":21.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":58.18,"gross_charge":71.82,"discounted_cash":21.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.37,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.12,"maximum":59.56,"gross_charge":73.52,"discounted_cash":21.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":59.56,"gross_charge":73.52,"discounted_cash":21.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.09,"maximum":64.92,"gross_charge":80.14,"discounted_cash":23.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":64.92,"gross_charge":80.14,"discounted_cash":23.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.52,"maximum":74.95,"gross_charge":92.53,"discounted_cash":27.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.52,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":74.95,"gross_charge":92.53,"discounted_cash":27.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.51,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0036-01","type":"NDC"}],"standard_charges":[{"minimum":43.34,"maximum":58.51,"gross_charge":72.23,"discounted_cash":21.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.34,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0036-01","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":58.51,"gross_charge":72.23,"discounted_cash":21.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.45,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-78","type":"NDC"}],"standard_charges":[{"minimum":42.84,"maximum":57.84,"gross_charge":71.4,"discounted_cash":21.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0410-78","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":57.84,"gross_charge":71.4,"discounted_cash":21.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0531-01","type":"NDC"}],"standard_charges":[{"minimum":69.54,"maximum":93.88,"gross_charge":115.89,"discounted_cash":34.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0531-01","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":93.88,"gross_charge":115.89,"discounted_cash":34.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.18,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-90","type":"NDC"}],"standard_charges":[{"minimum":50.12,"maximum":67.66,"gross_charge":83.53,"discounted_cash":24.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0568-90","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":67.66,"gross_charge":83.53,"discounted_cash":24.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-86","type":"NDC"}],"standard_charges":[{"minimum":47.21,"maximum":63.74,"gross_charge":78.68,"discounted_cash":23.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.21,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0410-86","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":63.74,"gross_charge":78.68,"discounted_cash":23.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.04,"maximum":62.16,"gross_charge":76.73,"discounted_cash":22.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.04,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":62.16,"gross_charge":76.73,"discounted_cash":22.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.35,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.35,"maximum":63.92,"gross_charge":78.91,"discounted_cash":23.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.35,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":63.92,"gross_charge":78.91,"discounted_cash":23.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.79,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":63.1,"maximum":85.18,"gross_charge":105.16,"discounted_cash":31.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.1,"methodology":"fee schedule"}]}]},{"description":"ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"J1650","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":85.18,"gross_charge":105.16,"discounted_cash":31.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":85.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":63.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.04,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0681-10","type":"NDC"}],"standard_charges":[{"minimum":77.27,"maximum":104.31,"gross_charge":128.77,"discounted_cash":38.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.27,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0681-10","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":104.31,"gross_charge":128.77,"discounted_cash":38.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0681-11","type":"NDC"}],"standard_charges":[{"minimum":107.97,"maximum":145.76,"gross_charge":179.95,"discounted_cash":53.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":116.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":125.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.97,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0681-11","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":145.76,"gross_charge":179.95,"discounted_cash":53.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":80.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":125.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.99,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0233-00","type":"NDC"}],"standard_charges":[{"minimum":84.79,"maximum":114.47,"gross_charge":141.31,"discounted_cash":41.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.79,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0233-00","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":114.47,"gross_charge":141.31,"discounted_cash":41.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":82.02,"maximum":110.72,"gross_charge":136.69,"discounted_cash":40.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.38,"maximum":110.72,"gross_charge":136.69,"discounted_cash":40.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.34,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0678-10","type":"NDC"}],"standard_charges":[{"minimum":44.96,"maximum":60.69,"gross_charge":74.92,"discounted_cash":22.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.96,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0678-10","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":60.69,"gross_charge":74.92,"discounted_cash":22.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0678-11","type":"NDC"}],"standard_charges":[{"minimum":52.62,"maximum":71.03,"gross_charge":87.69,"discounted_cash":25.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0678-11","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":71.03,"gross_charge":87.69,"discounted_cash":25.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.54,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0230-00","type":"NDC"}],"standard_charges":[{"minimum":44.81,"maximum":60.49,"gross_charge":74.67,"discounted_cash":22.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0230-00","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":60.49,"gross_charge":74.67,"discounted_cash":22.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0582-10","type":"NDC"}],"standard_charges":[{"minimum":47.48,"maximum":64.1,"gross_charge":79.13,"discounted_cash":23.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.48,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0582-10","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":64.1,"gross_charge":79.13,"discounted_cash":23.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.83,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.98,"maximum":70.17,"gross_charge":86.62,"discounted_cash":25.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.38,"maximum":70.17,"gross_charge":86.62,"discounted_cash":25.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0679-10","type":"NDC"}],"standard_charges":[{"minimum":92.22,"maximum":124.49,"gross_charge":153.69,"discounted_cash":45.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":124.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.22,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0679-10","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":124.49,"gross_charge":153.69,"discounted_cash":45.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":124.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":124.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":124.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":107.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":92.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0679-11","type":"NDC"}],"standard_charges":[{"minimum":103.39,"maximum":139.58,"gross_charge":172.31,"discounted_cash":51.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.39,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0679-11","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":139.58,"gross_charge":172.31,"discounted_cash":51.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.47,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0231-00","type":"NDC"}],"standard_charges":[{"minimum":66.69,"maximum":90.04,"gross_charge":111.15,"discounted_cash":32.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.69,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0231-00","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":90.04,"gross_charge":111.15,"discounted_cash":32.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.38,"maximum":88.26,"gross_charge":108.96,"discounted_cash":32.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.38,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.38,"maximum":88.26,"gross_charge":108.96,"discounted_cash":32.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.8,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":78.18,"maximum":105.54,"gross_charge":130.29,"discounted_cash":38.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.18,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE","code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.38,"maximum":105.54,"gross_charge":130.29,"discounted_cash":38.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.06,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0680-10","type":"NDC"}],"standard_charges":[{"minimum":59.24,"maximum":79.98,"gross_charge":98.73,"discounted_cash":29.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.24,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0680-10","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":79.98,"gross_charge":98.73,"discounted_cash":29.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0680-11","type":"NDC"}],"standard_charges":[{"minimum":90.83,"maximum":122.62,"gross_charge":151.38,"discounted_cash":44.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":98.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0680-11","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":122.62,"gross_charge":151.38,"discounted_cash":44.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0232-00","type":"NDC"}],"standard_charges":[{"minimum":59.13,"maximum":79.83,"gross_charge":98.55,"discounted_cash":29.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0232-00","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":79.83,"gross_charge":98.55,"discounted_cash":29.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.71,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0584-00","type":"NDC"}],"standard_charges":[{"minimum":114.93,"maximum":155.15,"gross_charge":191.54,"discounted_cash":56.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":124.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.93,"methodology":"fee schedule"}]}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0584-00","type":"NDC"}],"standard_charges":[{"minimum":1.38,"maximum":155.15,"gross_charge":191.54,"discounted_cash":56.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":122.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.38,"standard_charge_algorithm": "Lesser of $1.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":86.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.31,"methodology":"fee schedule"}]}]},{"description":"TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0634-20","type":"NDC"}],"standard_charges":[{"minimum":1391.41,"maximum":1878.4,"gross_charge":2319.01,"discounted_cash":686.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1878.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1878.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1878.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1507.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1623.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1391.41,"methodology":"fee schedule"}]}]},{"description":"TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1670","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0634-20","type":"NDC"}],"standard_charges":[{"minimum":347.86,"maximum":1878.4,"gross_charge":2319.01,"discounted_cash":686.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1878.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1878.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1878.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1484.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":572.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":572.07,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":578.61,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":575.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":589.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":880.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":607.68,"standard_charge_algorithm": "Lesser of $607.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":607.68,"standard_charge_algorithm": "Lesser of $607.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1043.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1623.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1391.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":347.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":463.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":514.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":550.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":530.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":540.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":566.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":545.63,"methodology":"case rate"}]}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":78.99,"maximum":106.63,"gross_charge":131.64,"discounted_cash":38.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.99,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.75,"maximum":106.63,"gross_charge":131.64,"discounted_cash":38.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":79.83,"maximum":107.77,"gross_charge":133.04,"discounted_cash":39.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":93.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.96,"maximum":107.77,"gross_charge":133.04,"discounted_cash":39.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":93.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":119,"maximum":160.64,"gross_charge":198.32,"discounted_cash":58.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.19,"maximum":160.64,"gross_charge":198.32,"discounted_cash":58.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":126.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69097-0004-67","type":"NDC"}],"standard_charges":[{"minimum":67.8,"maximum":91.53,"gross_charge":112.99,"discounted_cash":33.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.8,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69097-0004-67","type":"NDC"}],"standard_charges":[{"minimum":16.95,"maximum":91.53,"gross_charge":112.99,"discounted_cash":33.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.6,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.76,"maximum":90.13,"gross_charge":111.26,"discounted_cash":32.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.76,"methodology":"fee schedule"}]}]},{"description":"HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION","code_information":[{"code":"J1720","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16.69,"maximum":90.13,"gross_charge":111.26,"discounted_cash":32.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.19,"standard_charge_algorithm": "Lesser of $20.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.26,"methodology":"fee schedule"}]}]},{"description":"IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1740","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0191-83","type":"NDC"}],"standard_charges":[{"minimum":212.18,"maximum":286.44,"gross_charge":353.62,"discounted_cash":104.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":229.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":247.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.18,"methodology":"fee schedule"}]}]},{"description":"IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1740","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0191-83","type":"NDC"}],"standard_charges":[{"minimum":24.9,"maximum":286.44,"gross_charge":353.62,"discounted_cash":104.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":286.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":286.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":286.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":226.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"standard_charge_algorithm": "Lesser of $29.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.2,"standard_charge_algorithm": "Lesser of $29.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":159.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":247.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":212.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.73,"methodology":"fee schedule"}]}]},{"description":"IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1740","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0524-33","type":"NDC"}],"standard_charges":[{"minimum":183.49,"maximum":247.71,"gross_charge":305.81,"discounted_cash":90.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":198.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.49,"methodology":"fee schedule"}]}]},{"description":"IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1740","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0524-33","type":"NDC"}],"standard_charges":[{"minimum":24.9,"maximum":247.71,"gross_charge":305.81,"discounted_cash":90.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":195.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"standard_charge_algorithm": "Lesser of $29.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.2,"standard_charge_algorithm": "Lesser of $29.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.17,"methodology":"fee schedule"}]}]},{"description":"IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE","code_information":[{"code":"J1740","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1331.67,"maximum":1797.76,"gross_charge":2219.45,"discounted_cash":656.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1442.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1553.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1331.67,"methodology":"fee schedule"}]}]},{"description":"IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE","code_information":[{"code":"J1740","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":24.9,"maximum":1797.76,"gross_charge":2219.45,"discounted_cash":656.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1797.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1420.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":24.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.2,"standard_charge_algorithm": "Lesser of $29.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.2,"standard_charge_algorithm": "Lesser of $29.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":998.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1553.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1331.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":421.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":332.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":443.89,"methodology":"fee schedule"}]}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1742","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0366-10","type":"NDC"}],"standard_charges":[{"minimum":217.74,"maximum":293.95,"gross_charge":362.89,"discounted_cash":107.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":235.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":254.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.74,"methodology":"fee schedule"}]}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1742","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0366-10","type":"NDC"}],"standard_charges":[{"minimum":54.44,"maximum":298.3,"gross_charge":362.89,"discounted_cash":107.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":293.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":293.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":293.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":232.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":186.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":298.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":298.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":285.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":231.72,"standard_charge_algorithm": "Lesser of $231.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":231.72,"standard_charge_algorithm": "Lesser of $231.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":163.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":254.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":217.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":166.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":178.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":171.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":175.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":183.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":177,"methodology":"case rate"}]}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1742","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":249.77,"maximum":337.18,"gross_charge":416.27,"discounted_cash":123.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":270.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":291.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":249.77,"methodology":"fee schedule"}]}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1742","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.45,"maximum":337.18,"gross_charge":416.27,"discounted_cash":123.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":337.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":337.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":337.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":266.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":186.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":186.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":190.25,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":298.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":298.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":285.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":231.72,"standard_charge_algorithm": "Lesser of $231.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":231.72,"standard_charge_algorithm": "Lesser of $231.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":187.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":291.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":249.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":166.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":178.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":171.99,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":175.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":183.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":177,"methodology":"case rate"}]}]},{"description":"ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69097-0664-34","type":"NDC"}],"standard_charges":[{"minimum":4532.43,"maximum":6118.79,"gross_charge":7554.05,"discounted_cash":2236,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6118.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6118.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6118.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4910.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5287.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4532.43,"methodology":"fee schedule"}]}]},{"description":"ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1744","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69097-0664-34","type":"NDC"}],"standard_charges":[{"minimum":93.19,"maximum":6118.79,"gross_charge":7554.05,"discounted_cash":2236,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6118.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6118.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6118.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4834.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":135.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":135.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":170.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":101.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":191.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":195.3,"standard_charge_algorithm": "Lesser of $195.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":195.3,"standard_charge_algorithm": "Lesser of $195.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3399.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5287.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4532.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1435.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1510.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1133.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1510.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":112.04,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":119.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":115.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":117.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":123.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":118.76,"methodology":"case rate"}]}]},{"description":"INFLIXIMAB 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1745","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0030-01","type":"NDC"}],"standard_charges":[{"minimum":5104.39,"maximum":6890.93,"gross_charge":8507.31,"discounted_cash":2518.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6890.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6890.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5529.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5955.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5104.39,"methodology":"fee schedule"}]}]},{"description":"INFLIXIMAB 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1745","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0030-01","type":"NDC"}],"standard_charges":[{"minimum":27.29,"maximum":6890.93,"gross_charge":8507.31,"discounted_cash":2518.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6890.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6890.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6890.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5444.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32.16,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.57,"standard_charge_algorithm": "Lesser of $39.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.57,"standard_charge_algorithm": "Lesser of $39.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3828.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5955.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5104.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1616.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1276.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1701.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.93,"methodology":"case rate"}]}]},{"description":"INFLIXIMAB 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1745","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0160-01","type":"NDC"}],"standard_charges":[{"minimum":2201.61,"maximum":2972.18,"gross_charge":3669.35,"discounted_cash":1086.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2972.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2972.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2972.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2385.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2568.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2201.61,"methodology":"fee schedule"}]}]},{"description":"INFLIXIMAB 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1745","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0160-01","type":"NDC"}],"standard_charges":[{"minimum":27.29,"maximum":2972.18,"gross_charge":3669.35,"discounted_cash":1086.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2972.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2972.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2972.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2348.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":32.16,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.3,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.77,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.57,"standard_charge_algorithm": "Lesser of $39.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.57,"standard_charge_algorithm": "Lesser of $39.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1651.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2568.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2201.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":697.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":550.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":733.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.11,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.93,"methodology":"case rate"}]}]},{"description":"SPESOLIMAB-SBZO 60 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1747","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":112907.59,"maximum":152425.25,"gross_charge":188179.31,"discounted_cash":55701.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152425.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":122316.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":131725.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112907.59,"methodology":"fee schedule"}]}]},{"description":"SPESOLIMAB-SBZO 60 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1747","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28226.9,"maximum":152425.25,"gross_charge":188179.31,"discounted_cash":55701.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152425.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152425.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120434.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":94089.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":94089.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":84680.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":131725.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112907.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35754.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37635.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28226.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37635.87,"methodology":"fee schedule"}]}]},{"description":"IRON DEXTRAN 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1750","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"52544-0931-07","type":"NDC"}],"standard_charges":[{"minimum":105.06,"maximum":141.83,"gross_charge":175.09,"discounted_cash":51.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":113.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":122.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.06,"methodology":"fee schedule"}]}]},{"description":"IRON DEXTRAN 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1750","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"52544-0931-07","type":"NDC"}],"standard_charges":[{"minimum":15.41,"maximum":141.83,"gross_charge":175.09,"discounted_cash":51.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.32,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":78.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":122.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.41,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.33,"methodology":"case rate"}]}]},{"description":"IRON DEXTRAN 50 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1750","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":114.81,"maximum":155,"gross_charge":191.35,"discounted_cash":56.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":124.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":133.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.81,"methodology":"fee schedule"}]}]},{"description":"IRON DEXTRAN 50 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1750","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.41,"maximum":155,"gross_charge":191.35,"discounted_cash":56.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":122.47,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":17.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":17.32,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":26.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":133.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":114.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":15.41,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":16.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":15.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":16.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":16.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":16.33,"methodology":"case rate"}]}]},{"description":"IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1756","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":111.18,"maximum":150.09,"gross_charge":185.29,"discounted_cash":54.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.18,"methodology":"fee schedule"}]}]},{"description":"IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1756","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.23,"maximum":150.09,"gross_charge":185.29,"discounted_cash":54.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.23,"standard_charge_algorithm": "Lesser of $0.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.23,"standard_charge_algorithm": "Lesser of $0.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"}]}]},{"description":"IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1756","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":189.57,"maximum":255.92,"gross_charge":315.95,"discounted_cash":93.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":205.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":221.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.57,"methodology":"fee schedule"}]}]},{"description":"IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1756","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.23,"maximum":255.92,"gross_charge":315.95,"discounted_cash":93.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":255.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":255.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":255.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":202.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.23,"standard_charge_algorithm": "Lesser of $0.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.23,"standard_charge_algorithm": "Lesser of $0.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":142.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":221.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":189.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.19,"methodology":"fee schedule"}]}]},{"description":"DROPERIDOL 2.5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1790","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.51,"maximum":69.54,"gross_charge":85.84,"discounted_cash":25.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.51,"methodology":"fee schedule"}]}]},{"description":"DROPERIDOL 2.5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1790","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.42,"maximum":69.54,"gross_charge":85.84,"discounted_cash":25.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.42,"standard_charge_algorithm": "Lesser of $2.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.42,"standard_charge_algorithm": "Lesser of $2.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0604-01","type":"NDC"}],"standard_charges":[{"minimum":36.77,"maximum":49.63,"gross_charge":61.27,"discounted_cash":18.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0604-01","type":"NDC"}],"standard_charges":[{"minimum":3.75,"maximum":49.63,"gross_charge":61.27,"discounted_cash":18.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.75,"standard_charge_algorithm": "Lesser of $3.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.75,"standard_charge_algorithm": "Lesser of $3.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1800","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.88,"maximum":59.24,"gross_charge":73.13,"discounted_cash":21.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.88,"methodology":"fee schedule"}]}]},{"description":"PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1800","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.75,"maximum":59.24,"gross_charge":73.13,"discounted_cash":21.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.75,"standard_charge_algorithm": "Lesser of $3.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.75,"standard_charge_algorithm": "Lesser of $3.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0120-39","type":"NDC"}],"standard_charges":[{"minimum":60.07,"maximum":81.09,"gross_charge":100.11,"discounted_cash":29.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.07,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0120-39","type":"NDC"}],"standard_charges":[{"minimum":15.02,"maximum":81.09,"gross_charge":100.11,"discounted_cash":29.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.03,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0314-10","type":"NDC"}],"standard_charges":[{"minimum":38.12,"maximum":51.46,"gross_charge":63.52,"discounted_cash":18.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0314-10","type":"NDC"}],"standard_charges":[{"minimum":9.53,"maximum":51.46,"gross_charge":63.52,"discounted_cash":18.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0194-10","type":"NDC"}],"standard_charges":[{"minimum":37.99,"maximum":51.29,"gross_charge":63.31,"discounted_cash":18.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.99,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0194-10","type":"NDC"}],"standard_charges":[{"minimum":9.5,"maximum":51.29,"gross_charge":63.31,"discounted_cash":18.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0652-10","type":"NDC"}],"standard_charges":[{"minimum":38.93,"maximum":52.55,"gross_charge":64.87,"discounted_cash":19.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.93,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0652-10","type":"NDC"}],"standard_charges":[{"minimum":9.74,"maximum":52.55,"gross_charge":64.87,"discounted_cash":19.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0055-61","type":"NDC"}],"standard_charges":[{"minimum":268.33,"maximum":362.25,"gross_charge":447.21,"discounted_cash":132.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":290.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":313.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.33,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0055-61","type":"NDC"}],"standard_charges":[{"minimum":67.09,"maximum":362.25,"gross_charge":447.21,"discounted_cash":132.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":286.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":223.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":223.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":201.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":313.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.45,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0308-84","type":"NDC"}],"standard_charges":[{"minimum":183.08,"maximum":247.16,"gross_charge":305.13,"discounted_cash":90.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":198.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":213.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.08,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0308-84","type":"NDC"}],"standard_charges":[{"minimum":45.77,"maximum":247.16,"gross_charge":305.13,"discounted_cash":90.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":247.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":247.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":247.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":195.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":152.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":152.57,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":213.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.03,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0657-25","type":"NDC"}],"standard_charges":[{"minimum":263.91,"maximum":356.28,"gross_charge":439.85,"discounted_cash":130.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":285.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":307.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.91,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0657-25","type":"NDC"}],"standard_charges":[{"minimum":65.98,"maximum":356.28,"gross_charge":439.85,"discounted_cash":130.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":281.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":219.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":197.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":307.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1806","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0450-10","type":"NDC"}],"standard_charges":[{"minimum":33.65,"maximum":45.42,"gross_charge":56.07,"discounted_cash":16.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.65,"methodology":"fee schedule"}]}]},{"description":"ESMOLOL 2500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1806","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0450-10","type":"NDC"}],"standard_charges":[{"minimum":8.42,"maximum":45.42,"gross_charge":56.07,"discounted_cash":16.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"}]}]},{"description":"INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83257-0014-11","type":"NDC"}],"standard_charges":[{"minimum":33.75,"maximum":45.56,"gross_charge":56.24,"discounted_cash":16.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"}]}]},{"description":"INSULIN GLARGINE-YFGN (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83257-0014-11","type":"NDC"}],"standard_charges":[{"minimum":1.02,"maximum":45.56,"gross_charge":56.24,"discounted_cash":16.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"}]}]},{"description":"INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION","code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":79.01,"maximum":106.67,"gross_charge":131.68,"discounted_cash":38.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.01,"methodology":"fee schedule"}]}]},{"description":"INSULIN REGULAR 100 UNIT/100 ML (1 UNIT/ML) IN 0.9 % NACL IV SOLUTION","code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.02,"maximum":106.67,"gross_charge":131.68,"discounted_cash":38.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.34,"methodology":"fee schedule"}]}]},{"description":"INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN","code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":156.15,"maximum":210.81,"gross_charge":260.25,"discounted_cash":77.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":169.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":182.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.15,"methodology":"fee schedule"}]}]},{"description":"INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN","code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.02,"maximum":210.81,"gross_charge":260.25,"discounted_cash":77.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":166.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":117.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":182.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.05,"methodology":"fee schedule"}]}]},{"description":"INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.06,"maximum":12.23,"gross_charge":15.09,"discounted_cash":4.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"}]}]},{"description":"INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J1815","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.02,"maximum":12.23,"gross_charge":15.09,"discounted_cash":4.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.02,"standard_charge_algorithm": "Lesser of $1.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"}]}]},{"description":"INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1823","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"75987-0150-01","type":"NDC"}],"standard_charges":[{"minimum":197698.6,"maximum":266893.11,"gross_charge":329497.66,"discounted_cash":97531.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266893.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":266893.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":266893.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":214173.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":230648.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197698.6,"methodology":"fee schedule"}]}]},{"description":"INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1823","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"75987-0150-01","type":"NDC"}],"standard_charges":[{"minimum":433.08,"maximum":266893.11,"gross_charge":329497.66,"discounted_cash":97531.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":266893.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":266893.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":266893.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":210878.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":484.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":484.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":473.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":492.97,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":482.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":740.57,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":523.04,"standard_charge_algorithm": "Lesser of $523.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":523.04,"standard_charge_algorithm": "Lesser of $523.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":148273.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":230648.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":197698.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":62604.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":65899.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":49424.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":65899.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":433.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":463.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":446.07,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":454.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":476.39,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":459.06,"methodology":"case rate"}]}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1833","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":826.92,"maximum":1116.34,"gross_charge":1378.19,"discounted_cash":407.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1116.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1116.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1116.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":895.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":964.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":826.92,"methodology":"fee schedule"}]}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1833","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":1116.34,"gross_charge":1378.19,"discounted_cash":407.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1116.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1116.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1116.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":882.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":620.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":964.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":826.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.93,"methodology":"case rate"}]}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1833","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":916.59,"maximum":1237.39,"gross_charge":1527.64,"discounted_cash":452.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1237.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1237.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1237.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":992.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":916.59,"methodology":"fee schedule"}]}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J1833","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":1237.39,"gross_charge":1527.64,"discounted_cash":452.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1237.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1237.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1237.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":977.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.94,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.06,"standard_charge_algorithm": "Lesser of $1.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":687.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":916.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":290.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":305.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.88,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.91,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.93,"methodology":"case rate"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0131-82","type":"NDC"}],"standard_charges":[{"minimum":37.59,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0131-82","type":"NDC"}],"standard_charges":[{"minimum":9.4,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0993-01","type":"NDC"}],"standard_charges":[{"minimum":39.61,"maximum":53.47,"gross_charge":66.01,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0993-01","type":"NDC"}],"standard_charges":[{"minimum":9.91,"maximum":53.47,"gross_charge":66.01,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-2465-01","type":"NDC"}],"standard_charges":[{"minimum":32.85,"maximum":44.35,"gross_charge":54.75,"discounted_cash":16.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"80830-2465-01","type":"NDC"}],"standard_charges":[{"minimum":8.22,"maximum":44.35,"gross_charge":54.75,"discounted_cash":16.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.95,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.06,"maximum":47.33,"gross_charge":58.43,"discounted_cash":17.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.77,"maximum":47.33,"gross_charge":58.43,"discounted_cash":17.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.31,"maximum":47.67,"gross_charge":58.85,"discounted_cash":17.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.83,"maximum":47.67,"gross_charge":58.85,"discounted_cash":17.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.83,"maximum":49.72,"gross_charge":61.38,"discounted_cash":18.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.21,"maximum":49.72,"gross_charge":61.38,"discounted_cash":18.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.28,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.08,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.27,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.37,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"}]}]},{"description":"METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1836","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.1,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0161-01","type":"NDC"}],"standard_charges":[{"minimum":34.34,"maximum":46.35,"gross_charge":57.22,"discounted_cash":16.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0161-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":46.35,"gross_charge":57.22,"discounted_cash":16.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0700-41","type":"NDC"}],"standard_charges":[{"minimum":37.03,"maximum":49.99,"gross_charge":61.71,"discounted_cash":18.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.03,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0700-41","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":49.99,"gross_charge":61.71,"discounted_cash":18.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0234-01","type":"NDC"}],"standard_charges":[{"minimum":33.99,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0234-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0719-01","type":"NDC"}],"standard_charges":[{"minimum":35.26,"maximum":47.6,"gross_charge":58.76,"discounted_cash":17.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.26,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0719-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":47.6,"gross_charge":58.76,"discounted_cash":17.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.71,"maximum":45.51,"gross_charge":56.18,"discounted_cash":16.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.45,"maximum":45.51,"gross_charge":56.18,"discounted_cash":16.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.74,"maximum":53.65,"gross_charge":66.23,"discounted_cash":19.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 15 MG/ML INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.45,"maximum":53.65,"gross_charge":66.23,"discounted_cash":19.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.39,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0701-01","type":"NDC"}],"standard_charges":[{"minimum":35.72,"maximum":48.22,"gross_charge":59.53,"discounted_cash":17.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.72,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0701-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":48.22,"gross_charge":59.53,"discounted_cash":17.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.1,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0584-93","type":"NDC"}],"standard_charges":[{"minimum":35.42,"maximum":47.81,"gross_charge":59.02,"discounted_cash":17.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0584-93","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":47.81,"gross_charge":59.02,"discounted_cash":17.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62332-0600-25","type":"NDC"}],"standard_charges":[{"minimum":37.59,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62332-0600-25","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0162-00","type":"NDC"}],"standard_charges":[{"minimum":34.38,"maximum":46.42,"gross_charge":57.3,"discounted_cash":16.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0162-00","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":46.42,"gross_charge":57.3,"discounted_cash":16.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0756-25","type":"NDC"}],"standard_charges":[{"minimum":34.89,"maximum":47.1,"gross_charge":58.14,"discounted_cash":17.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.89,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0756-25","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":47.1,"gross_charge":58.14,"discounted_cash":17.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0118-01","type":"NDC"}],"standard_charges":[{"minimum":35.98,"maximum":48.57,"gross_charge":59.96,"discounted_cash":17.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0118-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":48.57,"gross_charge":59.96,"discounted_cash":17.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0355-01","type":"NDC"}],"standard_charges":[{"minimum":35.11,"maximum":47.4,"gross_charge":58.51,"discounted_cash":17.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.11,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0355-01","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":47.4,"gross_charge":58.51,"discounted_cash":17.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0722-25","type":"NDC"}],"standard_charges":[{"minimum":35.52,"maximum":47.95,"gross_charge":59.19,"discounted_cash":17.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0722-25","type":"NDC"}],"standard_charges":[{"minimum":0.45,"maximum":47.95,"gross_charge":59.19,"discounted_cash":17.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.52,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.45,"maximum":46.6,"gross_charge":57.53,"discounted_cash":17.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.76,"maximum":56.37,"gross_charge":69.59,"discounted_cash":20.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"}]}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J1885","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.45,"maximum":56.37,"gross_charge":69.59,"discounted_cash":20.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.77,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.72,"standard_charge_algorithm": "Lesser of $0.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.48,"methodology":"case rate"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0317-20","type":"NDC"}],"standard_charges":[{"minimum":37.54,"maximum":50.68,"gross_charge":62.56,"discounted_cash":18.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0317-20","type":"NDC"}],"standard_charges":[{"minimum":9.39,"maximum":50.68,"gross_charge":62.56,"discounted_cash":18.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0322-01","type":"NDC"}],"standard_charges":[{"minimum":37.59,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0322-01","type":"NDC"}],"standard_charges":[{"minimum":9.4,"maximum":50.74,"gross_charge":62.64,"discounted_cash":18.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0586-29","type":"NDC"}],"standard_charges":[{"minimum":41.78,"maximum":56.41,"gross_charge":69.63,"discounted_cash":20.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0586-29","type":"NDC"}],"standard_charges":[{"minimum":10.45,"maximum":56.41,"gross_charge":69.63,"discounted_cash":20.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0102-01","type":"NDC"}],"standard_charges":[{"minimum":48.7,"maximum":65.74,"gross_charge":81.16,"discounted_cash":24.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.7,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0102-01","type":"NDC"}],"standard_charges":[{"minimum":12.18,"maximum":65.74,"gross_charge":81.16,"discounted_cash":24.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0350-01","type":"NDC"}],"standard_charges":[{"minimum":33.15,"maximum":44.76,"gross_charge":55.25,"discounted_cash":16.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0350-01","type":"NDC"}],"standard_charges":[{"minimum":8.29,"maximum":44.76,"gross_charge":55.25,"discounted_cash":16.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0146-01","type":"NDC"}],"standard_charges":[{"minimum":33.23,"maximum":44.86,"gross_charge":55.38,"discounted_cash":16.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.23,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0146-01","type":"NDC"}],"standard_charges":[{"minimum":8.31,"maximum":44.86,"gross_charge":55.38,"discounted_cash":16.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0734-01","type":"NDC"}],"standard_charges":[{"minimum":60.57,"maximum":81.77,"gross_charge":100.95,"discounted_cash":29.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0734-01","type":"NDC"}],"standard_charges":[{"minimum":15.15,"maximum":81.77,"gross_charge":100.95,"discounted_cash":29.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.21,"maximum":44.83,"gross_charge":55.34,"discounted_cash":16.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1920","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.31,"maximum":44.83,"gross_charge":55.34,"discounted_cash":16.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1921","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.08,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"}]}]},{"description":"LABETALOL 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1921","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.27,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 1000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0265-00","type":"NDC"}],"standard_charges":[{"minimum":59.82,"maximum":80.75,"gross_charge":99.69,"discounted_cash":29.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.82,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 1000 MG/100 ML IN SODIUM CHLORIDE(ISO-OSM) IV PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0265-00","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":80.75,"gross_charge":99.69,"discounted_cash":29.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.94,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0780-05","type":"NDC"}],"standard_charges":[{"minimum":35.44,"maximum":47.84,"gross_charge":59.06,"discounted_cash":17.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.44,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0780-05","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":47.84,"gross_charge":59.06,"discounted_cash":17.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0177-05","type":"NDC"}],"standard_charges":[{"minimum":38.04,"maximum":51.36,"gross_charge":63.4,"discounted_cash":18.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.04,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0177-05","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":51.36,"gross_charge":63.4,"discounted_cash":18.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0400-44","type":"NDC"}],"standard_charges":[{"minimum":36.72,"maximum":49.57,"gross_charge":61.19,"discounted_cash":18.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0400-44","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":49.57,"gross_charge":61.19,"discounted_cash":18.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0790-00","type":"NDC"}],"standard_charges":[{"minimum":35.87,"maximum":48.43,"gross_charge":59.78,"discounted_cash":17.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.87,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0790-00","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":48.43,"gross_charge":59.78,"discounted_cash":17.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.96,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0106-10","type":"NDC"}],"standard_charges":[{"minimum":38.56,"maximum":52.06,"gross_charge":64.26,"discounted_cash":19.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.56,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0106-10","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":52.06,"gross_charge":64.26,"discounted_cash":19.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0360-01","type":"NDC"}],"standard_charges":[{"minimum":36.2,"maximum":48.86,"gross_charge":60.32,"discounted_cash":17.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0360-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":48.86,"gross_charge":60.32,"discounted_cash":17.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.1,"maximum":47.38,"gross_charge":58.49,"discounted_cash":17.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.11,"maximum":47.38,"gross_charge":58.49,"discounted_cash":17.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.94,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"}]}]},{"description":"LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J1953","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.11,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1955","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54482-0147-01","type":"NDC"}],"standard_charges":[{"minimum":88.73,"maximum":119.78,"gross_charge":147.87,"discounted_cash":43.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"}]}]},{"description":"LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1955","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54482-0147-01","type":"NDC"}],"standard_charges":[{"minimum":22.19,"maximum":119.78,"gross_charge":147.87,"discounted_cash":43.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":119.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":94.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.69,"standard_charge_algorithm": "Lesser of $31.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.69,"standard_charge_algorithm": "Lesser of $31.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0132-82","type":"NDC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0132-82","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0047-24","type":"NDC"}],"standard_charges":[{"minimum":38.09,"maximum":51.42,"gross_charge":63.48,"discounted_cash":18.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0047-24","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":51.42,"gross_charge":63.48,"discounted_cash":18.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0244-47","type":"NDC"}],"standard_charges":[{"minimum":47.19,"maximum":63.7,"gross_charge":78.64,"discounted_cash":23.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0244-47","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":63.7,"gross_charge":78.64,"discounted_cash":23.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.08,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.21,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0132-83","type":"NDC"}],"standard_charges":[{"minimum":41.51,"maximum":56.03,"gross_charge":69.17,"discounted_cash":20.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0132-83","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":56.03,"gross_charge":69.17,"discounted_cash":20.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0048-24","type":"NDC"}],"standard_charges":[{"minimum":38.47,"maximum":51.93,"gross_charge":64.11,"discounted_cash":18.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0048-24","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":51.93,"gross_charge":64.11,"discounted_cash":18.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0437-24","type":"NDC"}],"standard_charges":[{"minimum":39.61,"maximum":53.47,"gross_charge":66.01,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0437-24","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":53.47,"gross_charge":66.01,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.34,"maximum":50.4,"gross_charge":62.22,"discounted_cash":18.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.21,"maximum":50.4,"gross_charge":62.22,"discounted_cash":18.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.95,"maximum":52.58,"gross_charge":64.91,"discounted_cash":19.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.95,"methodology":"fee schedule"}]}]},{"description":"LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK","code_information":[{"code":"J1956","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.21,"maximum":52.58,"gross_charge":64.91,"discounted_cash":19.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3390-01","type":"NDC"}],"standard_charges":[{"minimum":44.24,"maximum":59.73,"gross_charge":73.73,"discounted_cash":21.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3390-01","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":59.73,"gross_charge":73.73,"discounted_cash":21.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE","code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.56,"maximum":54.76,"gross_charge":67.6,"discounted_cash":20.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE","code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.02,"maximum":54.76,"gross_charge":67.6,"discounted_cash":20.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0164-02","type":"NDC"}],"standard_charges":[{"minimum":34.87,"maximum":47.07,"gross_charge":58.11,"discounted_cash":17.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.87,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0164-02","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":47.07,"gross_charge":58.11,"discounted_cash":17.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0495-07","type":"NDC"}],"standard_charges":[{"minimum":34.39,"maximum":46.43,"gross_charge":57.31,"discounted_cash":16.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0495-07","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":46.43,"gross_charge":57.31,"discounted_cash":16.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0495-27","type":"NDC"}],"standard_charges":[{"minimum":35.59,"maximum":48.05,"gross_charge":59.31,"discounted_cash":17.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.59,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0495-27","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":48.05,"gross_charge":59.31,"discounted_cash":17.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0496-97","type":"NDC"}],"standard_charges":[{"minimum":38.65,"maximum":52.18,"gross_charge":64.41,"discounted_cash":19.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.65,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0496-97","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":52.18,"gross_charge":64.41,"discounted_cash":19.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.89,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0372-01","type":"NDC"}],"standard_charges":[{"minimum":34.62,"maximum":46.74,"gross_charge":57.7,"discounted_cash":17.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.62,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0372-01","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":46.74,"gross_charge":57.7,"discounted_cash":17.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.54,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0505-01","type":"NDC"}],"standard_charges":[{"minimum":35.64,"maximum":48.12,"gross_charge":59.4,"discounted_cash":17.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0505-01","type":"NDC"}],"standard_charges":[{"minimum":0.02,"maximum":48.12,"gross_charge":59.4,"discounted_cash":17.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.1,"maximum":46.03,"gross_charge":56.82,"discounted_cash":16.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.1,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.02,"maximum":46.03,"gross_charge":56.82,"discounted_cash":16.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.6,"maximum":49.41,"gross_charge":60.99,"discounted_cash":18.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J2001","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.02,"maximum":49.41,"gross_charge":60.99,"discounted_cash":18.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.02,"standard_charge_algorithm": "Lesser of $0.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION","code_information":[{"code":"J2002","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.94,"maximum":64.72,"gross_charge":79.9,"discounted_cash":23.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION","code_information":[{"code":"J2002","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.99,"maximum":64.72,"gross_charge":79.9,"discounted_cash":23.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION","code_information":[{"code":"J2002","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.26,"maximum":73.25,"gross_charge":90.43,"discounted_cash":26.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.26,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION","code_information":[{"code":"J2002","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.57,"maximum":73.25,"gross_charge":90.43,"discounted_cash":26.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.09,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INJECTION SYRINGE (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3390-01","type":"NDC"}],"standard_charges":[{"minimum":48.11,"maximum":64.94,"gross_charge":80.17,"discounted_cash":23.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INJECTION SYRINGE (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3390-01","type":"NDC"}],"standard_charges":[{"minimum":12.03,"maximum":64.94,"gross_charge":80.17,"discounted_cash":23.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.04,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INJECTION SYRINGE (WRAPPER)","code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.99,"maximum":59.39,"gross_charge":73.31,"discounted_cash":21.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) INJECTION SYRINGE (WRAPPER)","code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11,"maximum":59.39,"gross_charge":73.31,"discounted_cash":21.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0208-05","type":"NDC"}],"standard_charges":[{"minimum":36.4,"maximum":49.14,"gross_charge":60.66,"discounted_cash":17.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0208-05","type":"NDC"}],"standard_charges":[{"minimum":9.1,"maximum":49.14,"gross_charge":60.66,"discounted_cash":17.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83090-0007-01","type":"NDC"}],"standard_charges":[{"minimum":33.95,"maximum":45.83,"gross_charge":56.58,"discounted_cash":16.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.95,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83090-0007-01","type":"NDC"}],"standard_charges":[{"minimum":8.49,"maximum":45.83,"gross_charge":56.58,"discounted_cash":16.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.32,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0251-10","type":"NDC"}],"standard_charges":[{"minimum":36.98,"maximum":49.93,"gross_charge":61.63,"discounted_cash":18.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0251-10","type":"NDC"}],"standard_charges":[{"minimum":9.25,"maximum":49.93,"gross_charge":61.63,"discounted_cash":18.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0252-20","type":"NDC"}],"standard_charges":[{"minimum":35.21,"maximum":47.54,"gross_charge":58.68,"discounted_cash":17.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.21,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0252-20","type":"NDC"}],"standard_charges":[{"minimum":8.81,"maximum":47.54,"gross_charge":58.68,"discounted_cash":17.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0201-10","type":"NDC"}],"standard_charges":[{"minimum":38.42,"maximum":51.87,"gross_charge":64.03,"discounted_cash":18.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0201-10","type":"NDC"}],"standard_charges":[{"minimum":9.61,"maximum":51.87,"gross_charge":64.03,"discounted_cash":18.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0485-27","type":"NDC"}],"standard_charges":[{"minimum":40.62,"maximum":54.83,"gross_charge":67.69,"discounted_cash":20.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0485-27","type":"NDC"}],"standard_charges":[{"minimum":10.16,"maximum":54.83,"gross_charge":67.69,"discounted_cash":20.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.06,"maximum":47.33,"gross_charge":58.43,"discounted_cash":17.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"}]}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION","code_information":[{"code":"J2003","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.77,"maximum":47.33,"gross_charge":58.43,"discounted_cash":17.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0242-51","type":"NDC"}],"standard_charges":[{"minimum":54,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0242-51","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":72.9,"gross_charge":90,"discounted_cash":26.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57664-0683-31","type":"NDC"}],"standard_charges":[{"minimum":84.32,"maximum":113.83,"gross_charge":140.52,"discounted_cash":41.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.32,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57664-0683-31","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":113.83,"gross_charge":140.52,"discounted_cash":41.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.11,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0713-13","type":"NDC"}],"standard_charges":[{"minimum":88.11,"maximum":118.95,"gross_charge":146.84,"discounted_cash":43.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.11,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0713-13","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":118.95,"gross_charge":146.84,"discounted_cash":43.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.37,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0843-30","type":"NDC"}],"standard_charges":[{"minimum":76.74,"maximum":103.6,"gross_charge":127.89,"discounted_cash":37.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.74,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0843-30","type":"NDC"}],"standard_charges":[{"minimum":4.73,"maximum":103.6,"gross_charge":127.89,"discounted_cash":37.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.7,"maximum":65.74,"gross_charge":81.16,"discounted_cash":24.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.7,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.73,"maximum":65.74,"gross_charge":81.16,"discounted_cash":24.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":67.79,"gross_charge":83.69,"discounted_cash":24.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.73,"maximum":67.79,"gross_charge":83.69,"discounted_cash":24.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.97,"maximum":68.81,"gross_charge":84.95,"discounted_cash":25.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.97,"methodology":"fee schedule"}]}]},{"description":"LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK","code_information":[{"code":"J2020","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.73,"maximum":68.81,"gross_charge":84.95,"discounted_cash":25.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.73,"standard_charge_algorithm": "Lesser of $4.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0040-01","type":"NDC"}],"standard_charges":[{"minimum":39.53,"maximum":53.37,"gross_charge":65.88,"discounted_cash":19.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0040-01","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":53.37,"gross_charge":65.88,"discounted_cash":19.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0368-02","type":"NDC"}],"standard_charges":[{"minimum":35.47,"maximum":47.88,"gross_charge":59.11,"discounted_cash":17.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0368-02","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":47.88,"gross_charge":59.11,"discounted_cash":17.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0380-01","type":"NDC"}],"standard_charges":[{"minimum":34.45,"maximum":46.51,"gross_charge":57.41,"discounted_cash":17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0380-01","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":46.51,"gross_charge":57.41,"discounted_cash":17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-8261-00","type":"NDC"}],"standard_charges":[{"minimum":56.53,"maximum":76.32,"gross_charge":94.21,"discounted_cash":27.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.53,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-8261-00","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":76.32,"gross_charge":94.21,"discounted_cash":27.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.85,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.23,"maximum":46.21,"gross_charge":57.04,"discounted_cash":16.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.23,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":46.21,"gross_charge":57.04,"discounted_cash":16.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.41,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.24,"maximum":47.57,"gross_charge":58.72,"discounted_cash":17.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":47.57,"gross_charge":58.72,"discounted_cash":17.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.58,"maximum":48.03,"gross_charge":59.29,"discounted_cash":17.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":48.03,"gross_charge":59.29,"discounted_cash":17.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.78,"maximum":65.85,"gross_charge":81.29,"discounted_cash":24.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":65.85,"gross_charge":81.29,"discounted_cash":24.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.26,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.49,"maximum":72.22,"gross_charge":89.15,"discounted_cash":26.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":72.22,"gross_charge":89.15,"discounted_cash":26.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0040-01","type":"NDC"}],"standard_charges":[{"minimum":40.66,"maximum":54.89,"gross_charge":67.76,"discounted_cash":20.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0040-01","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":54.89,"gross_charge":67.76,"discounted_cash":20.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0380-01","type":"NDC"}],"standard_charges":[{"minimum":35.46,"maximum":47.88,"gross_charge":59.1,"discounted_cash":17.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0380-01","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":47.88,"gross_charge":59.1,"discounted_cash":17.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-8261-00","type":"NDC"}],"standard_charges":[{"minimum":58.05,"maximum":78.36,"gross_charge":96.74,"discounted_cash":28.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.05,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-8261-00","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":78.36,"gross_charge":96.74,"discounted_cash":28.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.62,"maximum":49.43,"gross_charge":61.02,"discounted_cash":18.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.62,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":49.43,"gross_charge":61.02,"discounted_cash":18.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.71,"maximum":54.96,"gross_charge":67.85,"discounted_cash":20.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.71,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":54.96,"gross_charge":67.85,"discounted_cash":20.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.12,"maximum":67.66,"gross_charge":83.52,"discounted_cash":24.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":67.66,"gross_charge":83.52,"discounted_cash":24.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.94,"maximum":74.17,"gross_charge":91.56,"discounted_cash":27.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SOLUTION WRAPPER","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":74.17,"gross_charge":91.56,"discounted_cash":27.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.32,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SYRINGE","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.12,"maximum":51.46,"gross_charge":63.52,"discounted_cash":18.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 2 MG/ML INJECTION SYRINGE","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":51.46,"gross_charge":63.52,"discounted_cash":18.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.9,"maximum":84.91,"gross_charge":104.82,"discounted_cash":31.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.9,"methodology":"fee schedule"}]}]},{"description":"LORAZEPAM 4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":84.91,"gross_charge":104.82,"discounted_cash":31.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2150","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0024-25","type":"NDC"}],"standard_charges":[{"minimum":46.81,"maximum":63.19,"gross_charge":78.01,"discounted_cash":23.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.81,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2150","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0024-25","type":"NDC"}],"standard_charges":[{"minimum":4.92,"maximum":63.19,"gross_charge":78.01,"discounted_cash":23.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.92,"standard_charge_algorithm": "Lesser of $4.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.92,"standard_charge_algorithm": "Lesser of $4.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.61,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION","code_information":[{"code":"J2150","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"MANNITOL 25 % INTRAVENOUS SOLUTION","code_information":[{"code":"J2150","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.92,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.92,"standard_charge_algorithm": "Lesser of $4.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.92,"standard_charge_algorithm": "Lesser of $4.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.81,"maximum":52.4,"gross_charge":64.68,"discounted_cash":19.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.81,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.77,"maximum":52.4,"gross_charge":64.68,"discounted_cash":19.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 25 MG/0.5 ML INJECTION SOLUTION","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.8,"maximum":51.03,"gross_charge":62.99,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 25 MG/0.5 ML INJECTION SOLUTION","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.77,"maximum":51.03,"gross_charge":62.99,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.07,"maximum":51.39,"gross_charge":63.44,"discounted_cash":18.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.77,"maximum":51.39,"gross_charge":63.44,"discounted_cash":18.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.68,"maximum":63.01,"gross_charge":77.79,"discounted_cash":23.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"}]}]},{"description":"MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE","code_information":[{"code":"J2175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.77,"maximum":63.01,"gross_charge":77.79,"discounted_cash":23.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.77,"standard_charge_algorithm": "Lesser of $6.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"}]}]},{"description":"MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION","code_information":[{"code":"J2182","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12964.99,"maximum":17502.74,"gross_charge":21608.31,"discounted_cash":6396.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17502.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17502.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17502.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14045.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15125.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12964.99,"methodology":"fee schedule"}]}]},{"description":"MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION","code_information":[{"code":"J2182","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.3,"maximum":17502.74,"gross_charge":21608.31,"discounted_cash":6396.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17502.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17502.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17502.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13829.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":30.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":30.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":46.68,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.12,"standard_charge_algorithm": "Lesser of $33.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.12,"standard_charge_algorithm": "Lesser of $33.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9723.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15125.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12964.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4105.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4321.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3241.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4321.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":27.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":29.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":28.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":28.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":30.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.94,"methodology":"case rate"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2183","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0400-01","type":"NDC"}],"standard_charges":[{"minimum":39.21,"maximum":52.94,"gross_charge":65.35,"discounted_cash":19.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.21,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2183","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0400-01","type":"NDC"}],"standard_charges":[{"minimum":9.81,"maximum":52.94,"gross_charge":65.35,"discounted_cash":19.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0208-30","type":"NDC"}],"standard_charges":[{"minimum":41.18,"maximum":55.59,"gross_charge":68.62,"discounted_cash":20.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0208-30","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":55.59,"gross_charge":68.62,"discounted_cash":20.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-30","type":"NDC"}],"standard_charges":[{"minimum":46.43,"maximum":62.67,"gross_charge":77.37,"discounted_cash":22.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-30","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":62.67,"gross_charge":77.37,"discounted_cash":22.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-31","type":"NDC"}],"standard_charges":[{"minimum":46.2,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-31","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":62.37,"gross_charge":77,"discounted_cash":22.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-45","type":"NDC"}],"standard_charges":[{"minimum":46.19,"maximum":62.36,"gross_charge":76.98,"discounted_cash":22.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0508-45","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":62.36,"gross_charge":76.98,"discounted_cash":22.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0416-10","type":"NDC"}],"standard_charges":[{"minimum":50.75,"maximum":68.51,"gross_charge":84.57,"discounted_cash":25.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.75,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0416-10","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":68.51,"gross_charge":84.57,"discounted_cash":25.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.92,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.56,"maximum":54.75,"gross_charge":67.59,"discounted_cash":20.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":54.75,"gross_charge":67.59,"discounted_cash":20.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.52,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.53,"maximum":57.41,"gross_charge":70.87,"discounted_cash":20.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":57.41,"gross_charge":70.87,"discounted_cash":20.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.18,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.95,"maximum":67.43,"gross_charge":83.24,"discounted_cash":24.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.95,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":67.43,"gross_charge":83.24,"discounted_cash":24.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":102.1,"maximum":137.83,"gross_charge":170.16,"discounted_cash":50.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.1,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":137.83,"gross_charge":170.16,"discounted_cash":50.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":725.9,"maximum":979.97,"gross_charge":1209.83,"discounted_cash":358.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":979.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":979.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":979.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":786.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":846.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":725.9,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 1 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":979.97,"gross_charge":1209.83,"discounted_cash":358.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":979.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":979.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":979.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":774.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":544.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":846.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":725.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":241.97,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0155-15","type":"NDC"}],"standard_charges":[{"minimum":46.62,"maximum":62.93,"gross_charge":77.69,"discounted_cash":23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0155-15","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":62.93,"gross_charge":77.69,"discounted_cash":23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0207-20","type":"NDC"}],"standard_charges":[{"minimum":36.41,"maximum":49.16,"gross_charge":60.68,"discounted_cash":17.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0207-20","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":49.16,"gross_charge":60.68,"discounted_cash":17.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0507-20","type":"NDC"}],"standard_charges":[{"minimum":39.72,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0507-20","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0507-25","type":"NDC"}],"standard_charges":[{"minimum":37.71,"maximum":50.91,"gross_charge":62.85,"discounted_cash":18.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.71,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0507-25","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":50.91,"gross_charge":62.85,"discounted_cash":18.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68001-0323-29","type":"NDC"}],"standard_charges":[{"minimum":66.99,"maximum":90.44,"gross_charge":111.65,"discounted_cash":33.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68001-0323-29","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":90.44,"gross_charge":111.65,"discounted_cash":33.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.33,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0415-01","type":"NDC"}],"standard_charges":[{"minimum":42.33,"maximum":57.15,"gross_charge":70.55,"discounted_cash":20.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0415-01","type":"NDC"}],"standard_charges":[{"minimum":0.81,"maximum":57.15,"gross_charge":70.55,"discounted_cash":20.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.57,"maximum":52.06,"gross_charge":64.27,"discounted_cash":19.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":52.06,"gross_charge":64.27,"discounted_cash":19.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.63,"maximum":58.9,"gross_charge":72.71,"discounted_cash":21.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":58.9,"gross_charge":72.71,"discounted_cash":21.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.47,"maximum":89.74,"gross_charge":110.78,"discounted_cash":32.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.47,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":89.74,"gross_charge":110.78,"discounted_cash":32.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.48,"maximum":89.74,"gross_charge":110.79,"discounted_cash":32.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.48,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2185","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.81,"maximum":89.74,"gross_charge":110.79,"discounted_cash":32.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.81,"standard_charge_algorithm": "Lesser of $0.81 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.16,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2186","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0120-06","type":"NDC"}],"standard_charges":[{"minimum":482.09,"maximum":650.82,"gross_charge":803.48,"discounted_cash":237.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":650.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":650.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":650.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":522.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":562.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.09,"methodology":"fee schedule"}]}]},{"description":"MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2186","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0120-06","type":"NDC"}],"standard_charges":[{"minimum":1.89,"maximum":650.82,"gross_charge":803.48,"discounted_cash":237.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":650.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":650.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":650.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":514.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.08,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.37,"standard_charge_algorithm": "Lesser of $2.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.37,"standard_charge_algorithm": "Lesser of $2.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":361.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":562.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.02,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.08,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2,"methodology":"case rate"}]}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2210","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51991-0144-99","type":"NDC"}],"standard_charges":[{"minimum":70.8,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.8,"methodology":"fee schedule"}]}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2210","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51991-0144-99","type":"NDC"}],"standard_charges":[{"minimum":17.7,"maximum":95.58,"gross_charge":118,"discounted_cash":34.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.04,"standard_charge_algorithm": "Lesser of $23.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.04,"standard_charge_algorithm": "Lesser of $23.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.6,"methodology":"fee schedule"}]}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J2210","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":82.92,"maximum":111.94,"gross_charge":138.19,"discounted_cash":40.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.92,"methodology":"fee schedule"}]}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION","code_information":[{"code":"J2210","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.73,"maximum":111.94,"gross_charge":138.19,"discounted_cash":40.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.04,"standard_charge_algorithm": "Lesser of $23.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.04,"standard_charge_algorithm": "Lesser of $23.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.64,"methodology":"fee schedule"}]}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2212","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65649-0551-02","type":"NDC"}],"standard_charges":[{"minimum":403.27,"maximum":544.41,"gross_charge":672.11,"discounted_cash":198.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":544.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":544.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":544.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":436.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":470.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":403.27,"methodology":"fee schedule"}]}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2212","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65649-0551-02","type":"NDC"}],"standard_charges":[{"minimum":1.2,"maximum":544.41,"gross_charge":672.11,"discounted_cash":198.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":544.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":544.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":544.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":430.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":302.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":470.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":403.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.43,"methodology":"fee schedule"}]}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2212","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65649-0551-07","type":"NDC"}],"standard_charges":[{"minimum":88.1,"maximum":118.94,"gross_charge":146.83,"discounted_cash":43.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.1,"methodology":"fee schedule"}]}]},{"description":"METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2212","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65649-0551-07","type":"NDC"}],"standard_charges":[{"minimum":1.2,"maximum":118.94,"gross_charge":146.83,"discounted_cash":43.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.98,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":88.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.37,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2247","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0230-01","type":"NDC"}],"standard_charges":[{"minimum":111.37,"maximum":150.35,"gross_charge":185.61,"discounted_cash":54.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.37,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2247","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0230-01","type":"NDC"}],"standard_charges":[{"minimum":27.85,"maximum":150.35,"gross_charge":185.61,"discounted_cash":54.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":92.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92.81,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0191-10","type":"NDC"}],"standard_charges":[{"minimum":102.12,"maximum":137.87,"gross_charge":170.2,"discounted_cash":50.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.12,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0191-10","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":137.87,"gross_charge":170.2,"discounted_cash":50.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.04,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0729-12","type":"NDC"}],"standard_charges":[{"minimum":111.37,"maximum":150.35,"gross_charge":185.61,"discounted_cash":54.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.37,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0729-12","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":150.35,"gross_charge":185.61,"discounted_cash":54.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":111.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0029-10","type":"NDC"}],"standard_charges":[{"minimum":90.57,"maximum":122.27,"gross_charge":150.94,"discounted_cash":44.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":98.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.57,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0029-10","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":122.27,"gross_charge":150.94,"discounted_cash":44.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.19,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0427-01","type":"NDC"}],"standard_charges":[{"minimum":155.04,"maximum":209.31,"gross_charge":258.4,"discounted_cash":76.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":167.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":180.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.04,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0427-01","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":209.31,"gross_charge":258.4,"discounted_cash":76.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":209.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":209.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":209.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":165.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":116.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":180.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":155.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.68,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":76.01,"maximum":102.62,"gross_charge":126.68,"discounted_cash":37.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":88.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.01,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":102.62,"gross_charge":126.68,"discounted_cash":37.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":88.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.34,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":109.07,"maximum":147.25,"gross_charge":181.78,"discounted_cash":53.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":127.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"}]}]},{"description":"MICAFUNGIN 100 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2248","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.88,"maximum":147.25,"gross_charge":181.78,"discounted_cash":53.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":116.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.88,"standard_charge_algorithm": "Lesser of $0.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":127.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":109.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.36,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.06,"maximum":45.98,"gross_charge":56.76,"discounted_cash":16.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":45.98,"gross_charge":56.76,"discounted_cash":16.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.73,"maximum":46.89,"gross_charge":57.88,"discounted_cash":17.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.73,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":46.89,"gross_charge":57.88,"discounted_cash":17.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.03,"maximum":47.29,"gross_charge":58.38,"discounted_cash":17.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":47.29,"gross_charge":58.38,"discounted_cash":17.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0600-31","type":"NDC"}],"standard_charges":[{"minimum":34.07,"maximum":45.99,"gross_charge":56.77,"discounted_cash":16.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.07,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0600-31","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":45.99,"gross_charge":56.77,"discounted_cash":16.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0588-68","type":"NDC"}],"standard_charges":[{"minimum":34.29,"maximum":46.3,"gross_charge":57.15,"discounted_cash":16.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0588-68","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":46.3,"gross_charge":57.15,"discounted_cash":16.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0411-25","type":"NDC"}],"standard_charges":[{"minimum":35.46,"maximum":47.88,"gross_charge":59.1,"discounted_cash":17.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0411-25","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":47.88,"gross_charge":59.1,"discounted_cash":17.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0600-02","type":"NDC"}],"standard_charges":[{"minimum":33.53,"maximum":45.26,"gross_charge":55.87,"discounted_cash":16.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.53,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0600-02","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":45.26,"gross_charge":55.87,"discounted_cash":16.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0430-01","type":"NDC"}],"standard_charges":[{"minimum":34.5,"maximum":46.58,"gross_charge":57.5,"discounted_cash":17.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.5,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0430-01","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":46.58,"gross_charge":57.5,"discounted_cash":17.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0432-01","type":"NDC"}],"standard_charges":[{"minimum":36.32,"maximum":49.03,"gross_charge":60.53,"discounted_cash":17.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0432-01","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":49.03,"gross_charge":60.53,"discounted_cash":17.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0741-25","type":"NDC"}],"standard_charges":[{"minimum":34.11,"maximum":46.05,"gross_charge":56.85,"discounted_cash":16.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0741-25","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":46.05,"gross_charge":56.85,"discounted_cash":16.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.47,"maximum":45.19,"gross_charge":55.78,"discounted_cash":16.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.47,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":45.19,"gross_charge":55.78,"discounted_cash":16.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.99,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0589-22","type":"NDC"}],"standard_charges":[{"minimum":46.68,"maximum":63.02,"gross_charge":77.8,"discounted_cash":23.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0589-22","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":63.02,"gross_charge":77.8,"discounted_cash":23.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0412-10","type":"NDC"}],"standard_charges":[{"minimum":102.96,"maximum":138.99,"gross_charge":171.59,"discounted_cash":50.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":111.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.96,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0412-10","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":138.99,"gross_charge":171.59,"discounted_cash":50.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":138.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":138.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":138.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0412-18","type":"NDC"}],"standard_charges":[{"minimum":40.32,"maximum":54.44,"gross_charge":67.2,"discounted_cash":19.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0412-18","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":54.44,"gross_charge":67.2,"discounted_cash":19.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0601-10","type":"NDC"}],"standard_charges":[{"minimum":36.98,"maximum":49.93,"gross_charge":61.63,"discounted_cash":18.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0601-10","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":49.93,"gross_charge":61.63,"discounted_cash":18.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0749-10","type":"NDC"}],"standard_charges":[{"minimum":47.69,"maximum":64.38,"gross_charge":79.48,"discounted_cash":23.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.69,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72611-0749-10","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":64.38,"gross_charge":79.48,"discounted_cash":23.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.16,"maximum":46.11,"gross_charge":56.92,"discounted_cash":16.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.16,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":46.11,"gross_charge":56.92,"discounted_cash":16.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.71,"maximum":49.55,"gross_charge":61.17,"discounted_cash":18.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.71,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":49.55,"gross_charge":61.17,"discounted_cash":18.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.08,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"}]}]},{"description":"MIDAZOLAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2250","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":50.06,"gross_charge":61.8,"discounted_cash":18.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.2,"standard_charge_algorithm": "Lesser of $0.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0313-82","type":"NDC"}],"standard_charges":[{"minimum":62.09,"maximum":83.82,"gross_charge":103.48,"discounted_cash":30.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.09,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0313-82","type":"NDC"}],"standard_charges":[{"minimum":2.01,"maximum":83.82,"gross_charge":103.48,"discounted_cash":30.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0287-10","type":"NDC"}],"standard_charges":[{"minimum":45.67,"maximum":61.65,"gross_charge":76.11,"discounted_cash":22.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.67,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0287-10","type":"NDC"}],"standard_charges":[{"minimum":2.01,"maximum":61.65,"gross_charge":76.11,"discounted_cash":22.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.23,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.21,"maximum":66.43,"gross_charge":82.01,"discounted_cash":24.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.01,"maximum":66.43,"gross_charge":82.01,"discounted_cash":24.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.41,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":69.16,"maximum":93.37,"gross_charge":115.26,"discounted_cash":34.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"}]}]},{"description":"MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK","code_information":[{"code":"J2260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.01,"maximum":93.37,"gross_charge":115.26,"discounted_cash":34.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.01,"standard_charge_algorithm": "Lesser of $2.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.06,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65293-0014-01","type":"NDC"}],"standard_charges":[{"minimum":450.33,"maximum":607.94,"gross_charge":750.54,"discounted_cash":222.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":487.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":525.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":450.33,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65293-0014-01","type":"NDC"}],"standard_charges":[{"minimum":2.32,"maximum":607.94,"gross_charge":750.54,"discounted_cash":222.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":607.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":607.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":607.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":480.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.62,"standard_charge_algorithm": "Lesser of $2.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.62,"standard_charge_algorithm": "Lesser of $2.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":337.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":525.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":450.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.46,"methodology":"case rate"}]}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0160-01","type":"NDC"}],"standard_charges":[{"minimum":554.69,"maximum":748.83,"gross_charge":924.47,"discounted_cash":273.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":748.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":748.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":748.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":600.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":647.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.69,"methodology":"fee schedule"}]}]},{"description":"MINOCYCLINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2265","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0160-01","type":"NDC"}],"standard_charges":[{"minimum":2.32,"maximum":748.83,"gross_charge":924.47,"discounted_cash":273.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":748.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":748.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":748.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":591.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.62,"standard_charge_algorithm": "Lesser of $2.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.62,"standard_charge_algorithm": "Lesser of $2.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":416.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":647.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":554.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.32,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.46,"methodology":"case rate"}]}]},{"description":"MIRIKIZUMAB-MRKZ 300 MG/15 ML (20 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J2267","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41668.85,"maximum":56252.95,"gross_charge":69448.08,"discounted_cash":20556.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56252.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56252.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56252.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45141.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48613.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41668.85,"methodology":"fee schedule"}]}]},{"description":"MIRIKIZUMAB-MRKZ 300 MG/15 ML (20 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J2267","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10417.22,"maximum":56252.95,"gross_charge":69448.08,"discounted_cash":20556.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56252.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56252.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56252.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44446.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34724.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34724.04,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31251.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48613.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41668.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13195.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13889.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10417.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13889.62,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11111-2029-02","type":"NDC"}],"standard_charges":[{"minimum":70.45,"maximum":95.11,"gross_charge":117.41,"discounted_cash":34.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.45,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11111-2029-02","type":"NDC"}],"standard_charges":[{"minimum":3.36,"maximum":95.11,"gross_charge":117.41,"discounted_cash":34.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.49,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"minimum":55.9,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"minimum":3.36,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.46,"maximum":66.77,"gross_charge":82.43,"discounted_cash":24.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.46,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) PCA INTRAVENOUS SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":66.77,"gross_charge":82.43,"discounted_cash":24.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.49,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.94,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.09,"maximum":51.42,"gross_charge":63.47,"discounted_cash":18.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":51.42,"gross_charge":63.47,"discounted_cash":18.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.16,"maximum":47.46,"gross_charge":58.59,"discounted_cash":17.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.16,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":47.46,"gross_charge":58.59,"discounted_cash":17.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INTRAVENOUS CARTRIDGE","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.72,"maximum":46.87,"gross_charge":57.86,"discounted_cash":17.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INTRAVENOUS CARTRIDGE","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":46.87,"gross_charge":57.86,"discounted_cash":17.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJ (CONTAINER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0004-10","type":"NDC"}],"standard_charges":[{"minimum":32.82,"maximum":44.3,"gross_charge":54.69,"discounted_cash":16.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.82,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJ (CONTAINER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0004-10","type":"NDC"}],"standard_charges":[{"minimum":3.36,"maximum":44.3,"gross_charge":54.69,"discounted_cash":16.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.26,"maximum":48.95,"gross_charge":60.42,"discounted_cash":17.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":48.95,"gross_charge":60.42,"discounted_cash":17.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.98,"maximum":51.28,"gross_charge":63.3,"discounted_cash":18.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":51.28,"gross_charge":63.3,"discounted_cash":18.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.66,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SYRINGE","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.6,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INTRAVENOUS SYRINGE","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":53.46,"gross_charge":66,"discounted_cash":19.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.2,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.34,"maximum":46.36,"gross_charge":57.23,"discounted_cash":16.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":46.36,"gross_charge":57.23,"discounted_cash":16.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.97,"maximum":80.96,"gross_charge":99.94,"discounted_cash":29.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.97,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2270","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.36,"maximum":80.96,"gross_charge":99.94,"discounted_cash":29.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.36,"standard_charge_algorithm": "Lesser of $3.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.99,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0451-00","type":"NDC"}],"standard_charges":[{"minimum":37.34,"maximum":50.41,"gross_charge":62.23,"discounted_cash":18.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0451-00","type":"NDC"}],"standard_charges":[{"minimum":9.34,"maximum":50.41,"gross_charge":62.23,"discounted_cash":18.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.12,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0004-11","type":"NDC"}],"standard_charges":[{"minimum":37.92,"maximum":51.19,"gross_charge":63.19,"discounted_cash":18.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.92,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0004-11","type":"NDC"}],"standard_charges":[{"minimum":9.48,"maximum":51.19,"gross_charge":63.19,"discounted_cash":18.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.64,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0452-01","type":"NDC"}],"standard_charges":[{"minimum":36.81,"maximum":49.69,"gross_charge":61.34,"discounted_cash":18.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0452-01","type":"NDC"}],"standard_charges":[{"minimum":9.21,"maximum":49.69,"gross_charge":61.34,"discounted_cash":18.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.27,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0004-10","type":"NDC"}],"standard_charges":[{"minimum":36.09,"maximum":48.72,"gross_charge":60.14,"discounted_cash":17.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.09,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 2 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0004-10","type":"NDC"}],"standard_charges":[{"minimum":9.03,"maximum":48.72,"gross_charge":60.14,"discounted_cash":17.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0454-01","type":"NDC"}],"standard_charges":[{"minimum":36.93,"maximum":49.85,"gross_charge":61.54,"discounted_cash":18.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0454-01","type":"NDC"}],"standard_charges":[{"minimum":9.24,"maximum":49.85,"gross_charge":61.54,"discounted_cash":18.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0005-01","type":"NDC"}],"standard_charges":[{"minimum":38.43,"maximum":51.88,"gross_charge":64.04,"discounted_cash":18.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0005-01","type":"NDC"}],"standard_charges":[{"minimum":9.61,"maximum":51.88,"gross_charge":64.04,"discounted_cash":18.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0005-10","type":"NDC"}],"standard_charges":[{"minimum":36.26,"maximum":48.95,"gross_charge":60.42,"discounted_cash":17.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJ (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0005-10","type":"NDC"}],"standard_charges":[{"minimum":9.07,"maximum":48.95,"gross_charge":60.42,"discounted_cash":17.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0005-11","type":"NDC"}],"standard_charges":[{"minimum":38.03,"maximum":51.34,"gross_charge":63.38,"discounted_cash":18.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"}]}]},{"description":"MORPHINE 4 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76045-0005-11","type":"NDC"}],"standard_charges":[{"minimum":9.51,"maximum":51.34,"gross_charge":63.38,"discounted_cash":18.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0291-10","type":"NDC"}],"standard_charges":[{"minimum":56.84,"maximum":76.73,"gross_charge":94.72,"discounted_cash":28.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.84,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0291-10","type":"NDC"}],"standard_charges":[{"minimum":13.37,"maximum":76.73,"gross_charge":94.72,"discounted_cash":28.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":66.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":67.79,"gross_charge":83.69,"discounted_cash":24.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.56,"maximum":67.79,"gross_charge":83.69,"discounted_cash":24.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":79.87,"maximum":107.82,"gross_charge":133.11,"discounted_cash":39.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":93.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.87,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 1 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.37,"maximum":107.82,"gross_charge":133.11,"discounted_cash":39.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":93.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.63,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":508.83,"maximum":686.92,"gross_charge":848.04,"discounted_cash":251.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":686.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":686.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":686.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":551.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":593.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":508.83,"methodology":"fee schedule"}]}]},{"description":"MORPHINE (PF) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2274","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.37,"maximum":686.92,"gross_charge":848.04,"discounted_cash":251.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":686.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":686.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":686.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":542.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.37,"standard_charge_algorithm": "Lesser of $13.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":381.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":593.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":508.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":161.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.61,"methodology":"fee schedule"}]}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2300","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.59,"maximum":62.89,"gross_charge":77.64,"discounted_cash":22.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"}]}]},{"description":"NALBUPHINE 20 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2300","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.55,"maximum":62.89,"gross_charge":77.64,"discounted_cash":22.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.55,"standard_charge_algorithm": "Lesser of $3.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.53,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J2305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":61.68,"maximum":83.27,"gross_charge":102.8,"discounted_cash":30.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.68,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J2305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.42,"maximum":83.27,"gross_charge":102.8,"discounted_cash":30.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.4,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.56,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS","code_information":[{"code":"J2305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":83.31,"maximum":112.47,"gross_charge":138.84,"discounted_cash":41.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.31,"methodology":"fee schedule"}]}]},{"description":"NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS","code_information":[{"code":"J2305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.83,"maximum":112.47,"gross_charge":138.84,"discounted_cash":41.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.77,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0308-01","type":"NDC"}],"standard_charges":[{"minimum":39.36,"maximum":53.13,"gross_charge":65.59,"discounted_cash":19.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0308-01","type":"NDC"}],"standard_charges":[{"minimum":9.84,"maximum":53.13,"gross_charge":65.59,"discounted_cash":19.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0292-02","type":"NDC"}],"standard_charges":[{"minimum":40.3,"maximum":54.4,"gross_charge":67.16,"discounted_cash":19.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0292-02","type":"NDC"}],"standard_charges":[{"minimum":10.08,"maximum":54.4,"gross_charge":67.16,"discounted_cash":19.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0450-25","type":"NDC"}],"standard_charges":[{"minimum":43.88,"maximum":59.23,"gross_charge":73.12,"discounted_cash":21.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.88,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0450-25","type":"NDC"}],"standard_charges":[{"minimum":10.97,"maximum":59.23,"gross_charge":73.12,"discounted_cash":21.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.32,"maximum":54.43,"gross_charge":67.19,"discounted_cash":19.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.08,"maximum":54.43,"gross_charge":67.19,"discounted_cash":19.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":68.29,"maximum":92.19,"gross_charge":113.81,"discounted_cash":33.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.29,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 0.4 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17.08,"maximum":92.19,"gross_charge":113.81,"discounted_cash":33.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.77,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0345-10","type":"NDC"}],"standard_charges":[{"minimum":110.81,"maximum":149.59,"gross_charge":184.67,"discounted_cash":54.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.81,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0345-10","type":"NDC"}],"standard_charges":[{"minimum":27.71,"maximum":149.59,"gross_charge":184.67,"discounted_cash":54.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":149.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":149.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":149.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":118.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":83.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":129.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":110.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.94,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3469-01","type":"NDC"}],"standard_charges":[{"minimum":56.43,"maximum":76.19,"gross_charge":94.05,"discounted_cash":27.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.43,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3469-01","type":"NDC"}],"standard_charges":[{"minimum":14.11,"maximum":76.19,"gross_charge":94.05,"discounted_cash":27.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":47.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.81,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.13,"maximum":71.72,"gross_charge":88.54,"discounted_cash":26.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"}]}]},{"description":"NALOXONE 1 MG/ML INJECTION SYRINGE","code_information":[{"code":"J2312","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.29,"maximum":71.72,"gross_charge":88.54,"discounted_cash":26.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"}]}]},{"description":"UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2329","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"73150-0150-06","type":"NDC"}],"standard_charges":[{"minimum":45468.69,"maximum":61382.74,"gross_charge":75781.15,"discounted_cash":22431.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61382.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61382.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61382.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49257.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53046.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45468.69,"methodology":"fee schedule"}]}]},{"description":"UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2329","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"73150-0150-06","type":"NDC"}],"standard_charges":[{"minimum":11367.18,"maximum":61382.74,"gross_charge":75781.15,"discounted_cash":22431.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61382.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61382.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61382.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48499.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37890.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37890.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34101.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53046.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45468.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14398.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15156.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11367.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15156.23,"methodology":"fee schedule"}]}]},{"description":"OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2350","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0150-01","type":"NDC"}],"standard_charges":[{"minimum":85407.75,"maximum":115300.46,"gross_charge":142346.24,"discounted_cash":42134.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115300.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115300.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115300.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":92525.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":99642.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85407.75,"methodology":"fee schedule"}]}]},{"description":"OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2350","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0150-01","type":"NDC"}],"standard_charges":[{"minimum":51.68,"maximum":115300.46,"gross_charge":142346.24,"discounted_cash":42134.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":115300.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":115300.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":115300.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91101.6,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":58.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":59.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":61.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":60.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":88.37,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.89,"standard_charge_algorithm": "Lesser of $67.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.89,"standard_charge_algorithm": "Lesser of $67.89 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":64055.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":99642.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":85407.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27045.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28469.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21351.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28469.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":51.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":55.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":53.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":54.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":56.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":54.78,"methodology":"case rate"}]}]},{"description":"OCTREOTIDEMICROSPHERES ER 20 MG INTRAMUSCULAR SUSP EXTENDED RELEASE","code_information":[{"code":"J2353","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":18993.27,"maximum":25640.91,"gross_charge":31655.44,"discounted_cash":9370.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25640.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25640.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25640.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20576.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22158.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18993.27,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDEMICROSPHERES ER 20 MG INTRAMUSCULAR SUSP EXTENDED RELEASE","code_information":[{"code":"J2353","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":182.91,"maximum":25640.91,"gross_charge":31655.44,"discounted_cash":9370.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25640.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25640.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25640.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20259.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":218.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":210.83,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":219.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":214.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":312.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":233.88,"standard_charge_algorithm": "Lesser of $233.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":233.88,"standard_charge_algorithm": "Lesser of $233.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14244.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22158.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18993.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6014.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6331.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4748.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6331.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":182.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":195.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":188.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":192.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":201.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":193.88,"methodology":"case rate"}]}]},{"description":"OCTREOTIDEMICROSPHERES ER 30 MG INTRAMUSCULAR SUSP EXTENDED RELEASE","code_information":[{"code":"J2353","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28335.85,"maximum":38253.4,"gross_charge":47226.41,"discounted_cash":13979.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38253.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38253.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38253.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30697.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33058.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28335.85,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDEMICROSPHERES ER 30 MG INTRAMUSCULAR SUSP EXTENDED RELEASE","code_information":[{"code":"J2353","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":182.91,"maximum":38253.4,"gross_charge":47226.41,"discounted_cash":13979.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38253.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38253.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38253.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30224.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":218.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":218.37,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":210.83,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":219.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":214.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":312.78,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":233.88,"standard_charge_algorithm": "Lesser of $233.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":233.88,"standard_charge_algorithm": "Lesser of $233.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21251.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33058.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28335.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8973.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9445.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7083.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9445.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":182.91,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":195.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":188.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":192.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":201.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":193.88,"methodology":"case rate"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0452-01","type":"NDC"}],"standard_charges":[{"minimum":44.12,"maximum":59.56,"gross_charge":73.52,"discounted_cash":21.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0452-01","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":59.56,"gross_charge":73.52,"discounted_cash":21.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0376-04","type":"NDC"}],"standard_charges":[{"minimum":38.59,"maximum":52.1,"gross_charge":64.31,"discounted_cash":19.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.59,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0376-04","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":52.1,"gross_charge":64.31,"discounted_cash":19.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0896-10","type":"NDC"}],"standard_charges":[{"minimum":37.01,"maximum":49.96,"gross_charge":61.67,"discounted_cash":18.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.01,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0896-10","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":49.96,"gross_charge":61.67,"discounted_cash":18.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":98.57,"maximum":133.06,"gross_charge":164.27,"discounted_cash":48.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":106.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":114.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.57,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":133.06,"gross_charge":164.27,"discounted_cash":48.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":133.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":133.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":114.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":99.88,"maximum":134.84,"gross_charge":166.46,"discounted_cash":49.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":116.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.88,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":134.84,"gross_charge":166.46,"discounted_cash":49.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":134.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":106.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":74.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":116.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":99.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0451-01","type":"NDC"}],"standard_charges":[{"minimum":42.5,"maximum":57.37,"gross_charge":70.82,"discounted_cash":20.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.5,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0451-01","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":57.37,"gross_charge":70.82,"discounted_cash":20.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.88,"maximum":51.13,"gross_charge":63.12,"discounted_cash":18.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":51.13,"gross_charge":63.12,"discounted_cash":18.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.69,"maximum":90.04,"gross_charge":111.15,"discounted_cash":32.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.69,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":90.04,"gross_charge":111.15,"discounted_cash":32.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.23,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":67.38,"maximum":90.96,"gross_charge":112.29,"discounted_cash":33.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.38,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":90.96,"gross_charge":112.29,"discounted_cash":33.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.46,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0377-41","type":"NDC"}],"standard_charges":[{"minimum":56.34,"maximum":76.06,"gross_charge":93.89,"discounted_cash":27.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.34,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0377-41","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":76.06,"gross_charge":93.89,"discounted_cash":27.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0897-01","type":"NDC"}],"standard_charges":[{"minimum":51.28,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0897-01","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":69.23,"gross_charge":85.46,"discounted_cash":25.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.75,"maximum":73.91,"gross_charge":91.24,"discounted_cash":27.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.75,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":73.91,"gross_charge":91.24,"discounted_cash":27.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.25,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":350.03,"maximum":472.54,"gross_charge":583.38,"discounted_cash":172.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":472.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":472.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":472.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":379.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":408.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.03,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":472.54,"gross_charge":583.38,"discounted_cash":172.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":472.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":472.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":472.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":373.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":262.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":408.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.68,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":356.37,"maximum":481.1,"gross_charge":593.95,"discounted_cash":175.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":481.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":481.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":481.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":386.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":415.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.37,"methodology":"fee schedule"}]}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2354","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":481.1,"gross_charge":593.95,"discounted_cash":175.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":481.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":481.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":481.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":267.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":415.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.79,"methodology":"fee schedule"}]}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2356","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0112-01","type":"NDC"}],"standard_charges":[{"minimum":17667.51,"maximum":23851.14,"gross_charge":29445.84,"discounted_cash":8715.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23851.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23851.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23851.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19139.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20612.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17667.51,"methodology":"fee schedule"}]}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2356","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0112-01","type":"NDC"}],"standard_charges":[{"minimum":4416.88,"maximum":23851.14,"gross_charge":29445.84,"discounted_cash":8715.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23851.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23851.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23851.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18845.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14722.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14722.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13250.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20612.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17667.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5594.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5889.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4416.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5889.17,"methodology":"fee schedule"}]}]},{"description":"OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0215-01","type":"NDC"}],"standard_charges":[{"minimum":6196.61,"maximum":8365.43,"gross_charge":10327.68,"discounted_cash":3057,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8365.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8365.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8365.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6713,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7229.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6196.61,"methodology":"fee schedule"}]}]},{"description":"OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0215-01","type":"NDC"}],"standard_charges":[{"minimum":35.87,"maximum":8365.43,"gross_charge":10327.68,"discounted_cash":3057,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8365.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8365.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8365.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6609.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":37.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.67,"standard_charge_algorithm": "Lesser of $43.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.67,"standard_charge_algorithm": "Lesser of $43.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4647.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7229.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6196.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1962.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1549.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":39.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38.02,"methodology":"case rate"}]}]},{"description":"OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0215-03","type":"NDC"}],"standard_charges":[{"minimum":6309.83,"maximum":8518.27,"gross_charge":10516.38,"discounted_cash":3112.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8518.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8518.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8518.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6835.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7361.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6309.83,"methodology":"fee schedule"}]}]},{"description":"OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0215-03","type":"NDC"}],"standard_charges":[{"minimum":35.87,"maximum":8518.27,"gross_charge":10516.38,"discounted_cash":3112.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8518.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8518.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8518.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6730.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":37.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.67,"standard_charge_algorithm": "Lesser of $43.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.67,"standard_charge_algorithm": "Lesser of $43.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4732.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7361.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6309.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1998.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1577.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2103.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":39.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38.02,"methodology":"case rate"}]}]},{"description":"OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0214-01","type":"NDC"}],"standard_charges":[{"minimum":3204.04,"maximum":4325.45,"gross_charge":5340.06,"discounted_cash":1580.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4325.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4325.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4325.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3471.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3738.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3204.04,"methodology":"fee schedule"}]}]},{"description":"OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0214-01","type":"NDC"}],"standard_charges":[{"minimum":35.87,"maximum":4325.45,"gross_charge":5340.06,"discounted_cash":1580.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4325.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4325.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4325.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3417.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":37.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":39.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":61.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.67,"standard_charge_algorithm": "Lesser of $43.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.67,"standard_charge_algorithm": "Lesser of $43.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2403.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3738.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3204.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1014.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1068.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":35.87,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":38.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":36.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":37.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":39.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38.02,"methodology":"case rate"}]}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0538-02","type":"NDC"}],"standard_charges":[{"minimum":40.96,"maximum":55.3,"gross_charge":68.26,"discounted_cash":20.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.96,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0538-02","type":"NDC"}],"standard_charges":[{"minimum":4.6,"maximum":55.3,"gross_charge":68.26,"discounted_cash":20.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.6,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.6,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0651-02","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0651-02","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.33,"maximum":57.15,"gross_charge":70.55,"discounted_cash":20.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"}]}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.6,"maximum":57.15,"gross_charge":70.55,"discounted_cash":20.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.6,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.6,"standard_charge_algorithm": "Lesser of $4.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.11,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0315-01","type":"NDC"}],"standard_charges":[{"minimum":34.55,"maximum":46.64,"gross_charge":57.57,"discounted_cash":17.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.55,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0315-01","type":"NDC"}],"standard_charges":[{"minimum":8.64,"maximum":46.64,"gross_charge":57.57,"discounted_cash":17.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0213-25","type":"NDC"}],"standard_charges":[{"minimum":40.32,"maximum":54.43,"gross_charge":67.19,"discounted_cash":19.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0213-25","type":"NDC"}],"standard_charges":[{"minimum":10.08,"maximum":54.43,"gross_charge":67.19,"discounted_cash":19.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0300-25","type":"NDC"}],"standard_charges":[{"minimum":35.64,"maximum":48.11,"gross_charge":59.39,"discounted_cash":17.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0300-25","type":"NDC"}],"standard_charges":[{"minimum":8.91,"maximum":48.11,"gross_charge":59.39,"discounted_cash":17.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0211-03","type":"NDC"}],"standard_charges":[{"minimum":35.98,"maximum":48.57,"gross_charge":59.96,"discounted_cash":17.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0211-03","type":"NDC"}],"standard_charges":[{"minimum":9,"maximum":48.57,"gross_charge":59.96,"discounted_cash":17.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0751-00","type":"NDC"}],"standard_charges":[{"minimum":40.19,"maximum":54.25,"gross_charge":66.97,"discounted_cash":19.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0751-00","type":"NDC"}],"standard_charges":[{"minimum":10.05,"maximum":54.25,"gross_charge":66.97,"discounted_cash":19.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0801-25","type":"NDC"}],"standard_charges":[{"minimum":35.92,"maximum":48.49,"gross_charge":59.86,"discounted_cash":17.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0801-25","type":"NDC"}],"standard_charges":[{"minimum":8.98,"maximum":48.49,"gross_charge":59.86,"discounted_cash":17.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0807-01","type":"NDC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0807-01","type":"NDC"}],"standard_charges":[{"minimum":9.46,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0504-01","type":"NDC"}],"standard_charges":[{"minimum":34.64,"maximum":46.76,"gross_charge":57.72,"discounted_cash":17.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.64,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0504-01","type":"NDC"}],"standard_charges":[{"minimum":8.66,"maximum":46.76,"gross_charge":57.72,"discounted_cash":17.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0571-01","type":"NDC"}],"standard_charges":[{"minimum":37.74,"maximum":50.95,"gross_charge":62.89,"discounted_cash":18.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0571-01","type":"NDC"}],"standard_charges":[{"minimum":9.44,"maximum":50.95,"gross_charge":62.89,"discounted_cash":18.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0571-25","type":"NDC"}],"standard_charges":[{"minimum":37.79,"maximum":51.02,"gross_charge":62.98,"discounted_cash":18.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.79,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0571-25","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":51.02,"gross_charge":62.98,"discounted_cash":18.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76014-0004-25","type":"NDC"}],"standard_charges":[{"minimum":41.27,"maximum":55.72,"gross_charge":68.78,"discounted_cash":20.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76014-0004-25","type":"NDC"}],"standard_charges":[{"minimum":10.32,"maximum":55.72,"gross_charge":68.78,"discounted_cash":20.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.39,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.76,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81284-0211-00","type":"NDC"}],"standard_charges":[{"minimum":35.56,"maximum":48.01,"gross_charge":59.26,"discounted_cash":17.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"81284-0211-00","type":"NDC"}],"standard_charges":[{"minimum":8.89,"maximum":48.01,"gross_charge":59.26,"discounted_cash":17.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.98,"maximum":47.23,"gross_charge":58.3,"discounted_cash":17.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.75,"maximum":47.23,"gross_charge":58.3,"discounted_cash":17.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.85,"maximum":84.84,"gross_charge":104.74,"discounted_cash":31.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.85,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.72,"maximum":84.84,"gross_charge":104.74,"discounted_cash":31.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE INJ 1000 MCG/10 ML SYRG","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0957-10","type":"NDC"}],"standard_charges":[{"minimum":44.18,"maximum":59.65,"gross_charge":73.63,"discounted_cash":21.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.18,"methodology":"fee schedule"}]}]},{"description":"PHENYLEPHRINE INJ 1000 MCG/10 ML SYRG","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0957-10","type":"NDC"}],"standard_charges":[{"minimum":11.05,"maximum":59.65,"gross_charge":73.63,"discounted_cash":21.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.73,"methodology":"fee schedule"}]}]},{"description":"CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0477-01","type":"NDC"}],"standard_charges":[{"minimum":77.09,"maximum":104.07,"gross_charge":128.48,"discounted_cash":38.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.09,"methodology":"fee schedule"}]}]},{"description":"CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0477-01","type":"NDC"}],"standard_charges":[{"minimum":19.28,"maximum":104.07,"gross_charge":128.48,"discounted_cash":38.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.7,"methodology":"fee schedule"}]}]},{"description":"CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J2401","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.14,"maximum":83.89,"gross_charge":103.56,"discounted_cash":30.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"}]}]},{"description":"CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION","code_information":[{"code":"J2401","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.54,"maximum":83.89,"gross_charge":103.56,"discounted_cash":30.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.78,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.72,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0548-31","type":"NDC"}],"standard_charges":[{"minimum":34.72,"maximum":46.87,"gross_charge":57.86,"discounted_cash":17.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0548-31","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":46.87,"gross_charge":57.86,"discounted_cash":17.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0548-42","type":"NDC"}],"standard_charges":[{"minimum":33.7,"maximum":45.49,"gross_charge":56.16,"discounted_cash":16.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.7,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0548-42","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":45.49,"gross_charge":56.16,"discounted_cash":16.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0012-25","type":"NDC"}],"standard_charges":[{"minimum":33.83,"maximum":45.67,"gross_charge":56.38,"discounted_cash":16.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0012-25","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":45.67,"gross_charge":56.38,"discounted_cash":16.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.28,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6130-00","type":"NDC"}],"standard_charges":[{"minimum":33.71,"maximum":45.5,"gross_charge":56.17,"discounted_cash":16.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6130-00","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":45.5,"gross_charge":56.17,"discounted_cash":16.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0373-02","type":"NDC"}],"standard_charges":[{"minimum":38.08,"maximum":51.41,"gross_charge":63.46,"discounted_cash":18.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0373-02","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":51.41,"gross_charge":63.46,"discounted_cash":18.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0440-00","type":"NDC"}],"standard_charges":[{"minimum":33.99,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0440-00","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":45.88,"gross_charge":56.64,"discounted_cash":16.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0776-02","type":"NDC"}],"standard_charges":[{"minimum":33.85,"maximum":45.7,"gross_charge":56.41,"discounted_cash":16.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.85,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0776-02","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":45.7,"gross_charge":56.41,"discounted_cash":16.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0520-25","type":"NDC"}],"standard_charges":[{"minimum":34.5,"maximum":46.58,"gross_charge":57.5,"discounted_cash":17.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.5,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0520-25","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":46.58,"gross_charge":57.5,"discounted_cash":17.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.5,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.32,"maximum":44.98,"gross_charge":55.53,"discounted_cash":16.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":44.98,"gross_charge":55.53,"discounted_cash":16.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.71,"maximum":45.51,"gross_charge":56.18,"discounted_cash":16.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":45.51,"gross_charge":56.18,"discounted_cash":16.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.24,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.55,"maximum":46.64,"gross_charge":57.57,"discounted_cash":17.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.55,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":46.64,"gross_charge":57.57,"discounted_cash":17.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.75,"maximum":48.26,"gross_charge":59.58,"discounted_cash":17.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.75,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":48.26,"gross_charge":59.58,"discounted_cash":17.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0298-05","type":"NDC"}],"standard_charges":[{"minimum":46.68,"maximum":63.02,"gross_charge":77.8,"discounted_cash":23.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0298-05","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":63.02,"gross_charge":77.8,"discounted_cash":23.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.56,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0549-31","type":"NDC"}],"standard_charges":[{"minimum":41.58,"maximum":56.13,"gross_charge":69.29,"discounted_cash":20.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0549-31","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":56.13,"gross_charge":69.29,"discounted_cash":20.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.86,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0441-20","type":"NDC"}],"standard_charges":[{"minimum":38.55,"maximum":52.04,"gross_charge":64.24,"discounted_cash":19.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0441-20","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":52.04,"gross_charge":64.24,"discounted_cash":19.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0777-20","type":"NDC"}],"standard_charges":[{"minimum":41.03,"maximum":55.38,"gross_charge":68.37,"discounted_cash":20.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.03,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0777-20","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":55.38,"gross_charge":68.37,"discounted_cash":20.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0124-01","type":"NDC"}],"standard_charges":[{"minimum":41.53,"maximum":56.07,"gross_charge":69.21,"discounted_cash":20.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.53,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0124-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":56.07,"gross_charge":69.21,"discounted_cash":20.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.85,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.5,"maximum":51.97,"gross_charge":64.16,"discounted_cash":19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":51.97,"gross_charge":64.16,"discounted_cash":19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.84,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.31,"maximum":66.56,"gross_charge":82.17,"discounted_cash":24.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.31,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":66.56,"gross_charge":82.17,"discounted_cash":24.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.93,"maximum":68.75,"gross_charge":84.87,"discounted_cash":25.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.93,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2405","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":68.75,"gross_charge":84.87,"discounted_cash":25.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.98,"methodology":"fee schedule"}]}]},{"description":"ORITAVANCIN 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77778-8101-04","type":"NDC"}],"standard_charges":[{"minimum":2175.94,"maximum":2937.52,"gross_charge":3626.56,"discounted_cash":1073.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2937.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2937.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2937.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2357.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2538.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2175.94,"methodology":"fee schedule"}]}]},{"description":"ORITAVANCIN 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77778-8101-04","type":"NDC"}],"standard_charges":[{"minimum":25.5,"maximum":2937.52,"gross_charge":3626.56,"discounted_cash":1073.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2937.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2937.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2937.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2321,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.15,"standard_charge_algorithm": "Lesser of $29.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.15,"standard_charge_algorithm": "Lesser of $29.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1631.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2538.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2175.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":689.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":543.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":725.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.03,"methodology":"case rate"}]}]},{"description":"ORITAVANCIN 400 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0140-01","type":"NDC"}],"standard_charges":[{"minimum":2554.71,"maximum":3448.86,"gross_charge":4257.85,"discounted_cash":1260.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3448.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3448.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3448.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2767.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2980.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2554.71,"methodology":"fee schedule"}]}]},{"description":"ORITAVANCIN 400 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0140-01","type":"NDC"}],"standard_charges":[{"minimum":25.5,"maximum":3448.86,"gross_charge":4257.85,"discounted_cash":1260.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3448.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3448.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3448.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2725.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.15,"standard_charge_algorithm": "Lesser of $29.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.15,"standard_charge_algorithm": "Lesser of $29.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1916.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2980.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2554.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":809,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":638.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":851.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.03,"methodology":"case rate"}]}]},{"description":"ORITAVANCIN 400 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0140-03","type":"NDC"}],"standard_charges":[{"minimum":7598.57,"maximum":10258.06,"gross_charge":12664.27,"discounted_cash":3748.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10258.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10258.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10258.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8231.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8864.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7598.57,"methodology":"fee schedule"}]}]},{"description":"ORITAVANCIN 400 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70842-0140-03","type":"NDC"}],"standard_charges":[{"minimum":25.5,"maximum":10258.06,"gross_charge":12664.27,"discounted_cash":3748.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10258.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10258.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10258.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8105.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":27.6,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":28.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":43.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.15,"standard_charge_algorithm": "Lesser of $29.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.15,"standard_charge_algorithm": "Lesser of $29.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5698.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8864.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7598.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2406.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2532.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1899.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2532.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":25.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":27.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":26.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":28.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":27.03,"methodology":"case rate"}]}]},{"description":"PAMIDRONATE 30 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59923-0601-10","type":"NDC"}],"standard_charges":[{"minimum":74.75,"maximum":100.91,"gross_charge":124.57,"discounted_cash":36.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":87.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.75,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 30 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59923-0601-10","type":"NDC"}],"standard_charges":[{"minimum":18.69,"maximum":100.91,"gross_charge":124.57,"discounted_cash":36.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":87.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.92,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0324-18","type":"NDC"}],"standard_charges":[{"minimum":59.28,"maximum":80.03,"gross_charge":98.8,"discounted_cash":29.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.28,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0324-18","type":"NDC"}],"standard_charges":[{"minimum":14.82,"maximum":80.03,"gross_charge":98.8,"discounted_cash":29.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":80.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":69.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0430-10","type":"NDC"}],"standard_charges":[{"minimum":53.48,"maximum":72.19,"gross_charge":89.12,"discounted_cash":26.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.48,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0430-10","type":"NDC"}],"standard_charges":[{"minimum":13.37,"maximum":72.19,"gross_charge":89.12,"discounted_cash":26.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.83,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0325-18","type":"NDC"}],"standard_charges":[{"minimum":115.44,"maximum":155.84,"gross_charge":192.39,"discounted_cash":56.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.44,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 60 MG/10 ML (6 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0325-18","type":"NDC"}],"standard_charges":[{"minimum":28.86,"maximum":155.84,"gross_charge":192.39,"discounted_cash":56.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 90 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59923-0603-10","type":"NDC"}],"standard_charges":[{"minimum":159.03,"maximum":214.7,"gross_charge":265.05,"discounted_cash":78.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":172.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":185.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.03,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 90 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59923-0603-10","type":"NDC"}],"standard_charges":[{"minimum":39.76,"maximum":214.7,"gross_charge":265.05,"discounted_cash":78.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":214.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":169.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":119.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":185.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.01,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0326-18","type":"NDC"}],"standard_charges":[{"minimum":105.15,"maximum":141.96,"gross_charge":175.25,"discounted_cash":51.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":113.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":122.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.15,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0326-18","type":"NDC"}],"standard_charges":[{"minimum":26.29,"maximum":141.96,"gross_charge":175.25,"discounted_cash":51.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":141.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":141.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":141.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":78.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":122.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.05,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0446-10","type":"NDC"}],"standard_charges":[{"minimum":90.68,"maximum":122.42,"gross_charge":151.13,"discounted_cash":44.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":98.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.68,"methodology":"fee schedule"}]}]},{"description":"PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0446-10","type":"NDC"}],"standard_charges":[{"minimum":22.67,"maximum":122.42,"gross_charge":151.13,"discounted_cash":44.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":122.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":122.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":122.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.53,"standard_charge_algorithm": "Lesser of $70.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":68.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"}]}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2440","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0121-05","type":"NDC"}],"standard_charges":[{"minimum":70.92,"maximum":95.75,"gross_charge":118.2,"discounted_cash":34.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.92,"methodology":"fee schedule"}]}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2440","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0121-05","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":95.75,"gross_charge":118.2,"discounted_cash":34.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":95.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":95.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":95.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.64,"methodology":"fee schedule"}]}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2440","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0142-01","type":"NDC"}],"standard_charges":[{"minimum":73.24,"maximum":98.87,"gross_charge":122.06,"discounted_cash":36.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":85.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.24,"methodology":"fee schedule"}]}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2440","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0142-01","type":"NDC"}],"standard_charges":[{"minimum":1.45,"maximum":98.87,"gross_charge":122.06,"discounted_cash":36.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":85.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.42,"methodology":"fee schedule"}]}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2440","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":128.41,"maximum":173.35,"gross_charge":214.01,"discounted_cash":63.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":139.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":149.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.41,"methodology":"fee schedule"}]}]},{"description":"PAPAVERINE 30 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2440","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.45,"maximum":173.35,"gross_charge":214.01,"discounted_cash":63.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":173.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":173.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":173.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":136.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.45,"standard_charge_algorithm": "Lesser of $1.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":96.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":149.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":128.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.81,"methodology":"fee schedule"}]}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6193-01","type":"NDC"}],"standard_charges":[{"minimum":39.26,"maximum":53,"gross_charge":65.42,"discounted_cash":19.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"}]}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6193-01","type":"NDC"}],"standard_charges":[{"minimum":1.24,"maximum":53,"gross_charge":65.42,"discounted_cash":19.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.24,"standard_charge_algorithm": "Lesser of $1.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.24,"standard_charge_algorithm": "Lesser of $1.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0797-01","type":"NDC"}],"standard_charges":[{"minimum":185.69,"maximum":250.68,"gross_charge":309.47,"discounted_cash":91.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":201.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":216.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":185.69,"methodology":"fee schedule"}]}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0797-01","type":"NDC"}],"standard_charges":[{"minimum":1.24,"maximum":250.68,"gross_charge":309.47,"discounted_cash":91.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":198.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.24,"standard_charge_algorithm": "Lesser of $1.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.24,"standard_charge_algorithm": "Lesser of $1.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":139.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":216.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":185.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.9,"methodology":"fee schedule"}]}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2469","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.92,"maximum":64.69,"gross_charge":79.86,"discounted_cash":23.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"}]}]},{"description":"PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2469","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.24,"maximum":64.69,"gross_charge":79.86,"discounted_cash":23.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.24,"standard_charge_algorithm": "Lesser of $1.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.24,"standard_charge_algorithm": "Lesser of $1.24 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0751-10","type":"NDC"}],"standard_charges":[{"minimum":37.28,"maximum":50.33,"gross_charge":62.13,"discounted_cash":18.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0751-10","type":"NDC"}],"standard_charges":[{"minimum":9.32,"maximum":50.33,"gross_charge":62.13,"discounted_cash":18.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0202-10","type":"NDC"}],"standard_charges":[{"minimum":36.45,"maximum":49.21,"gross_charge":60.75,"discounted_cash":17.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0202-10","type":"NDC"}],"standard_charges":[{"minimum":9.12,"maximum":49.21,"gross_charge":60.75,"discounted_cash":17.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0129-40","type":"NDC"}],"standard_charges":[{"minimum":40.32,"maximum":54.43,"gross_charge":67.19,"discounted_cash":19.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0129-40","type":"NDC"}],"standard_charges":[{"minimum":10.08,"maximum":54.43,"gross_charge":67.19,"discounted_cash":19.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0433-01","type":"NDC"}],"standard_charges":[{"minimum":44.07,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0433-01","type":"NDC"}],"standard_charges":[{"minimum":11.02,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67850-0150-00","type":"NDC"}],"standard_charges":[{"minimum":37.17,"maximum":50.18,"gross_charge":61.95,"discounted_cash":18.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.17,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67850-0150-00","type":"NDC"}],"standard_charges":[{"minimum":9.3,"maximum":50.18,"gross_charge":61.95,"discounted_cash":18.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67850-0150-25","type":"NDC"}],"standard_charges":[{"minimum":41.78,"maximum":56.41,"gross_charge":69.63,"discounted_cash":20.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67850-0150-25","type":"NDC"}],"standard_charges":[{"minimum":10.45,"maximum":56.41,"gross_charge":69.63,"discounted_cash":20.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.93,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0024-02","type":"NDC"}],"standard_charges":[{"minimum":45.42,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0024-02","type":"NDC"}],"standard_charges":[{"minimum":11.36,"maximum":61.31,"gross_charge":75.69,"discounted_cash":22.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0600-11","type":"NDC"}],"standard_charges":[{"minimum":35.42,"maximum":47.82,"gross_charge":59.03,"discounted_cash":17.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0600-11","type":"NDC"}],"standard_charges":[{"minimum":8.86,"maximum":47.82,"gross_charge":59.03,"discounted_cash":17.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":29.52,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0550-01","type":"NDC"}],"standard_charges":[{"minimum":39.86,"maximum":53.81,"gross_charge":66.43,"discounted_cash":19.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0550-01","type":"NDC"}],"standard_charges":[{"minimum":9.97,"maximum":53.81,"gross_charge":66.43,"discounted_cash":19.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0128-10","type":"NDC"}],"standard_charges":[{"minimum":36.71,"maximum":49.55,"gross_charge":61.17,"discounted_cash":18.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.71,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0128-10","type":"NDC"}],"standard_charges":[{"minimum":9.18,"maximum":49.55,"gross_charge":61.17,"discounted_cash":18.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.72,"maximum":49.57,"gross_charge":61.19,"discounted_cash":18.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.18,"maximum":49.57,"gross_charge":61.19,"discounted_cash":18.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.95,"maximum":49.88,"gross_charge":61.57,"discounted_cash":18.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.95,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2470","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.24,"maximum":49.88,"gross_charge":61.57,"discounted_cash":18.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.32,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2471","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.57,"maximum":52.06,"gross_charge":64.27,"discounted_cash":19.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"}]}]},{"description":"PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2471","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.65,"maximum":52.06,"gross_charge":64.27,"discounted_cash":19.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.86,"methodology":"fee schedule"}]}]},{"description":"PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2506","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0190-01","type":"NDC"}],"standard_charges":[{"minimum":19640.85,"maximum":26515.14,"gross_charge":32734.74,"discounted_cash":9689.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26515.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26515.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26515.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":21277.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22914.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19640.85,"methodology":"fee schedule"}]}]},{"description":"PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2506","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0190-01","type":"NDC"}],"standard_charges":[{"minimum":4910.22,"maximum":26515.14,"gross_charge":32734.74,"discounted_cash":9689.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26515.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26515.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26515.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20950.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16367.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16367.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14730.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22914.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19640.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6219.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6546.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4910.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6546.95,"methodology":"fee schedule"}]}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24201-0010-20","type":"NDC"}],"standard_charges":[{"minimum":2831.18,"maximum":3822.09,"gross_charge":4718.62,"discounted_cash":1396.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3822.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3822.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3822.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3067.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3303.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2831.18,"methodology":"fee schedule"}]}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24201-0010-20","type":"NDC"}],"standard_charges":[{"minimum":23.02,"maximum":3822.09,"gross_charge":4718.62,"discounted_cash":1396.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3822.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3822.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3822.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3019.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.02,"standard_charge_algorithm": "Lesser of $23.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.02,"standard_charge_algorithm": "Lesser of $23.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2123.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3303.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2831.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":896.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":707.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":943.73,"methodology":"fee schedule"}]}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0676-20","type":"NDC"}],"standard_charges":[{"minimum":2524.69,"maximum":3408.33,"gross_charge":4207.81,"discounted_cash":1245.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3408.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3408.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3408.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2735.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2945.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2524.69,"methodology":"fee schedule"}]}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0676-20","type":"NDC"}],"standard_charges":[{"minimum":23.02,"maximum":3408.33,"gross_charge":4207.81,"discounted_cash":1245.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3408.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3408.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3408.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2693,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":23.02,"standard_charge_algorithm": "Lesser of $23.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":23.02,"standard_charge_algorithm": "Lesser of $23.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1893.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2945.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2524.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":841.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":841.57,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0311-10","type":"NDC"}],"standard_charges":[{"minimum":42.84,"maximum":57.84,"gross_charge":71.4,"discounted_cash":21.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0311-10","type":"NDC"}],"standard_charges":[{"minimum":0.87,"maximum":57.84,"gross_charge":71.4,"discounted_cash":21.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0126-20","type":"NDC"}],"standard_charges":[{"minimum":42.78,"maximum":57.76,"gross_charge":71.3,"discounted_cash":21.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0126-20","type":"NDC"}],"standard_charges":[{"minimum":0.87,"maximum":57.76,"gross_charge":71.3,"discounted_cash":21.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.26,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.05,"maximum":56.76,"gross_charge":70.07,"discounted_cash":20.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.87,"maximum":56.76,"gross_charge":70.07,"discounted_cash":20.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.19,"maximum":58.3,"gross_charge":71.97,"discounted_cash":21.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"}]}]},{"description":"PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J2540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.87,"maximum":58.3,"gross_charge":71.97,"discounted_cash":21.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.87,"standard_charge_algorithm": "Lesser of $0.87 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0165-30","type":"NDC"}],"standard_charges":[{"minimum":60.57,"maximum":81.77,"gross_charge":100.95,"discounted_cash":29.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0165-30","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":81.77,"gross_charge":100.95,"discounted_cash":29.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0176-20","type":"NDC"}],"standard_charges":[{"minimum":37.13,"maximum":50.13,"gross_charge":61.88,"discounted_cash":18.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0176-20","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":50.13,"gross_charge":61.88,"discounted_cash":18.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.38,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0125-03","type":"NDC"}],"standard_charges":[{"minimum":37.95,"maximum":51.24,"gross_charge":63.25,"discounted_cash":18.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0125-03","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":51.24,"gross_charge":63.25,"discounted_cash":18.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0802-10","type":"NDC"}],"standard_charges":[{"minimum":44.64,"maximum":60.27,"gross_charge":74.4,"discounted_cash":22.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.64,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0802-10","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":60.27,"gross_charge":74.4,"discounted_cash":22.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.88,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0120-30","type":"NDC"}],"standard_charges":[{"minimum":38.08,"maximum":51.41,"gross_charge":63.46,"discounted_cash":18.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0120-30","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":51.41,"gross_charge":63.46,"discounted_cash":18.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6157-04","type":"NDC"}],"standard_charges":[{"minimum":37.65,"maximum":50.82,"gross_charge":62.74,"discounted_cash":18.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6157-04","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":50.82,"gross_charge":62.74,"discounted_cash":18.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0120-01","type":"NDC"}],"standard_charges":[{"minimum":39.72,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0120-01","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":53.63,"gross_charge":66.2,"discounted_cash":19.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0056-02","type":"NDC"}],"standard_charges":[{"minimum":39.49,"maximum":53.31,"gross_charge":65.81,"discounted_cash":19.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0056-02","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":53.31,"gross_charge":65.81,"discounted_cash":19.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.17,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0436-20","type":"NDC"}],"standard_charges":[{"minimum":38.45,"maximum":51.91,"gross_charge":64.08,"discounted_cash":18.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.45,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0436-20","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":51.91,"gross_charge":64.08,"discounted_cash":18.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0121-41","type":"NDC"}],"standard_charges":[{"minimum":52.55,"maximum":70.94,"gross_charge":87.58,"discounted_cash":25.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.55,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0121-41","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":70.94,"gross_charge":87.58,"discounted_cash":25.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.52,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0576-01","type":"NDC"}],"standard_charges":[{"minimum":43.12,"maximum":58.21,"gross_charge":71.86,"discounted_cash":21.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0576-01","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":58.21,"gross_charge":71.86,"discounted_cash":21.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.6,"maximum":69.66,"gross_charge":86,"discounted_cash":25.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.67,"maximum":69.66,"gross_charge":86,"discounted_cash":25.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.2,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0166-48","type":"NDC"}],"standard_charges":[{"minimum":69.41,"maximum":93.71,"gross_charge":115.68,"discounted_cash":34.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.41,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0166-48","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":93.71,"gross_charge":115.68,"discounted_cash":34.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.14,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0177-50","type":"NDC"}],"standard_charges":[{"minimum":39.26,"maximum":53,"gross_charge":65.43,"discounted_cash":19.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0177-50","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":53,"gross_charge":65.43,"discounted_cash":19.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0127-06","type":"NDC"}],"standard_charges":[{"minimum":44.06,"maximum":59.48,"gross_charge":73.43,"discounted_cash":21.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.06,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0127-06","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":59.48,"gross_charge":73.43,"discounted_cash":21.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0803-10","type":"NDC"}],"standard_charges":[{"minimum":44.07,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0803-10","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":59.49,"gross_charge":73.44,"discounted_cash":21.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0121-50","type":"NDC"}],"standard_charges":[{"minimum":41.76,"maximum":56.37,"gross_charge":69.59,"discounted_cash":20.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0121-50","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":56.37,"gross_charge":69.59,"discounted_cash":20.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6159-04","type":"NDC"}],"standard_charges":[{"minimum":40.01,"maximum":54.02,"gross_charge":66.68,"discounted_cash":19.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6159-04","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":54.02,"gross_charge":66.68,"discounted_cash":19.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.34,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0130-02","type":"NDC"}],"standard_charges":[{"minimum":43.19,"maximum":58.31,"gross_charge":71.98,"discounted_cash":21.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61990-0130-02","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":58.31,"gross_charge":71.98,"discounted_cash":21.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0012-02","type":"NDC"}],"standard_charges":[{"minimum":43.53,"maximum":58.77,"gross_charge":72.55,"discounted_cash":21.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.53,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0012-02","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":58.77,"gross_charge":72.55,"discounted_cash":21.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.51,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0259-05","type":"NDC"}],"standard_charges":[{"minimum":40.41,"maximum":54.56,"gross_charge":67.35,"discounted_cash":19.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0259-05","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":54.56,"gross_charge":67.35,"discounted_cash":19.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0404-01","type":"NDC"}],"standard_charges":[{"minimum":43.19,"maximum":58.3,"gross_charge":71.97,"discounted_cash":21.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0404-01","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":58.3,"gross_charge":71.97,"discounted_cash":21.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.4,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0577-01","type":"NDC"}],"standard_charges":[{"minimum":46.96,"maximum":63.4,"gross_charge":78.26,"discounted_cash":23.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.96,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0577-01","type":"NDC"}],"standard_charges":[{"minimum":1.67,"maximum":63.4,"gross_charge":78.26,"discounted_cash":23.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.66,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.88,"maximum":55.19,"gross_charge":68.13,"discounted_cash":20.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.67,"maximum":55.19,"gross_charge":68.13,"discounted_cash":20.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.61,"maximum":62.92,"gross_charge":77.67,"discounted_cash":23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"}]}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J2543","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.67,"maximum":62.92,"gross_charge":77.67,"discounted_cash":23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.67,"standard_charge_algorithm": "Lesser of $1.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.54,"methodology":"fee schedule"}]}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61364-0181-01","type":"NDC"}],"standard_charges":[{"minimum":832.65,"maximum":1124.07,"gross_charge":1387.74,"discounted_cash":410.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1124.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1124.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1124.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":902.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":971.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":832.65,"methodology":"fee schedule"}]}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61364-0181-01","type":"NDC"}],"standard_charges":[{"minimum":1.5,"maximum":1124.07,"gross_charge":1387.74,"discounted_cash":410.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1124.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1124.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1124.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":888.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.83,"standard_charge_algorithm": "Lesser of $1.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.83,"standard_charge_algorithm": "Lesser of $1.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":624.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":971.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":832.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":263.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":208.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":277.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.59,"methodology":"case rate"}]}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61364-0181-03","type":"NDC"}],"standard_charges":[{"minimum":2432.43,"maximum":3283.78,"gross_charge":4054.04,"discounted_cash":1200,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3283.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3283.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3283.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2635.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2837.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2432.43,"methodology":"fee schedule"}]}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61364-0181-03","type":"NDC"}],"standard_charges":[{"minimum":1.5,"maximum":3283.78,"gross_charge":4054.04,"discounted_cash":1200,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3283.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3283.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3283.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2594.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.83,"standard_charge_algorithm": "Lesser of $1.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.83,"standard_charge_algorithm": "Lesser of $1.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1824.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2837.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2432.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":770.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.59,"methodology":"case rate"}]}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72769-0181-03","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72769-0181-03","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":2.56,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.68,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.54,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.59,"methodology":"case rate"}]}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2550","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.63,"maximum":49.46,"gross_charge":61.05,"discounted_cash":18.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2550","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.32,"maximum":49.46,"gross_charge":61.05,"discounted_cash":18.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.32,"standard_charge_algorithm": "Lesser of $3.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.32,"standard_charge_algorithm": "Lesser of $3.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42494-0416-01","type":"NDC"}],"standard_charges":[{"minimum":122.69,"maximum":165.63,"gross_charge":204.48,"discounted_cash":60.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":165.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":165.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":132.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":143.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.69,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42494-0416-01","type":"NDC"}],"standard_charges":[{"minimum":30.68,"maximum":165.63,"gross_charge":204.48,"discounted_cash":60.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":165.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":165.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":130.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.76,"standard_charge_algorithm": "Lesser of $50.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"standard_charge_algorithm": "Lesser of $50.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":92.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":143.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2560","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":122.19,"maximum":164.95,"gross_charge":203.64,"discounted_cash":60.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":132.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":142.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.19,"methodology":"fee schedule"}]}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2560","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30.55,"maximum":164.95,"gross_charge":203.64,"discounted_cash":60.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":130.33,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":36.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.76,"standard_charge_algorithm": "Lesser of $50.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.76,"standard_charge_algorithm": "Lesser of $50.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":91.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":142.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":122.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.73,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0116-83","type":"NDC"}],"standard_charges":[{"minimum":36.39,"maximum":49.13,"gross_charge":60.65,"discounted_cash":17.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0116-83","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":49.13,"gross_charge":60.65,"discounted_cash":17.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0012-01","type":"NDC"}],"standard_charges":[{"minimum":36.27,"maximum":48.97,"gross_charge":60.45,"discounted_cash":17.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0012-01","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":48.97,"gross_charge":60.45,"discounted_cash":17.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0012-11","type":"NDC"}],"standard_charges":[{"minimum":40.76,"maximum":55.03,"gross_charge":67.93,"discounted_cash":20.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.76,"methodology":"fee schedule"}]}]},{"description":"OXYTOCIN 10 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0012-11","type":"NDC"}],"standard_charges":[{"minimum":0.6,"maximum":55.03,"gross_charge":67.93,"discounted_cash":20.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0015-01","type":"NDC"}],"standard_charges":[{"minimum":668.09,"maximum":901.92,"gross_charge":1113.47,"discounted_cash":329.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":901.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":723.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":779.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":668.09,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0015-01","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":901.92,"gross_charge":1113.47,"discounted_cash":329.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":901.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":901.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":901.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":712.63,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":501.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":779.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":668.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0460-01","type":"NDC"}],"standard_charges":[{"minimum":77.61,"maximum":104.77,"gross_charge":129.34,"discounted_cash":38.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.61,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0460-01","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":104.77,"gross_charge":129.34,"discounted_cash":38.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0461-10","type":"NDC"}],"standard_charges":[{"minimum":414.15,"maximum":559.11,"gross_charge":690.25,"discounted_cash":204.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":559.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":559.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":559.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":448.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":483.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.15,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0461-10","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":559.11,"gross_charge":690.25,"discounted_cash":204.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":559.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":559.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":559.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":441.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":310.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":483.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-6250-01","type":"NDC"}],"standard_charges":[{"minimum":66.3,"maximum":89.51,"gross_charge":110.5,"discounted_cash":32.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.3,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-6250-01","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":89.51,"gross_charge":110.5,"discounted_cash":32.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0053-11","type":"NDC"}],"standard_charges":[{"minimum":379.47,"maximum":512.29,"gross_charge":632.45,"discounted_cash":187.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":411.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.47,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0053-11","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":512.29,"gross_charge":632.45,"discounted_cash":187.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":404.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":284.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0931-11","type":"NDC"}],"standard_charges":[{"minimum":81.56,"maximum":110.11,"gross_charge":135.93,"discounted_cash":40.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.56,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0931-11","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":110.11,"gross_charge":135.93,"discounted_cash":40.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-2200-00","type":"NDC"}],"standard_charges":[{"minimum":145.55,"maximum":196.49,"gross_charge":242.57,"discounted_cash":71.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":157.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":169.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-2200-00","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":196.49,"gross_charge":242.57,"discounted_cash":71.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":196.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":196.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":196.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":155.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":169.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":145.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-2300-00","type":"NDC"}],"standard_charges":[{"minimum":1210,"maximum":1633.5,"gross_charge":2016.66,"discounted_cash":596.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1633.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1633.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1633.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1310.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1411.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1210,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-2300-00","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":1633.5,"gross_charge":2016.66,"discounted_cash":596.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1633.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1633.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1633.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1290.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":907.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1411.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1210,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":383.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0529-40","type":"NDC"}],"standard_charges":[{"minimum":1406.42,"maximum":1898.66,"gross_charge":2344.02,"discounted_cash":693.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1898.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1898.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1898.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1523.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1640.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1406.42,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62756-0529-40","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":1898.66,"gross_charge":2344.02,"discounted_cash":693.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1898.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1898.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1898.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1500.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1054.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1640.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1406.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":445.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":351.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":468.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0899-01","type":"NDC"}],"standard_charges":[{"minimum":82.35,"maximum":111.18,"gross_charge":137.25,"discounted_cash":40.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0899-01","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":111.18,"gross_charge":137.25,"discounted_cash":40.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":111.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0901-10","type":"NDC"}],"standard_charges":[{"minimum":426.63,"maximum":575.96,"gross_charge":711.05,"discounted_cash":210.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":462.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":497.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":426.63,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0901-10","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":575.96,"gross_charge":711.05,"discounted_cash":210.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":455.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":497.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":426.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0026-01","type":"NDC"}],"standard_charges":[{"minimum":165.4,"maximum":223.29,"gross_charge":275.66,"discounted_cash":81.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":179.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":192.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.4,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0026-01","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":223.29,"gross_charge":275.66,"discounted_cash":81.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":223.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":176.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":124.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":192.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":165.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0031-01","type":"NDC"}],"standard_charges":[{"minimum":182.88,"maximum":246.88,"gross_charge":304.79,"discounted_cash":90.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":246.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":198.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":213.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":182.88,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70095-0031-01","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":246.88,"gross_charge":304.79,"discounted_cash":90.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":246.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":246.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":246.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":195.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":213.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":182.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0454-10","type":"NDC"}],"standard_charges":[{"minimum":1246.45,"maximum":1682.71,"gross_charge":2077.41,"discounted_cash":614.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1682.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1682.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1682.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1454.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1246.45,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0454-10","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":1682.71,"gross_charge":2077.41,"discounted_cash":614.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1682.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1682.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1682.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1329.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":934.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1454.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1246.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":394.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":311.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":415.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83634-0451-10","type":"NDC"}],"standard_charges":[{"minimum":366.29,"maximum":494.49,"gross_charge":610.47,"discounted_cash":180.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":494.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":494.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":494.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":396.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":427.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":366.29,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"83634-0451-10","type":"NDC"}],"standard_charges":[{"minimum":4.01,"maximum":494.49,"gross_charge":610.47,"discounted_cash":180.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":494.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":494.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":494.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":390.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":274.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":427.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":366.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1477.29,"maximum":1994.35,"gross_charge":2462.15,"discounted_cash":728.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1994.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1994.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1994.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1600.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1723.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1477.29,"methodology":"fee schedule"}]}]},{"description":"DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J2597","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.01,"maximum":1994.35,"gross_charge":2462.15,"discounted_cash":728.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1994.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1994.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1994.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1575.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":6.33,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.6,"standard_charge_algorithm": "Lesser of $8.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1107.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1723.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1477.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":467.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":369.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":492.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.25,"methodology":"case rate"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0164-01","type":"NDC"}],"standard_charges":[{"minimum":81.6,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.6,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0164-01","type":"NDC"}],"standard_charges":[{"minimum":20.4,"maximum":110.16,"gross_charge":136,"discounted_cash":40.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0164-83","type":"NDC"}],"standard_charges":[{"minimum":61.35,"maximum":82.83,"gross_charge":102.25,"discounted_cash":30.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.35,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0164-83","type":"NDC"}],"standard_charges":[{"minimum":15.34,"maximum":82.83,"gross_charge":102.25,"discounted_cash":30.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.45,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42367-0570-22","type":"NDC"}],"standard_charges":[{"minimum":346.6,"maximum":467.91,"gross_charge":577.66,"discounted_cash":170.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":375.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":404.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":346.6,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42367-0570-22","type":"NDC"}],"standard_charges":[{"minimum":86.65,"maximum":467.91,"gross_charge":577.66,"discounted_cash":170.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":467.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":369.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":288.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":288.83,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":259.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":404.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":346.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.54,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0085-25","type":"NDC"}],"standard_charges":[{"minimum":243.62,"maximum":328.88,"gross_charge":406.02,"discounted_cash":120.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":263.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":284.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":243.62,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0085-25","type":"NDC"}],"standard_charges":[{"minimum":60.91,"maximum":328.88,"gross_charge":406.02,"discounted_cash":120.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":328.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":328.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":328.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":259.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":203.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":203.01,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":284.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":243.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.21,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0914-25","type":"NDC"}],"standard_charges":[{"minimum":58.67,"maximum":79.21,"gross_charge":97.78,"discounted_cash":28.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.67,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0914-25","type":"NDC"}],"standard_charges":[{"minimum":14.67,"maximum":79.21,"gross_charge":97.78,"discounted_cash":28.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":48.89,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0370-00","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0370-00","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2599","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":81.56,"maximum":110.1,"gross_charge":135.92,"discounted_cash":40.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.56,"methodology":"fee schedule"}]}]},{"description":"VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2599","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.39,"maximum":110.1,"gross_charge":135.92,"discounted_cash":40.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.96,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.19,"methodology":"fee schedule"}]}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0900-10","type":"NDC"}],"standard_charges":[{"minimum":202.63,"maximum":273.55,"gross_charge":337.71,"discounted_cash":99.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":273.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":273.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":273.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":219.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":236.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.63,"methodology":"fee schedule"}]}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0900-10","type":"NDC"}],"standard_charges":[{"minimum":50.66,"maximum":434.7,"gross_charge":337.71,"discounted_cash":99.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":273.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":273.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":273.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":216.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":183.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":146.32,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":434.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":115.77,"standard_charge_algorithm": "Lesser of $115.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":115.77,"standard_charge_algorithm": "Lesser of $115.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":151.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":236.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":202.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":254.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":272,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":261.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":266.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":279.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":269.46,"methodology":"case rate"}]}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0901-07","type":"NDC"}],"standard_charges":[{"minimum":1350.19,"maximum":1822.76,"gross_charge":2250.31,"discounted_cash":666.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1462.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1575.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.19,"methodology":"fee schedule"}]}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0901-07","type":"NDC"}],"standard_charges":[{"minimum":115.77,"maximum":1822.76,"gross_charge":2250.31,"discounted_cash":666.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1822.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1440.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":183.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":146.32,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":434.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":115.77,"standard_charge_algorithm": "Lesser of $115.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":115.77,"standard_charge_algorithm": "Lesser of $115.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1012.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1575.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":427.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":337.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":450.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":254.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":272,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":261.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":266.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":279.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":269.46,"methodology":"case rate"}]}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":170.07,"maximum":229.6,"gross_charge":283.45,"discounted_cash":83.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":184.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":198.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.07,"methodology":"fee schedule"}]}]},{"description":"PROCAINAMIDE 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2690","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.52,"maximum":434.7,"gross_charge":283.45,"discounted_cash":83.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":229.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":181.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":183.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":183.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":146.32,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":434.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":115.77,"standard_charge_algorithm": "Lesser of $115.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":115.77,"standard_charge_algorithm": "Lesser of $115.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":127.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":198.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":170.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":254.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":272,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":261.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":266.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":279.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":269.46,"methodology":"case rate"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0162-24","type":"NDC"}],"standard_charges":[{"minimum":83.76,"maximum":113.08,"gross_charge":139.6,"discounted_cash":41.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.76,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0162-24","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":113.08,"gross_charge":139.6,"discounted_cash":41.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.92,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0128-24","type":"NDC"}],"standard_charges":[{"minimum":47.05,"maximum":63.52,"gross_charge":78.41,"discounted_cash":23.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.05,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0128-24","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":63.52,"gross_charge":78.41,"discounted_cash":23.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0812-20","type":"NDC"}],"standard_charges":[{"minimum":46.94,"maximum":63.36,"gross_charge":78.22,"discounted_cash":23.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.94,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0812-20","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":63.36,"gross_charge":78.22,"discounted_cash":23.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.65,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0699-02","type":"NDC"}],"standard_charges":[{"minimum":54.29,"maximum":73.29,"gross_charge":90.47,"discounted_cash":26.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.29,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0699-02","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":73.29,"gross_charge":90.47,"discounted_cash":26.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.1,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70655-0109-95","type":"NDC"}],"standard_charges":[{"minimum":55.14,"maximum":74.44,"gross_charge":91.89,"discounted_cash":27.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70655-0109-95","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":74.44,"gross_charge":91.89,"discounted_cash":27.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.38,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0409-10","type":"NDC"}],"standard_charges":[{"minimum":53.59,"maximum":72.35,"gross_charge":89.31,"discounted_cash":26.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.59,"methodology":"fee schedule"}]}]},{"description":"OXACILLIN 2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0409-10","type":"NDC"}],"standard_charges":[{"minimum":1.39,"maximum":72.35,"gross_charge":89.31,"discounted_cash":26.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.39,"standard_charge_algorithm": "Lesser of $1.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0528-01","type":"NDC"}],"standard_charges":[{"minimum":37.19,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0528-01","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0528-10","type":"NDC"}],"standard_charges":[{"minimum":37.69,"maximum":50.88,"gross_charge":62.81,"discounted_cash":18.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0528-10","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":50.88,"gross_charge":62.81,"discounted_cash":18.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0690-10","type":"NDC"}],"standard_charges":[{"minimum":51.23,"maximum":69.15,"gross_charge":85.37,"discounted_cash":25.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0690-10","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":69.15,"gross_charge":85.37,"discounted_cash":25.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.08,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0608-20","type":"NDC"}],"standard_charges":[{"minimum":37.89,"maximum":51.15,"gross_charge":63.14,"discounted_cash":18.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0608-20","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":51.15,"gross_charge":63.14,"discounted_cash":18.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0608-50","type":"NDC"}],"standard_charges":[{"minimum":48.95,"maximum":66.08,"gross_charge":81.58,"discounted_cash":24.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0608-50","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":66.08,"gross_charge":81.58,"discounted_cash":24.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0608-51","type":"NDC"}],"standard_charges":[{"minimum":65.12,"maximum":87.91,"gross_charge":108.53,"discounted_cash":32.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.12,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0608-51","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":87.91,"gross_charge":108.53,"discounted_cash":32.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":65.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.71,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0548-50","type":"NDC"}],"standard_charges":[{"minimum":42.39,"maximum":57.22,"gross_charge":70.64,"discounted_cash":20.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.39,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0548-50","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":57.22,"gross_charge":70.64,"discounted_cash":20.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.13,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0549-10","type":"NDC"}],"standard_charges":[{"minimum":50.47,"maximum":68.13,"gross_charge":84.11,"discounted_cash":24.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0549-10","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":68.13,"gross_charge":84.11,"discounted_cash":24.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-22","type":"NDC"}],"standard_charges":[{"minimum":37.44,"maximum":50.54,"gross_charge":62.39,"discounted_cash":18.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-22","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":50.54,"gross_charge":62.39,"discounted_cash":18.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-50","type":"NDC"}],"standard_charges":[{"minimum":44.41,"maximum":59.95,"gross_charge":74.01,"discounted_cash":21.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-50","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":59.95,"gross_charge":74.01,"discounted_cash":21.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.81,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-69","type":"NDC"}],"standard_charges":[{"minimum":60.57,"maximum":81.77,"gross_charge":100.95,"discounted_cash":29.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-69","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":81.77,"gross_charge":100.95,"discounted_cash":29.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-77","type":"NDC"}],"standard_charges":[{"minimum":45.92,"maximum":61.99,"gross_charge":76.53,"discounted_cash":22.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-77","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":61.99,"gross_charge":76.53,"discounted_cash":22.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-78","type":"NDC"}],"standard_charges":[{"minimum":59.06,"maximum":79.73,"gross_charge":98.42,"discounted_cash":29.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.06,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-78","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":79.73,"gross_charge":98.42,"discounted_cash":29.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.69,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-94","type":"NDC"}],"standard_charges":[{"minimum":38.34,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-94","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":51.76,"gross_charge":63.9,"discounted_cash":18.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0590-10","type":"NDC"}],"standard_charges":[{"minimum":38.6,"maximum":52.1,"gross_charge":64.32,"discounted_cash":19.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0590-10","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":52.1,"gross_charge":64.32,"discounted_cash":19.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0612-01","type":"NDC"}],"standard_charges":[{"minimum":80.78,"maximum":109.06,"gross_charge":134.63,"discounted_cash":39.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.78,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0612-01","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":109.06,"gross_charge":134.63,"discounted_cash":39.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.93,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.68,"maximum":49.51,"gross_charge":61.12,"discounted_cash":18.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":49.51,"gross_charge":61.12,"discounted_cash":18.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.93,"maximum":49.86,"gross_charge":61.55,"discounted_cash":18.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":49.86,"gross_charge":61.55,"discounted_cash":18.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.31,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.64,"maximum":50.81,"gross_charge":62.72,"discounted_cash":18.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.64,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":50.81,"gross_charge":62.72,"discounted_cash":18.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.51,"maximum":57.39,"gross_charge":70.85,"discounted_cash":20.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":57.39,"gross_charge":70.85,"discounted_cash":20.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.14,"maximum":58.24,"gross_charge":71.9,"discounted_cash":21.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.14,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":58.24,"gross_charge":71.9,"discounted_cash":21.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.38,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.7,"maximum":59,"gross_charge":72.83,"discounted_cash":21.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":59,"gross_charge":72.83,"discounted_cash":21.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.57,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.91,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.23,"maximum":62.41,"gross_charge":77.04,"discounted_cash":22.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":62.41,"gross_charge":77.04,"discounted_cash":22.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.41,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.63,"maximum":62.95,"gross_charge":77.71,"discounted_cash":23.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.63,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":62.95,"gross_charge":77.71,"discounted_cash":23.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.5,"maximum":72.22,"gross_charge":89.16,"discounted_cash":26.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.5,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML INTRAVENOUS EMULSION","code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.17,"maximum":72.22,"gross_charge":89.16,"discounted_cash":26.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.84,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML IV BOLUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-70","type":"NDC"}],"standard_charges":[{"minimum":38.04,"maximum":51.36,"gross_charge":63.4,"discounted_cash":18.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.04,"methodology":"fee schedule"}]}]},{"description":"PROPOFOL 10 MG/ML IV BOLUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0269-70","type":"NDC"}],"standard_charges":[{"minimum":0.17,"maximum":51.36,"gross_charge":63.4,"discounted_cash":18.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.17,"standard_charge_algorithm": "Lesser of $0.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0611-10","type":"NDC"}],"standard_charges":[{"minimum":38.8,"maximum":52.38,"gross_charge":64.66,"discounted_cash":19.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0611-10","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":52.38,"gross_charge":64.66,"discounted_cash":19.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.94,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0189-01","type":"NDC"}],"standard_charges":[{"minimum":46.43,"maximum":62.67,"gross_charge":77.37,"discounted_cash":22.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42023-0189-01","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":62.67,"gross_charge":77.37,"discounted_cash":22.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0529-11","type":"NDC"}],"standard_charges":[{"minimum":40.87,"maximum":55.17,"gross_charge":68.11,"discounted_cash":20.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0529-11","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":55.17,"gross_charge":68.11,"discounted_cash":20.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0415-36","type":"NDC"}],"standard_charges":[{"minimum":42.49,"maximum":57.36,"gross_charge":70.81,"discounted_cash":20.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0415-36","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":57.36,"gross_charge":70.81,"discounted_cash":20.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0806-10","type":"NDC"}],"standard_charges":[{"minimum":41.1,"maximum":55.48,"gross_charge":68.49,"discounted_cash":20.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.1,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0806-10","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":55.48,"gross_charge":68.49,"discounted_cash":20.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.7,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70700-0172-23","type":"NDC"}],"standard_charges":[{"minimum":42.66,"maximum":57.6,"gross_charge":71.1,"discounted_cash":21.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.66,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70700-0172-23","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":57.6,"gross_charge":71.1,"discounted_cash":21.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0501-11","type":"NDC"}],"standard_charges":[{"minimum":53.63,"maximum":72.39,"gross_charge":89.37,"discounted_cash":26.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0501-11","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":72.39,"gross_charge":89.37,"discounted_cash":26.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.88,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0461-24","type":"NDC"}],"standard_charges":[{"minimum":48.02,"maximum":64.83,"gross_charge":80.03,"discounted_cash":23.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.02,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0461-24","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":64.83,"gross_charge":80.03,"discounted_cash":23.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.41,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.1,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.03,"maximum":56.75,"gross_charge":70.05,"discounted_cash":20.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.1,"maximum":56.75,"gross_charge":70.05,"discounted_cash":20.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62295-3324-05","type":"NDC"}],"standard_charges":[{"minimum":42.9,"maximum":57.91,"gross_charge":71.49,"discounted_cash":21.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.9,"methodology":"fee schedule"}]}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5 ML (1 MG/ML) INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62295-3324-05","type":"NDC"}],"standard_charges":[{"minimum":0.1,"maximum":57.91,"gross_charge":71.49,"discounted_cash":21.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.1,"standard_charge_algorithm": "Lesser of $0.10 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-35","type":"NDC"}],"standard_charges":[{"minimum":108.38,"maximum":146.31,"gross_charge":180.62,"discounted_cash":53.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":117.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":126.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.38,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-35","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":146.31,"gross_charge":180.62,"discounted_cash":53.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":126.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.13,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-94","type":"NDC"}],"standard_charges":[{"minimum":57.98,"maximum":78.28,"gross_charge":96.63,"discounted_cash":28.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.98,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-94","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":78.28,"gross_charge":96.63,"discounted_cash":28.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":57.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.33,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-95","type":"NDC"}],"standard_charges":[{"minimum":108.44,"maximum":146.4,"gross_charge":180.73,"discounted_cash":53.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":117.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":126.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.44,"methodology":"fee schedule"}]}]},{"description":"PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0229-95","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":146.4,"gross_charge":180.73,"discounted_cash":53.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":126.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.15,"methodology":"fee schedule"}]}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2760","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68094-0101-20","type":"NDC"}],"standard_charges":[{"minimum":847.5,"maximum":1144.13,"gross_charge":1412.5,"discounted_cash":418.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1144.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1144.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1144.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":918.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":988.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":847.5,"methodology":"fee schedule"}]}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2760","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68094-0101-20","type":"NDC"}],"standard_charges":[{"minimum":211.88,"maximum":1144.13,"gross_charge":1412.5,"discounted_cash":418.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1144.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1144.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1144.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":904,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":394.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":446.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":455.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":686.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":467.22,"standard_charge_algorithm": "Lesser of $467.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":467.22,"standard_charge_algorithm": "Lesser of $467.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":635.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":988.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":847.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":268.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":211.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":282.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":401.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":429.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":413.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":421.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":441.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":425.79,"methodology":"case rate"}]}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION","code_information":[{"code":"J2760","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":726.16,"maximum":980.32,"gross_charge":1210.26,"discounted_cash":358.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":786.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.16,"methodology":"fee schedule"}]}]},{"description":"PHENTOLAMINE 5 MG INJECTION SOLUTION","code_information":[{"code":"J2760","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":181.54,"maximum":980.32,"gross_charge":1210.26,"discounted_cash":358.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":774.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":394.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":446.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":406.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":455.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":686.89,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":467.22,"standard_charge_algorithm": "Lesser of $467.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":467.22,"standard_charge_algorithm": "Lesser of $467.22 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":544.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":401.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":429.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":413.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":421.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":441.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":425.79,"methodology":"case rate"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0240-31","type":"NDC"}],"standard_charges":[{"minimum":35.01,"maximum":47.26,"gross_charge":58.34,"discounted_cash":17.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0240-31","type":"NDC"}],"standard_charges":[{"minimum":1.2,"maximum":47.26,"gross_charge":58.34,"discounted_cash":17.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.66,"maximum":46.79,"gross_charge":57.76,"discounted_cash":17.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.66,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":46.79,"gross_charge":57.76,"discounted_cash":17.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.79,"maximum":46.96,"gross_charge":57.97,"discounted_cash":17.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":46.96,"gross_charge":57.97,"discounted_cash":17.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":46.98,"gross_charge":57.99,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":46.98,"gross_charge":57.99,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.8,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":46.98,"gross_charge":58,"discounted_cash":17.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.6,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.25,"maximum":55.69,"gross_charge":68.75,"discounted_cash":20.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"}]}]},{"description":"METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2765","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.2,"maximum":55.69,"gross_charge":68.75,"discounted_cash":20.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.2,"standard_charge_algorithm": "Lesser of $1.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"}]}]},{"description":"RASBURICASE 1.5 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2783","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2746.95,"maximum":3708.38,"gross_charge":4578.24,"discounted_cash":1355.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3708.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3708.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3708.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2975.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3204.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2746.95,"methodology":"fee schedule"}]}]},{"description":"RASBURICASE 1.5 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2783","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":331.2,"maximum":3708.38,"gross_charge":4578.24,"discounted_cash":1355.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3708.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3708.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3708.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2930.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":369.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":367.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":377.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":374.2,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":566.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":375.25,"standard_charge_algorithm": "Lesser of $375.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":375.25,"standard_charge_algorithm": "Lesser of $375.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2060.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3204.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2746.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":686.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":331.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":354.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":341.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":347.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":364.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":351.07,"methodology":"case rate"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INJ","code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":338.4,"maximum":456.84,"gross_charge":564,"discounted_cash":166.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":366.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":338.4,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INJ","code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":69.31,"maximum":456.84,"gross_charge":564,"discounted_cash":166.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":456.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":360.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":253.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":394.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":338.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.8,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0616-11","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0616-11","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6116-00","type":"NDC"}],"standard_charges":[{"minimum":143.04,"maximum":193.11,"gross_charge":238.4,"discounted_cash":70.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":154.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":166.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.04,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6116-00","type":"NDC"}],"standard_charges":[{"minimum":35.76,"maximum":193.11,"gross_charge":238.4,"discounted_cash":70.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":193.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":152.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":107.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":166.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":143.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.68,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0994-05","type":"NDC"}],"standard_charges":[{"minimum":35.82,"maximum":48.35,"gross_charge":59.69,"discounted_cash":17.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0994-05","type":"NDC"}],"standard_charges":[{"minimum":8.96,"maximum":59.69,"gross_charge":59.69,"discounted_cash":17.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.69,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.69,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0201-85","type":"NDC"}],"standard_charges":[{"minimum":50.6,"maximum":68.3,"gross_charge":84.32,"discounted_cash":24.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0201-85","type":"NDC"}],"standard_charges":[{"minimum":12.65,"maximum":69.31,"gross_charge":84.32,"discounted_cash":24.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3321-00","type":"NDC"}],"standard_charges":[{"minimum":38.34,"maximum":51.76,"gross_charge":63.89,"discounted_cash":18.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-3321-00","type":"NDC"}],"standard_charges":[{"minimum":9.59,"maximum":63.89,"gross_charge":63.89,"discounted_cash":18.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63.89,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.89,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58.22,"maximum":78.6,"gross_charge":97.03,"discounted_cash":28.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.22,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":14.56,"maximum":78.6,"gross_charge":97.03,"discounted_cash":28.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":503.42,"maximum":679.62,"gross_charge":839.03,"discounted_cash":248.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":679.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":545.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":587.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.42,"methodology":"fee schedule"}]}]},{"description":"REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE","code_information":[{"code":"J2785","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":69.31,"maximum":679.62,"gross_charge":839.03,"discounted_cash":248.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":679.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":536.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":69.31,"standard_charge_algorithm": "Lesser of $69.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":377.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":587.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.81,"methodology":"fee schedule"}]}]},{"description":"RHO(D) IMMUNE GLOBULIN 1500 UNIT (300 MCG)/2 ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2791","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0300-01","type":"NDC"}],"standard_charges":[{"minimum":209.6,"maximum":282.96,"gross_charge":349.33,"discounted_cash":103.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":282.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":282.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":227.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":244.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.6,"methodology":"fee schedule"}]}]},{"description":"RHO(D) IMMUNE GLOBULIN 1500 UNIT (300 MCG)/2 ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2791","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0300-01","type":"NDC"}],"standard_charges":[{"minimum":5.32,"maximum":282.96,"gross_charge":349.33,"discounted_cash":103.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":282.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":282.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":282.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":223.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.32,"standard_charge_algorithm": "Lesser of $5.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.32,"standard_charge_algorithm": "Lesser of $5.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":157.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":244.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":209.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.87,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0082-90","type":"NDC"}],"standard_charges":[{"minimum":121.95,"maximum":164.64,"gross_charge":203.25,"discounted_cash":60.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":132.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":142.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0082-90","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":164.64,"gross_charge":203.25,"discounted_cash":60.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":164.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":164.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":164.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":130.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":142.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.65,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0082-92","type":"NDC"}],"standard_charges":[{"minimum":169.19,"maximum":228.41,"gross_charge":281.98,"discounted_cash":83.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":228.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":183.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":197.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.19,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0082-92","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":228.41,"gross_charge":281.98,"discounted_cash":83.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":228.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":228.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":228.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":180.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":126.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":197.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":169.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.4,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0671-67","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0671-67","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0671-82","type":"NDC"}],"standard_charges":[{"minimum":123.47,"maximum":166.69,"gross_charge":205.78,"discounted_cash":60.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":133.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":144.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.47,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0671-82","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":166.69,"gross_charge":205.78,"discounted_cash":60.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":166.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":166.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":166.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":92.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":144.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":123.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.16,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0671-87","type":"NDC"}],"standard_charges":[{"minimum":135.34,"maximum":182.71,"gross_charge":225.56,"discounted_cash":66.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":146.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":157.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.34,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0671-87","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":182.71,"gross_charge":225.56,"discounted_cash":66.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":182.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":144.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":101.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":157.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":135.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.12,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0015-10","type":"NDC"}],"standard_charges":[{"minimum":41.48,"maximum":55.99,"gross_charge":69.12,"discounted_cash":20.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0015-10","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":55.99,"gross_charge":69.12,"discounted_cash":20.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0152-10","type":"NDC"}],"standard_charges":[{"minimum":33.29,"maximum":44.94,"gross_charge":55.48,"discounted_cash":16.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.29,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0152-10","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":44.94,"gross_charge":55.48,"discounted_cash":16.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0154-10","type":"NDC"}],"standard_charges":[{"minimum":33.16,"maximum":44.77,"gross_charge":55.26,"discounted_cash":16.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.16,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0154-10","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":44.77,"gross_charge":55.26,"discounted_cash":16.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0195-20","type":"NDC"}],"standard_charges":[{"minimum":46.43,"maximum":62.67,"gross_charge":77.37,"discounted_cash":22.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0195-20","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":62.67,"gross_charge":77.37,"discounted_cash":22.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0196-99","type":"NDC"}],"standard_charges":[{"minimum":86.84,"maximum":117.24,"gross_charge":144.73,"discounted_cash":42.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":94.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":101.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.84,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0196-99","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":117.24,"gross_charge":144.73,"discounted_cash":42.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":92.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":101.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":86.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-07","type":"NDC"}],"standard_charges":[{"minimum":47.29,"maximum":63.84,"gross_charge":78.81,"discounted_cash":23.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.29,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-07","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":63.84,"gross_charge":78.81,"discounted_cash":23.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.77,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-13","type":"NDC"}],"standard_charges":[{"minimum":40.37,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-13","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":54.49,"gross_charge":67.27,"discounted_cash":19.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-20","type":"NDC"}],"standard_charges":[{"minimum":55.17,"maximum":74.48,"gross_charge":91.94,"discounted_cash":27.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-20","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":74.48,"gross_charge":91.94,"discounted_cash":27.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-57","type":"NDC"}],"standard_charges":[{"minimum":124.23,"maximum":167.71,"gross_charge":207.04,"discounted_cash":61.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":134.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":144.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.23,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-57","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":167.71,"gross_charge":207.04,"discounted_cash":61.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":167.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":167.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":167.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":132.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":93.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":144.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":124.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.41,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-68","type":"NDC"}],"standard_charges":[{"minimum":77.75,"maximum":104.96,"gross_charge":129.58,"discounted_cash":38.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.75,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0285-68","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":104.96,"gross_charge":129.58,"discounted_cash":38.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.92,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0799-99","type":"NDC"}],"standard_charges":[{"minimum":33.21,"maximum":44.83,"gross_charge":55.34,"discounted_cash":16.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0799-99","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":44.83,"gross_charge":55.34,"discounted_cash":16.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0062-01","type":"NDC"}],"standard_charges":[{"minimum":41.43,"maximum":55.93,"gross_charge":69.04,"discounted_cash":20.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0062-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":55.93,"gross_charge":69.04,"discounted_cash":20.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.81,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.82,"maximum":55.11,"gross_charge":68.03,"discounted_cash":20.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.82,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION","code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.11,"maximum":55.11,"gross_charge":68.03,"discounted_cash":20.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0023-01","type":"NDC"}],"standard_charges":[{"minimum":40.67,"maximum":54.91,"gross_charge":67.78,"discounted_cash":20.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43066-0023-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":54.91,"gross_charge":67.78,"discounted_cash":20.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.56,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0197-20","type":"NDC"}],"standard_charges":[{"minimum":38.19,"maximum":51.56,"gross_charge":63.65,"discounted_cash":18.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0197-20","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":51.56,"gross_charge":63.65,"discounted_cash":18.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0198-30","type":"NDC"}],"standard_charges":[{"minimum":42.64,"maximum":57.56,"gross_charge":71.06,"discounted_cash":21.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0198-30","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":57.56,"gross_charge":71.06,"discounted_cash":21.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.22,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0286-43","type":"NDC"}],"standard_charges":[{"minimum":44.31,"maximum":59.82,"gross_charge":73.84,"discounted_cash":21.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.31,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0286-43","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":59.82,"gross_charge":73.84,"discounted_cash":21.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.77,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0707-01","type":"NDC"}],"standard_charges":[{"minimum":43.02,"maximum":58.07,"gross_charge":71.69,"discounted_cash":21.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0707-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":58.07,"gross_charge":71.69,"discounted_cash":21.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.34,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0218-01","type":"NDC"}],"standard_charges":[{"minimum":42.49,"maximum":57.36,"gross_charge":70.81,"discounted_cash":20.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0218-01","type":"NDC"}],"standard_charges":[{"minimum":0.11,"maximum":57.36,"gross_charge":70.81,"discounted_cash":20.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.37,"maximum":68,"gross_charge":83.94,"discounted_cash":24.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.37,"methodology":"fee schedule"}]}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION","code_information":[{"code":"J2795","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.11,"maximum":68,"gross_charge":83.94,"discounted_cash":24.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.11,"standard_charge_algorithm": "Lesser of $0.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.79,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0675-10","type":"NDC"}],"standard_charges":[{"minimum":45.52,"maximum":61.45,"gross_charge":75.86,"discounted_cash":22.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0675-10","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":61.45,"gross_charge":75.86,"discounted_cash":22.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0839-36","type":"NDC"}],"standard_charges":[{"minimum":46.65,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0839-36","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0223-10","type":"NDC"}],"standard_charges":[{"minimum":41.3,"maximum":55.76,"gross_charge":68.83,"discounted_cash":20.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.3,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0223-10","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":55.76,"gross_charge":68.83,"discounted_cash":20.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0778-21","type":"NDC"}],"standard_charges":[{"minimum":55.9,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0778-21","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0273-00","type":"NDC"}],"standard_charges":[{"minimum":44.81,"maximum":60.5,"gross_charge":74.68,"discounted_cash":22.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0273-00","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":60.5,"gross_charge":74.68,"discounted_cash":22.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0101-01","type":"NDC"}],"standard_charges":[{"minimum":43.65,"maximum":58.92,"gross_charge":72.74,"discounted_cash":21.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0101-01","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":58.92,"gross_charge":72.74,"discounted_cash":21.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0101-25","type":"NDC"}],"standard_charges":[{"minimum":43.88,"maximum":59.23,"gross_charge":73.12,"discounted_cash":21.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.88,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0101-25","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":59.23,"gross_charge":73.12,"discounted_cash":21.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.63,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0716-10","type":"NDC"}],"standard_charges":[{"minimum":45.92,"maximum":61.99,"gross_charge":76.53,"discounted_cash":22.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0716-10","type":"NDC"}],"standard_charges":[{"minimum":8.17,"maximum":61.99,"gross_charge":76.53,"discounted_cash":22.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.31,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58.68,"maximum":79.21,"gross_charge":97.79,"discounted_cash":28.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.68,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.17,"maximum":79.21,"gross_charge":97.79,"discounted_cash":28.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.56,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":68.13,"maximum":91.97,"gross_charge":113.54,"discounted_cash":33.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"}]}]},{"description":"METHOCARBAMOL 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J2800","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.17,"maximum":91.97,"gross_charge":113.54,"discounted_cash":33.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.17,"standard_charge_algorithm": "Lesser of $8.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.71,"methodology":"fee schedule"}]}]},{"description":"SINCALIDE 5 MCG SOLUTION FOR INJECTION","code_information":[{"code":"J2805","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":288.92,"maximum":390.04,"gross_charge":481.53,"discounted_cash":142.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":390.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":313,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":337.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":288.92,"methodology":"fee schedule"}]}]},{"description":"SINCALIDE 5 MCG SOLUTION FOR INJECTION","code_information":[{"code":"J2805","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":72.23,"maximum":390.04,"gross_charge":481.53,"discounted_cash":142.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":390.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":390.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":390.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":308.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":139.17,"standard_charge_algorithm": "Lesser of $139.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":139.17,"standard_charge_algorithm": "Lesser of $139.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":216.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":337.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":288.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.31,"methodology":"fee schedule"}]}]},{"description":"SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2850","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67066-0005-01","type":"NDC"}],"standard_charges":[{"minimum":1358.9,"maximum":1834.52,"gross_charge":2264.83,"discounted_cash":670.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1834.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1834.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1834.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1472.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1585.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.9,"methodology":"fee schedule"}]}]},{"description":"SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2850","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67066-0005-01","type":"NDC"}],"standard_charges":[{"minimum":38.06,"maximum":1834.52,"gross_charge":2264.83,"discounted_cash":670.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1834.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1834.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1834.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1449.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":42.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":41.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":65.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.3,"standard_charge_algorithm": "Lesser of $39.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.3,"standard_charge_algorithm": "Lesser of $39.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1019.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1585.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1358.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":452.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":38.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":40.72,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":39.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":39.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":41.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":40.34,"methodology":"case rate"}]}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS","code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.98,"maximum":70.17,"gross_charge":86.62,"discounted_cash":25.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"}]}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS","code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.19,"maximum":70.17,"gross_charge":86.62,"discounted_cash":25.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.33,"methodology":"fee schedule"}]}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS","code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":56.37,"maximum":76.1,"gross_charge":93.94,"discounted_cash":27.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":61.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"}]}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS","code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.19,"maximum":76.1,"gross_charge":93.94,"discounted_cash":27.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":76.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.79,"methodology":"fee schedule"}]}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS","code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":107.33,"maximum":144.89,"gross_charge":178.87,"discounted_cash":52.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":116.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.33,"methodology":"fee schedule"}]}]},{"description":"SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS","code_information":[{"code":"J2916","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.19,"maximum":144.89,"gross_charge":178.87,"discounted_cash":52.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":114.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.19,"standard_charge_algorithm": "Lesser of $2.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":80.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":125.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.78,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.04,"maximum":59.46,"gross_charge":73.4,"discounted_cash":21.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.04,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.01,"maximum":59.46,"gross_charge":73.4,"discounted_cash":21.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.68,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.13,"maximum":59.57,"gross_charge":73.54,"discounted_cash":21.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.04,"maximum":59.57,"gross_charge":73.54,"discounted_cash":21.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.71,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":134.43,"maximum":181.49,"gross_charge":224.05,"discounted_cash":66.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":145.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":156.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.43,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SOD SUCC (PF) 500 MG/4 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":33.61,"maximum":181.49,"gross_charge":224.05,"discounted_cash":66.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":181.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":181.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":181.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":143.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":112.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":112.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":100.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":156.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":134.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.81,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0810-30","type":"NDC"}],"standard_charges":[{"minimum":103.23,"maximum":139.37,"gross_charge":172.05,"discounted_cash":50.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":111.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.23,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0810-30","type":"NDC"}],"standard_charges":[{"minimum":25.81,"maximum":139.37,"gross_charge":172.05,"discounted_cash":50.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":139.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":139.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":86.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":86.03,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":77.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":103.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.41,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0130-74","type":"NDC"}],"standard_charges":[{"minimum":60.87,"maximum":82.18,"gross_charge":101.45,"discounted_cash":30.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.87,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0130-74","type":"NDC"}],"standard_charges":[{"minimum":15.22,"maximum":82.18,"gross_charge":101.45,"discounted_cash":30.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.73,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.29,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0265-30","type":"NDC"}],"standard_charges":[{"minimum":64.46,"maximum":87.02,"gross_charge":107.43,"discounted_cash":31.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":69.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.46,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0265-30","type":"NDC"}],"standard_charges":[{"minimum":16.12,"maximum":87.02,"gross_charge":107.43,"discounted_cash":31.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":64.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.49,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.6,"maximum":72.36,"gross_charge":89.33,"discounted_cash":26.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.6,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.4,"maximum":72.36,"gross_charge":89.33,"discounted_cash":26.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.87,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":60.72,"maximum":81.98,"gross_charge":101.2,"discounted_cash":29.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.72,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.18,"maximum":81.98,"gross_charge":101.2,"discounted_cash":29.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.24,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":77.9,"maximum":105.17,"gross_charge":129.83,"discounted_cash":38.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.9,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 1000 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.48,"maximum":105.17,"gross_charge":129.83,"discounted_cash":38.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64.92,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.97,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0808-10","type":"NDC"}],"standard_charges":[{"minimum":51.57,"maximum":69.62,"gross_charge":85.95,"discounted_cash":25.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.57,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0808-10","type":"NDC"}],"standard_charges":[{"minimum":12.9,"maximum":69.62,"gross_charge":85.95,"discounted_cash":25.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.19,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0128-11","type":"NDC"}],"standard_charges":[{"minimum":68.38,"maximum":92.31,"gross_charge":113.96,"discounted_cash":33.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.38,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0128-11","type":"NDC"}],"standard_charges":[{"minimum":17.1,"maximum":92.31,"gross_charge":113.96,"discounted_cash":33.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":92.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":92.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":92.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":72.09,"maximum":97.33,"gross_charge":120.15,"discounted_cash":35.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":18.03,"maximum":97.33,"gross_charge":120.15,"discounted_cash":35.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.08,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.03,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":81.69,"maximum":110.28,"gross_charge":136.14,"discounted_cash":40.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J2919","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.43,"maximum":110.28,"gross_charge":136.14,"discounted_cash":40.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":68.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":68.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION","code_information":[{"code":"J2920","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.07,"maximum":50.05,"gross_charge":61.78,"discounted_cash":18.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.07,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG SOLUTION FOR INJECTION","code_information":[{"code":"J2920","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.83,"maximum":50.05,"gross_charge":61.78,"discounted_cash":18.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.83,"standard_charge_algorithm": "Lesser of $4.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.83,"standard_charge_algorithm": "Lesser of $4.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 1 MG/ML BOLUS (ACUDOSE DILUTED VIAL)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77775-0006-93","type":"NDC"}],"standard_charges":[{"minimum":18751.69,"maximum":25314.78,"gross_charge":31252.81,"discounted_cash":9250.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25314.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25314.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25314.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20314.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21876.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18751.69,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 1 MG/ML BOLUS (ACUDOSE DILUTED VIAL)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77775-0006-93","type":"NDC"}],"standard_charges":[{"minimum":81.77,"maximum":25314.78,"gross_charge":31252.81,"discounted_cash":9250.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25314.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25314.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25314.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20001.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":139.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14063.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21876.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18751.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5938.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6250.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4687.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6250.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":81.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":87.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":84.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":85.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":89.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":86.68,"methodology":"case rate"}]}]},{"description":"ALTEPLASE 1 MG/ML INFUSION (ACUDOSE DILUTED VIAL)","code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3708239.78,"maximum":5006123.71,"gross_charge":6180399.63,"discounted_cash":1829398.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5006123.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5006123.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5006123.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4017259.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4326279.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3708239.78,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 1 MG/ML INFUSION (ACUDOSE DILUTED VIAL)","code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":81.77,"maximum":5006123.71,"gross_charge":6180399.63,"discounted_cash":1829398.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5006123.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5006123.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5006123.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3955455.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":139.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2781179.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4326279.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3708239.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1174275.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236079.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":927059.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1236079.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":81.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":87.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":84.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":85.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":89.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":86.68,"methodology":"case rate"}]}]},{"description":"ALTEPLASE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0085-25","type":"NDC"}],"standard_charges":[{"minimum":35009.85,"maximum":47263.29,"gross_charge":58349.74,"discounted_cash":17271.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47263.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47263.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47263.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37927.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40844.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35009.85,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0085-25","type":"NDC"}],"standard_charges":[{"minimum":81.77,"maximum":47263.29,"gross_charge":58349.74,"discounted_cash":17271.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47263.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47263.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47263.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37343.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":139.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26257.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40844.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35009.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11086.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11669.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8752.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11669.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":81.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":87.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":84.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":85.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":89.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":86.68,"methodology":"case rate"}]}]},{"description":"ALTEPLASE 2 MG INTRA-CATHETER SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0041-64","type":"NDC"}],"standard_charges":[{"minimum":908.79,"maximum":1226.86,"gross_charge":1514.64,"discounted_cash":448.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1226.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1226.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1226.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":984.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1060.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":908.79,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 2 MG INTRA-CATHETER SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0041-64","type":"NDC"}],"standard_charges":[{"minimum":81.77,"maximum":1226.86,"gross_charge":1514.64,"discounted_cash":448.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1226.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1226.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1226.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":969.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":139.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":681.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1060.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":908.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":81.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":87.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":84.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":85.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":89.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":86.68,"methodology":"case rate"}]}]},{"description":"ALTEPLASE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0044-13","type":"NDC"}],"standard_charges":[{"minimum":17610.63,"maximum":23774.36,"gross_charge":29351.05,"discounted_cash":8687.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23774.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19078.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20545.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17610.63,"methodology":"fee schedule"}]}]},{"description":"ALTEPLASE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0044-13","type":"NDC"}],"standard_charges":[{"minimum":81.77,"maximum":23774.36,"gross_charge":29351.05,"discounted_cash":8687.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23774.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23774.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18784.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":91.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":88.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":93.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.66,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":139.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":99.47,"standard_charge_algorithm": "Lesser of $99.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13207.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20545.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17610.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5576.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5870.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4402.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5870.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":81.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":87.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":84.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":85.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":89.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":86.68,"methodology":"case rate"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0030-05","type":"NDC"}],"standard_charges":[{"minimum":38.02,"maximum":51.33,"gross_charge":63.36,"discounted_cash":18.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"17478-0030-05","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":51.33,"gross_charge":63.36,"discounted_cash":18.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0806-02","type":"NDC"}],"standard_charges":[{"minimum":36.39,"maximum":49.13,"gross_charge":60.65,"discounted_cash":17.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0806-02","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":49.13,"gross_charge":60.65,"discounted_cash":17.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0806-13","type":"NDC"}],"standard_charges":[{"minimum":37.36,"maximum":50.44,"gross_charge":62.26,"discounted_cash":18.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.36,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0806-13","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":50.44,"gross_charge":62.26,"discounted_cash":18.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0806-50","type":"NDC"}],"standard_charges":[{"minimum":49.59,"maximum":66.94,"gross_charge":82.64,"discounted_cash":24.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.59,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0806-50","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":66.94,"gross_charge":82.64,"discounted_cash":24.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.53,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0170-01","type":"NDC"}],"standard_charges":[{"minimum":35.99,"maximum":48.58,"gross_charge":59.97,"discounted_cash":17.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.99,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0170-01","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":48.58,"gross_charge":59.97,"discounted_cash":17.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0170-25","type":"NDC"}],"standard_charges":[{"minimum":37.19,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0170-25","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":50.2,"gross_charge":61.97,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0171-25","type":"NDC"}],"standard_charges":[{"minimum":39.78,"maximum":53.71,"gross_charge":66.3,"discounted_cash":19.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0171-25","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":53.71,"gross_charge":66.3,"discounted_cash":19.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0172-01","type":"NDC"}],"standard_charges":[{"minimum":87.35,"maximum":117.92,"gross_charge":145.57,"discounted_cash":43.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":94.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":101.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.35,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0172-01","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":117.92,"gross_charge":145.57,"discounted_cash":43.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":117.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":117.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":117.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":101.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.12,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.38,"maximum":46.42,"gross_charge":57.3,"discounted_cash":16.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":46.42,"gross_charge":57.3,"discounted_cash":16.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.46,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.34,"maximum":47.71,"gross_charge":58.89,"discounted_cash":17.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.34,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":47.71,"gross_charge":58.89,"discounted_cash":17.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.81,"maximum":48.34,"gross_charge":59.67,"discounted_cash":17.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.81,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":48.34,"gross_charge":59.67,"discounted_cash":17.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.94,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.35,"maximum":49.07,"gross_charge":60.57,"discounted_cash":17.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.35,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":49.07,"gross_charge":60.57,"discounted_cash":17.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.12,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.48,"maximum":49.25,"gross_charge":60.8,"discounted_cash":18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":49.25,"gross_charge":60.8,"discounted_cash":18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.16,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.55,"maximum":49.34,"gross_charge":60.91,"discounted_cash":18.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.55,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":49.34,"gross_charge":60.91,"discounted_cash":18.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.19,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.32,"maximum":50.39,"gross_charge":62.2,"discounted_cash":18.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":50.39,"gross_charge":62.2,"discounted_cash":18.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.49,"maximum":50.61,"gross_charge":62.47,"discounted_cash":18.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.49,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":50.61,"gross_charge":62.47,"discounted_cash":18.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.12,"maximum":51.46,"gross_charge":63.52,"discounted_cash":18.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":51.46,"gross_charge":63.52,"discounted_cash":18.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.33,"maximum":51.75,"gross_charge":63.88,"discounted_cash":18.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.33,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":51.75,"gross_charge":63.88,"discounted_cash":18.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.42,"maximum":51.87,"gross_charge":64.03,"discounted_cash":18.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":51.87,"gross_charge":64.03,"discounted_cash":18.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":49.01,"maximum":66.16,"gross_charge":81.67,"discounted_cash":24.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":66.16,"gross_charge":81.67,"discounted_cash":24.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":66.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":57.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.72,"maximum":68.47,"gross_charge":84.53,"discounted_cash":25.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.72,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":68.47,"gross_charge":84.53,"discounted_cash":25.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.91,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":52.44,"maximum":70.79,"gross_charge":87.39,"discounted_cash":25.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.44,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":70.79,"gross_charge":87.39,"discounted_cash":25.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":52.74,"maximum":71.2,"gross_charge":87.9,"discounted_cash":26.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.74,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":71.2,"gross_charge":87.9,"discounted_cash":26.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.58,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.27,"maximum":74.61,"gross_charge":92.11,"discounted_cash":27.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.27,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":74.61,"gross_charge":92.11,"discounted_cash":27.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":58.2,"maximum":78.57,"gross_charge":96.99,"discounted_cash":28.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":78.57,"gross_charge":96.99,"discounted_cash":28.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":78.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":78.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":78.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":67.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.4,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":71.56,"maximum":96.61,"gross_charge":119.26,"discounted_cash":35.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.56,"methodology":"fee schedule"}]}]},{"description":"FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.01,"maximum":96.61,"gross_charge":119.26,"discounted_cash":35.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":83.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.86,"methodology":"fee schedule"}]}]},{"description":"FENTANYL PCA 10 MCG/ML IN NS (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-1911-01","type":"NDC"}],"standard_charges":[{"minimum":55.9,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"}]}]},{"description":"FENTANYL PCA 10 MCG/ML IN NS (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76329-1911-01","type":"NDC"}],"standard_charges":[{"minimum":1.01,"maximum":75.46,"gross_charge":93.16,"discounted_cash":27.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.01,"standard_charge_algorithm": "Lesser of $1.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0173-01","type":"NDC"}],"standard_charges":[{"minimum":41.91,"maximum":56.58,"gross_charge":69.85,"discounted_cash":20.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0173-01","type":"NDC"}],"standard_charges":[{"minimum":10.48,"maximum":58.64,"gross_charge":69.85,"discounted_cash":20.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.97,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0728-01","type":"NDC"}],"standard_charges":[{"minimum":44.35,"maximum":59.87,"gross_charge":73.91,"discounted_cash":21.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0728-01","type":"NDC"}],"standard_charges":[{"minimum":11.09,"maximum":59.87,"gross_charge":73.91,"discounted_cash":21.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.79,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0804-01","type":"NDC"}],"standard_charges":[{"minimum":43.29,"maximum":58.45,"gross_charge":72.15,"discounted_cash":21.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.29,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0804-01","type":"NDC"}],"standard_charges":[{"minimum":10.83,"maximum":58.64,"gross_charge":72.15,"discounted_cash":21.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.43,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0804-05","type":"NDC"}],"standard_charges":[{"minimum":44.22,"maximum":59.7,"gross_charge":73.7,"discounted_cash":21.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0804-05","type":"NDC"}],"standard_charges":[{"minimum":11.06,"maximum":59.7,"gross_charge":73.7,"discounted_cash":21.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.36,"maximum":57.18,"gross_charge":70.59,"discounted_cash":20.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.36,"methodology":"fee schedule"}]}]},{"description":"SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J3030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.59,"maximum":58.64,"gross_charge":70.59,"discounted_cash":20.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":58.64,"standard_charge_algorithm": "Lesser of $58.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.12,"methodology":"fee schedule"}]}]},{"description":"EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3032","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67386-0130-51","type":"NDC"}],"standard_charges":[{"minimum":4497.96,"maximum":6072.24,"gross_charge":7496.59,"discounted_cash":2219,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6072.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6072.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6072.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4872.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5247.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4497.96,"methodology":"fee schedule"}]}]},{"description":"EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3032","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67386-0130-51","type":"NDC"}],"standard_charges":[{"minimum":17.27,"maximum":6072.24,"gross_charge":7496.59,"discounted_cash":2219,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6072.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6072.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6072.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4797.82,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":19.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":18.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":18.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":29.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.54,"standard_charge_algorithm": "Lesser of $18.54 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3373.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5247.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4497.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1424.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1124.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1499.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":17.27,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":18.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":17.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":18.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":18.31,"methodology":"case rate"}]}]},{"description":"TENECTEPLASE (TNKASE) INJECTION-STROKE (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"minimum":30261.83,"maximum":40853.46,"gross_charge":50436.37,"discounted_cash":14929.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40853.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40853.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40853.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32783.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35305.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30261.83,"methodology":"fee schedule"}]}]},{"description":"TENECTEPLASE (TNKASE) INJECTION-STROKE (MCT)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"minimum":145.24,"maximum":40853.46,"gross_charge":50436.37,"discounted_cash":14929.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40853.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40853.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40853.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32279.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":162.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":153.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":248.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.57,"standard_charge_algorithm": "Lesser of $162.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":162.57,"standard_charge_algorithm": "Lesser of $162.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22696.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35305.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30261.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9582.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10087.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7565.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10087.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":145.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":155.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":149.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":152.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":159.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":153.95,"methodology":"case rate"}]}]},{"description":"TENECTEPLASE 50 MG INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-01","type":"NDC"}],"standard_charges":[{"minimum":22597.83,"maximum":30507.08,"gross_charge":37663.05,"discounted_cash":11148.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30507.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30507.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30507.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":24480.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":26364.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22597.83,"methodology":"fee schedule"}]}]},{"description":"TENECTEPLASE 50 MG INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-01","type":"NDC"}],"standard_charges":[{"minimum":145.24,"maximum":30507.08,"gross_charge":37663.05,"discounted_cash":11148.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30507.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30507.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30507.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":24104.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":162.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":153.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":248.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.57,"standard_charge_algorithm": "Lesser of $162.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":162.57,"standard_charge_algorithm": "Lesser of $162.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16948.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":26364.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22597.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7155.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7532.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5649.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7532.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":145.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":155.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":149.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":152.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":159.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":153.95,"methodology":"case rate"}]}]},{"description":"TENECTEPLASE 50 MG INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"minimum":28036.32,"maximum":37849.03,"gross_charge":46727.19,"discounted_cash":13831.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37849.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37849.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37849.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30372.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32709.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28036.32,"methodology":"fee schedule"}]}]},{"description":"TENECTEPLASE 50 MG INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"minimum":145.24,"maximum":37849.03,"gross_charge":46727.19,"discounted_cash":13831.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37849.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37849.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37849.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29905.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":162.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":153.11,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":156.01,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":248.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":162.57,"standard_charge_algorithm": "Lesser of $162.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":162.57,"standard_charge_algorithm": "Lesser of $162.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21027.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32709.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28036.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8878.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9345.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7009.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9345.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":145.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":155.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":149.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":152.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":159.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":153.95,"methodology":"case rate"}]}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3105","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0665-00","type":"NDC"}],"standard_charges":[{"minimum":35.91,"maximum":48.48,"gross_charge":59.84,"discounted_cash":17.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"}]}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3105","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0665-00","type":"NDC"}],"standard_charges":[{"minimum":8.98,"maximum":48.48,"gross_charge":59.84,"discounted_cash":17.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.97,"methodology":"fee schedule"}]}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J3105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.79,"maximum":48.32,"gross_charge":59.65,"discounted_cash":17.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"}]}]},{"description":"TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION","code_information":[{"code":"J3105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.95,"maximum":48.32,"gross_charge":59.65,"discounted_cash":17.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":14.43,"standard_charge_algorithm": "Lesser of $14.43 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3230","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":87.81,"maximum":118.54,"gross_charge":146.34,"discounted_cash":43.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":95.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.81,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3230","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":21.96,"maximum":118.54,"gross_charge":146.34,"discounted_cash":43.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":118.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":93.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.42,"standard_charge_algorithm": "Lesser of $38.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.42,"standard_charge_algorithm": "Lesser of $38.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":65.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":102.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":87.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.27,"methodology":"fee schedule"}]}]},{"description":"THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3240","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58468-0030-02","type":"NDC"}],"standard_charges":[{"minimum":8756.16,"maximum":11820.82,"gross_charge":14593.6,"discounted_cash":4319.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11820.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11820.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11820.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9485.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10215.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8756.16,"methodology":"fee schedule"}]}]},{"description":"THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3240","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58468-0030-02","type":"NDC"}],"standard_charges":[{"minimum":1858.45,"maximum":11820.82,"gross_charge":14593.6,"discounted_cash":4319.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11820.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11820.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11820.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9339.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2067.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2067.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2104.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2059.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3177.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2177.18,"standard_charge_algorithm": "Lesser of $2177.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2177.18,"standard_charge_algorithm": "Lesser of $2177.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6567.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10215.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8756.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2772.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2918.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2189.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2918.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1858.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1914.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1951.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2044.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1969.96,"methodology":"case rate"}]}]},{"description":"THYROTROPIN ALFA 1.1 MG (0.9 MG/ML FINAL CONC.) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3240","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58468-0030-02","type":"NDC"}],"standard_charges":[{"minimum":7733.05,"maximum":10439.62,"gross_charge":12888.41,"discounted_cash":3814.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10439.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10439.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10439.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8377.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9021.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7733.05,"methodology":"fee schedule"}]}]},{"description":"THYROTROPIN ALFA 1.1 MG (0.9 MG/ML FINAL CONC.) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3240","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58468-0030-02","type":"NDC"}],"standard_charges":[{"minimum":1858.45,"maximum":10439.62,"gross_charge":12888.41,"discounted_cash":3814.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10439.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10439.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10439.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8248.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2067.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2067.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2021.17,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2104.81,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2059.3,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3177.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2177.18,"standard_charge_algorithm": "Lesser of $2177.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2177.18,"standard_charge_algorithm": "Lesser of $2177.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5799.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9021.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7733.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2448.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2577.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1933.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2577.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1858.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1988.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1914.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1951.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2044.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1969.96,"methodology":"case rate"}]}]},{"description":"TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3241","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"75987-0130-15","type":"NDC"}],"standard_charges":[{"minimum":73753.62,"maximum":99567.38,"gross_charge":122922.69,"discounted_cash":36385.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99567.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99567.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99567.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79899.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86045.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73753.62,"methodology":"fee schedule"}]}]},{"description":"TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3241","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"75987-0130-15","type":"NDC"}],"standard_charges":[{"minimum":315.21,"maximum":99567.38,"gross_charge":122922.69,"discounted_cash":36385.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":99567.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":99567.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":99567.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78670.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":347.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":347.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":328,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":342.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":334.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":539.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":363.72,"standard_charge_algorithm": "Lesser of $363.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":363.72,"standard_charge_algorithm": "Lesser of $363.72 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55315.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86045.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":73753.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23355.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24584.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18438.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24584.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":315.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":337.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":324.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":330.97,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":346.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":334.12,"methodology":"case rate"}]}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3243","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0960-10","type":"NDC"}],"standard_charges":[{"minimum":393.34,"maximum":531.01,"gross_charge":655.56,"discounted_cash":194.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":531.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":426.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":458.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":393.34,"methodology":"fee schedule"}]}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3243","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0960-10","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":531.01,"gross_charge":655.56,"discounted_cash":194.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":531.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":531.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":531.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":419.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":295.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":458.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":393.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.12,"methodology":"fee schedule"}]}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3243","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0019-11","type":"NDC"}],"standard_charges":[{"minimum":95.94,"maximum":129.52,"gross_charge":159.89,"discounted_cash":47.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":103.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.94,"methodology":"fee schedule"}]}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3243","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0019-11","type":"NDC"}],"standard_charges":[{"minimum":1.03,"maximum":129.52,"gross_charge":159.89,"discounted_cash":47.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":129.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":129.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":129.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":102.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":111.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.98,"methodology":"fee schedule"}]}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3243","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":75.78,"maximum":102.3,"gross_charge":126.29,"discounted_cash":37.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":88.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.78,"methodology":"fee schedule"}]}]},{"description":"TIGECYCLINE 50 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3243","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.03,"maximum":102.3,"gross_charge":126.29,"discounted_cash":37.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":102.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":102.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":102.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.03,"standard_charge_algorithm": "Lesser of $1.03 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":88.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":75.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.26,"methodology":"fee schedule"}]}]},{"description":"TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25208-0002-02","type":"NDC"}],"standard_charges":[{"minimum":541.51,"maximum":731.04,"gross_charge":902.51,"discounted_cash":267.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":731.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":586.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":631.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":541.51,"methodology":"fee schedule"}]}]},{"description":"TIROFIBAN 12.5 MG/250 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25208-0002-02","type":"NDC"}],"standard_charges":[{"minimum":4.32,"maximum":731.04,"gross_charge":902.51,"discounted_cash":267.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":731.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":731.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":731.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":577.61,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.52,"standard_charge_algorithm": "Lesser of $10.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.52,"standard_charge_algorithm": "Lesser of $10.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":406.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":631.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":541.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.51,"methodology":"fee schedule"}]}]},{"description":"TIROFIBAN 250 MCG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25208-0001-04","type":"NDC"}],"standard_charges":[{"minimum":149.27,"maximum":201.51,"gross_charge":248.77,"discounted_cash":73.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":161.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":174.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.27,"methodology":"fee schedule"}]}]},{"description":"TIROFIBAN 250 MCG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25208-0001-04","type":"NDC"}],"standard_charges":[{"minimum":4.32,"maximum":201.51,"gross_charge":248.77,"discounted_cash":73.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":201.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":201.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":201.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":159.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.52,"standard_charge_algorithm": "Lesser of $10.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.52,"standard_charge_algorithm": "Lesser of $10.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":111.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":174.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":149.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"}]}]},{"description":"TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25208-0002-03","type":"NDC"}],"standard_charges":[{"minimum":226.24,"maximum":305.42,"gross_charge":377.06,"discounted_cash":111.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":305.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":305.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":305.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":245.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":263.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.24,"methodology":"fee schedule"}]}]},{"description":"TIROFIBAN 5 MG/100 ML (50 MCG/ML)-0.9 % SODIUM CHLORIDE INTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25208-0002-03","type":"NDC"}],"standard_charges":[{"minimum":4.32,"maximum":305.42,"gross_charge":377.06,"discounted_cash":111.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":305.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":305.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":305.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":241.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.52,"standard_charge_algorithm": "Lesser of $10.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.52,"standard_charge_algorithm": "Lesser of $10.52 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":169.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":263.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.42,"methodology":"fee schedule"}]}]},{"description":"SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3247","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5428.56,"maximum":7328.56,"gross_charge":9047.6,"discounted_cash":2678.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7328.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7328.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7328.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5880.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6333.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5428.56,"methodology":"fee schedule"}]}]},{"description":"SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3247","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1357.14,"maximum":7328.56,"gross_charge":9047.6,"discounted_cash":2678.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7328.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7328.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7328.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5790.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4523.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4523.8,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4071.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6333.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5428.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1719.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1809.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1357.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1809.52,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0412-01","type":"NDC"}],"standard_charges":[{"minimum":159.92,"maximum":215.89,"gross_charge":266.52,"discounted_cash":78.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":215.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":215.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":215.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":173.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":186.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.92,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0412-01","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":215.89,"gross_charge":266.52,"discounted_cash":78.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":215.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":215.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":215.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":170.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":119.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":186.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.31,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0412-06","type":"NDC"}],"standard_charges":[{"minimum":119.8,"maximum":161.73,"gross_charge":199.66,"discounted_cash":59.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":139.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-0412-06","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":161.73,"gross_charge":199.66,"discounted_cash":59.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":161.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":127.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":139.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":119.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.94,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0303-51","type":"NDC"}],"standard_charges":[{"minimum":225.78,"maximum":304.8,"gross_charge":376.29,"discounted_cash":111.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":244.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":263.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.78,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0303-51","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":304.8,"gross_charge":376.29,"discounted_cash":111.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":169.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":263.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.26,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70700-0173-22","type":"NDC"}],"standard_charges":[{"minimum":156.71,"maximum":211.56,"gross_charge":261.18,"discounted_cash":77.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":169.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":182.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.71,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70700-0173-22","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":211.56,"gross_charge":261.18,"discounted_cash":77.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":211.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":167.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":117.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":182.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.24,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0163-06","type":"NDC"}],"standard_charges":[{"minimum":108.46,"maximum":146.42,"gross_charge":180.76,"discounted_cash":53.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":117.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":126.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.46,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0163-06","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":146.42,"gross_charge":180.76,"discounted_cash":53.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":146.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":146.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":146.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":81.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":126.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":108.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.16,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0244-25","type":"NDC"}],"standard_charges":[{"minimum":35.45,"maximum":47.85,"gross_charge":59.07,"discounted_cash":17.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"36000-0244-25","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":47.85,"gross_charge":59.07,"discounted_cash":17.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0306-02","type":"NDC"}],"standard_charges":[{"minimum":40.62,"maximum":54.84,"gross_charge":67.7,"discounted_cash":20.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0306-02","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":54.84,"gross_charge":67.7,"discounted_cash":20.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.54,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0306-26","type":"NDC"}],"standard_charges":[{"minimum":36.37,"maximum":49.1,"gross_charge":60.61,"discounted_cash":17.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.37,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0306-26","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":49.1,"gross_charge":60.61,"discounted_cash":17.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0473-22","type":"NDC"}],"standard_charges":[{"minimum":34.97,"maximum":47.2,"gross_charge":58.27,"discounted_cash":17.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.97,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0473-22","type":"NDC"}],"standard_charges":[{"minimum":2.94,"maximum":47.2,"gross_charge":58.27,"discounted_cash":17.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.47,"maximum":53.29,"gross_charge":65.78,"discounted_cash":19.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"}]}]},{"description":"TOBRAMYCIN 40 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.94,"maximum":53.29,"gross_charge":65.78,"discounted_cash":19.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.94,"standard_charge_algorithm": "Lesser of $2.94 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.16,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0130-25","type":"NDC"}],"standard_charges":[{"minimum":38.63,"maximum":52.15,"gross_charge":64.38,"discounted_cash":19.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.63,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0130-25","type":"NDC"}],"standard_charges":[{"minimum":1.23,"maximum":52.15,"gross_charge":64.38,"discounted_cash":19.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1049-01","type":"NDC"}],"standard_charges":[{"minimum":41.07,"maximum":55.45,"gross_charge":68.45,"discounted_cash":20.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.07,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1049-01","type":"NDC"}],"standard_charges":[{"minimum":1.23,"maximum":55.45,"gross_charge":68.45,"discounted_cash":20.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.69,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.19,"maximum":54.26,"gross_charge":66.98,"discounted_cash":19.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.23,"maximum":54.26,"gross_charge":66.98,"discounted_cash":19.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54.41,"maximum":73.46,"gross_charge":90.68,"discounted_cash":26.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.41,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION","code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.23,"maximum":73.46,"gross_charge":90.68,"discounted_cash":26.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.14,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE(PF) 40 MG/ML IN 0.9 % SODIUM CHLORIDE INJ SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71266-1080-02","type":"NDC"}],"standard_charges":[{"minimum":79.97,"maximum":107.96,"gross_charge":133.28,"discounted_cash":39.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":93.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.97,"methodology":"fee schedule"}]}]},{"description":"TRIAMCINOLONE ACETONIDE(PF) 40 MG/ML IN 0.9 % SODIUM CHLORIDE INJ SUSP","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71266-1080-02","type":"NDC"}],"standard_charges":[{"minimum":1.23,"maximum":107.96,"gross_charge":133.28,"discounted_cash":39.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.23,"standard_charge_algorithm": "Lesser of $1.23 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":93.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.66,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":112.76,"maximum":152.23,"gross_charge":187.93,"discounted_cash":55.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":122.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":131.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.76,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.44,"maximum":152.23,"gross_charge":187.93,"discounted_cash":55.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":152.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":152.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":120.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":84.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":131.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":112.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0106-11","type":"NDC"}],"standard_charges":[{"minimum":105.52,"maximum":142.45,"gross_charge":175.86,"discounted_cash":52.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":114.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":123.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.52,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0106-11","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":142.45,"gross_charge":175.86,"discounted_cash":52.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":142.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":142.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":112.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":79.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":123.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":105.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.18,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69339-0136-03","type":"NDC"}],"standard_charges":[{"minimum":84.21,"maximum":113.68,"gross_charge":140.34,"discounted_cash":41.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.21,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69339-0136-03","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":113.68,"gross_charge":140.34,"discounted_cash":41.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":113.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":113.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":113.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.07,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69339-0136-32","type":"NDC"}],"standard_charges":[{"minimum":74.21,"maximum":100.19,"gross_charge":123.68,"discounted_cash":36.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.21,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69339-0136-32","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":100.19,"gross_charge":123.68,"discounted_cash":36.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.74,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0965-02","type":"NDC"}],"standard_charges":[{"minimum":74.46,"maximum":100.53,"gross_charge":124.1,"discounted_cash":36.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69374-0965-02","type":"NDC"}],"standard_charges":[{"minimum":7.44,"maximum":100.53,"gross_charge":124.1,"discounted_cash":36.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.82,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":67.46,"maximum":91.07,"gross_charge":112.43,"discounted_cash":33.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.46,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.44,"maximum":91.07,"gross_charge":112.43,"discounted_cash":33.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":93.3,"maximum":125.95,"gross_charge":155.49,"discounted_cash":46.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":101.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":108.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.3,"methodology":"fee schedule"}]}]},{"description":"DIAZEPAM 5 MG/ML INJECTION SYRINGE","code_information":[{"code":"J3360","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.44,"maximum":125.95,"gross_charge":155.49,"discounted_cash":46.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7.44,"standard_charge_algorithm": "Lesser of $7.44 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":69.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":108.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.1,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0158-99","type":"NDC"}],"standard_charges":[{"minimum":148.35,"maximum":200.27,"gross_charge":247.24,"discounted_cash":73.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":160.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":173.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.35,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0158-99","type":"NDC"}],"standard_charges":[{"minimum":37.09,"maximum":200.27,"gross_charge":247.24,"discounted_cash":73.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":200.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":158.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":123.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":123.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":111.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":173.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":148.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":49.45,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0314-66","type":"NDC"}],"standard_charges":[{"minimum":93.11,"maximum":125.69,"gross_charge":155.17,"discounted_cash":45.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":100.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":108.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.11,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0314-66","type":"NDC"}],"standard_charges":[{"minimum":23.28,"maximum":125.69,"gross_charge":155.17,"discounted_cash":45.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":77.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":69.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":108.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":93.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.04,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0314-68","type":"NDC"}],"standard_charges":[{"minimum":523.93,"maximum":707.31,"gross_charge":873.21,"discounted_cash":258.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":567.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":611.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":523.93,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0314-68","type":"NDC"}],"standard_charges":[{"minimum":130.99,"maximum":707.31,"gross_charge":873.21,"discounted_cash":258.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":707.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":707.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":707.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":558.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":436.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":436.61,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":392.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":611.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":523.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.65,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0342-10","type":"NDC"}],"standard_charges":[{"minimum":525.09,"maximum":708.88,"gross_charge":875.15,"discounted_cash":259.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":708.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":708.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":708.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":568.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":612.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":525.09,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0342-10","type":"NDC"}],"standard_charges":[{"minimum":131.28,"maximum":708.88,"gross_charge":875.15,"discounted_cash":259.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":708.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":708.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":708.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":560.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":437.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":437.58,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":393.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":612.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":525.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.03,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0023-82","type":"NDC"}],"standard_charges":[{"minimum":97.28,"maximum":131.32,"gross_charge":162.12,"discounted_cash":47.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.28,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0023-82","type":"NDC"}],"standard_charges":[{"minimum":24.32,"maximum":131.32,"gross_charge":162.12,"discounted_cash":47.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":81.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":81.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.43,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0048-01","type":"NDC"}],"standard_charges":[{"minimum":184.34,"maximum":248.86,"gross_charge":307.23,"discounted_cash":90.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":199.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":215.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":184.34,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0048-01","type":"NDC"}],"standard_charges":[{"minimum":46.09,"maximum":248.86,"gross_charge":307.23,"discounted_cash":90.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":196.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":153.62,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":138.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":215.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":184.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0805-01","type":"NDC"}],"standard_charges":[{"minimum":115.26,"maximum":155.6,"gross_charge":192.09,"discounted_cash":56.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":124.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.26,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0805-01","type":"NDC"}],"standard_charges":[{"minimum":28.82,"maximum":155.6,"gross_charge":192.09,"discounted_cash":56.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":122.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":96.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":96.05,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":86.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.42,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":84.8,"maximum":114.47,"gross_charge":141.32,"discounted_cash":41.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":21.2,"maximum":114.47,"gross_charge":141.32,"discounted_cash":41.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.66,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0309-10","type":"NDC"}],"standard_charges":[{"minimum":38.29,"maximum":51.69,"gross_charge":63.81,"discounted_cash":18.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.29,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0309-10","type":"NDC"}],"standard_charges":[{"minimum":9.58,"maximum":51.69,"gross_charge":63.81,"discounted_cash":18.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0151-20","type":"NDC"}],"standard_charges":[{"minimum":44.8,"maximum":60.48,"gross_charge":74.66,"discounted_cash":22.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.8,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0151-20","type":"NDC"}],"standard_charges":[{"minimum":11.2,"maximum":60.48,"gross_charge":74.66,"discounted_cash":22.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.94,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0284-41","type":"NDC"}],"standard_charges":[{"minimum":39.39,"maximum":53.17,"gross_charge":65.64,"discounted_cash":19.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0284-41","type":"NDC"}],"standard_charges":[{"minimum":9.85,"maximum":53.17,"gross_charge":65.64,"discounted_cash":19.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.82,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.13,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0284-42","type":"NDC"}],"standard_charges":[{"minimum":37.46,"maximum":50.57,"gross_charge":62.42,"discounted_cash":18.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0284-42","type":"NDC"}],"standard_charges":[{"minimum":9.37,"maximum":50.57,"gross_charge":62.42,"discounted_cash":18.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.21,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0340-00","type":"NDC"}],"standard_charges":[{"minimum":40.88,"maximum":55.19,"gross_charge":68.13,"discounted_cash":20.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0340-00","type":"NDC"}],"standard_charges":[{"minimum":10.22,"maximum":55.19,"gross_charge":68.13,"discounted_cash":20.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0046-01","type":"NDC"}],"standard_charges":[{"minimum":47.94,"maximum":64.72,"gross_charge":79.9,"discounted_cash":23.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70594-0046-01","type":"NDC"}],"standard_charges":[{"minimum":11.99,"maximum":64.72,"gross_charge":79.9,"discounted_cash":23.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":39.95,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.98,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0105-20","type":"NDC"}],"standard_charges":[{"minimum":50.13,"maximum":67.67,"gross_charge":83.54,"discounted_cash":24.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.13,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0105-20","type":"NDC"}],"standard_charges":[{"minimum":12.54,"maximum":67.67,"gross_charge":83.54,"discounted_cash":24.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0801-02","type":"NDC"}],"standard_charges":[{"minimum":41.51,"maximum":56.03,"gross_charge":69.17,"discounted_cash":20.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0801-02","type":"NDC"}],"standard_charges":[{"minimum":10.38,"maximum":56.03,"gross_charge":69.17,"discounted_cash":20.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.59,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.84,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.06,"maximum":50.03,"gross_charge":61.76,"discounted_cash":18.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.27,"maximum":50.03,"gross_charge":61.76,"discounted_cash":18.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.36,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.65,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 1000 MG INTRAVENOUS INJECTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.67,"maximum":62.98,"gross_charge":77.75,"discounted_cash":23.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":38.88,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0247-01","type":"NDC"}],"standard_charges":[{"minimum":38.6,"maximum":52.1,"gross_charge":64.32,"discounted_cash":19.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0247-01","type":"NDC"}],"standard_charges":[{"minimum":9.65,"maximum":52.1,"gross_charge":64.32,"discounted_cash":19.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51991-0940-99","type":"NDC"}],"standard_charges":[{"minimum":39.84,"maximum":53.79,"gross_charge":66.4,"discounted_cash":19.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.84,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51991-0940-99","type":"NDC"}],"standard_charges":[{"minimum":9.96,"maximum":53.79,"gross_charge":66.4,"discounted_cash":19.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0221-16","type":"NDC"}],"standard_charges":[{"minimum":37.18,"maximum":50.19,"gross_charge":61.96,"discounted_cash":18.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0221-16","type":"NDC"}],"standard_charges":[{"minimum":9.3,"maximum":50.19,"gross_charge":61.96,"discounted_cash":18.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.4,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0221-33","type":"NDC"}],"standard_charges":[{"minimum":38.09,"maximum":51.42,"gross_charge":63.48,"discounted_cash":18.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0221-33","type":"NDC"}],"standard_charges":[{"minimum":9.53,"maximum":51.42,"gross_charge":63.48,"discounted_cash":18.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.74,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.7,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0020-82","type":"NDC"}],"standard_charges":[{"minimum":37.27,"maximum":50.31,"gross_charge":62.11,"discounted_cash":18.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0020-82","type":"NDC"}],"standard_charges":[{"minimum":9.32,"maximum":50.31,"gross_charge":62.11,"discounted_cash":18.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.43,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.39,"maximum":49.13,"gross_charge":60.65,"discounted_cash":17.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.1,"maximum":49.13,"gross_charge":60.65,"discounted_cash":17.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.13,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.03,"maximum":56.74,"gross_charge":70.04,"discounted_cash":20.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 500 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.51,"maximum":56.74,"gross_charge":70.04,"discounted_cash":20.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":35.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":35.02,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 750 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0203-20","type":"NDC"}],"standard_charges":[{"minimum":45.08,"maximum":60.86,"gross_charge":75.13,"discounted_cash":22.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.08,"methodology":"fee schedule"}]}]},{"description":"VANCOMYCIN 750 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3373","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0203-20","type":"NDC"}],"standard_charges":[{"minimum":11.27,"maximum":60.86,"gross_charge":75.13,"discounted_cash":22.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.03,"methodology":"fee schedule"}]}]},{"description":"VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3380","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64764-0300-20","type":"NDC"}],"standard_charges":[{"minimum":37664.35,"maximum":50846.87,"gross_charge":62773.91,"discounted_cash":18581.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50846.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50846.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50846.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40803.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43941.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37664.35,"methodology":"fee schedule"}]}]},{"description":"VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3380","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64764-0300-20","type":"NDC"}],"standard_charges":[{"minimum":18.92,"maximum":50846.87,"gross_charge":62773.91,"discounted_cash":18581.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50846.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50846.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50846.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40175.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":21.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":22.06,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":22.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":32.35,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":25.19,"standard_charge_algorithm": "Lesser of $25.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25.19,"standard_charge_algorithm": "Lesser of $25.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28248.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43941.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37664.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11927.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12554.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9416.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12554.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":18.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":20.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":19.49,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":19.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":20.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":20.06,"methodology":"case rate"}]}]},{"description":"HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION","code_information":[{"code":"J3410","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION","code_information":[{"code":"J3410","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $12.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $12.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION","code_information":[{"code":"J3410","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":79.04,"maximum":106.7,"gross_charge":131.72,"discounted_cash":38.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.04,"methodology":"fee schedule"}]}]},{"description":"HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION","code_information":[{"code":"J3410","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.8,"maximum":106.7,"gross_charge":131.72,"discounted_cash":38.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.8,"standard_charge_algorithm": "Lesser of $12.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.8,"standard_charge_algorithm": "Lesser of $12.80 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.35,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0500-02","type":"NDC"}],"standard_charges":[{"minimum":41.76,"maximum":56.37,"gross_charge":69.59,"discounted_cash":20.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0500-02","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":56.37,"gross_charge":69.59,"discounted_cash":20.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.92,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0050-11","type":"NDC"}],"standard_charges":[{"minimum":39.72,"maximum":53.62,"gross_charge":66.19,"discounted_cash":19.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0050-11","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":53.62,"gross_charge":66.19,"discounted_cash":19.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0273-25","type":"NDC"}],"standard_charges":[{"minimum":41.81,"maximum":56.44,"gross_charge":69.67,"discounted_cash":20.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0273-25","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":56.44,"gross_charge":69.67,"discounted_cash":20.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.94,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0013-26","type":"NDC"}],"standard_charges":[{"minimum":42.29,"maximum":57.09,"gross_charge":70.47,"discounted_cash":20.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0013-26","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":57.09,"gross_charge":70.47,"discounted_cash":20.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":49.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65145-0129-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65145-0129-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0196-00","type":"NDC"}],"standard_charges":[{"minimum":40.46,"maximum":54.62,"gross_charge":67.42,"discounted_cash":19.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.46,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0196-00","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":54.62,"gross_charge":67.42,"discounted_cash":19.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0507-25","type":"NDC"}],"standard_charges":[{"minimum":41.48,"maximum":55.99,"gross_charge":69.12,"discounted_cash":20.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0507-25","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":55.99,"gross_charge":69.12,"discounted_cash":20.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.83,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0139-01","type":"NDC"}],"standard_charges":[{"minimum":40.45,"maximum":54.61,"gross_charge":67.41,"discounted_cash":19.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0139-01","type":"NDC"}],"standard_charges":[{"minimum":3.25,"maximum":54.61,"gross_charge":67.41,"discounted_cash":19.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.49,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.11,"maximum":55.5,"gross_charge":68.51,"discounted_cash":20.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"}]}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3411","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.25,"maximum":55.5,"gross_charge":68.51,"discounted_cash":20.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.25,"standard_charge_algorithm": "Lesser of $3.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"}]}]},{"description":"PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3415","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0180-01","type":"NDC"}],"standard_charges":[{"minimum":52.41,"maximum":70.75,"gross_charge":87.34,"discounted_cash":25.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.41,"methodology":"fee schedule"}]}]},{"description":"PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3415","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0180-01","type":"NDC"}],"standard_charges":[{"minimum":10.92,"maximum":70.75,"gross_charge":87.34,"discounted_cash":25.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":70.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":70.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":70.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.92,"standard_charge_algorithm": "Lesser of $10.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.92,"standard_charge_algorithm": "Lesser of $10.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.47,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0364-25","type":"NDC"}],"standard_charges":[{"minimum":37.23,"maximum":50.27,"gross_charge":62.05,"discounted_cash":18.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.23,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55150-0364-25","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":50.27,"gross_charge":62.05,"discounted_cash":18.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.41,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0044-01","type":"NDC"}],"standard_charges":[{"minimum":35.79,"maximum":48.32,"gross_charge":59.65,"discounted_cash":17.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0044-01","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":48.32,"gross_charge":59.65,"discounted_cash":17.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0044-44","type":"NDC"}],"standard_charges":[{"minimum":38.21,"maximum":51.59,"gross_charge":63.68,"discounted_cash":18.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0044-44","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":51.59,"gross_charge":63.68,"discounted_cash":18.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.74,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0005-10","type":"NDC"}],"standard_charges":[{"minimum":36.72,"maximum":49.57,"gross_charge":61.19,"discounted_cash":18.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70069-0005-10","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":49.57,"gross_charge":61.19,"discounted_cash":18.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0650-01","type":"NDC"}],"standard_charges":[{"minimum":35.42,"maximum":47.81,"gross_charge":59.02,"discounted_cash":17.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0650-01","type":"NDC"}],"standard_charges":[{"minimum":2.2,"maximum":47.81,"gross_charge":59.02,"discounted_cash":17.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0650-25","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0650-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.41,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":38.43,"maximum":51.88,"gross_charge":64.04,"discounted_cash":18.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"}]}]},{"description":"CYANOCOBALAMIN (VIT B-12) 1000 MCG/ML INJECTION SOLUTION","code_information":[{"code":"J3420","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.2,"maximum":51.88,"gross_charge":64.04,"discounted_cash":18.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.2,"standard_charge_algorithm": "Lesser of $2.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.81,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0405-16","type":"NDC"}],"standard_charges":[{"minimum":78.55,"maximum":106.04,"gross_charge":130.91,"discounted_cash":38.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.55,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0405-16","type":"NDC"}],"standard_charges":[{"minimum":3.74,"maximum":106.04,"gross_charge":130.91,"discounted_cash":38.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.74,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.74,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":91.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":78.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.19,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0758-01","type":"NDC"}],"standard_charges":[{"minimum":66.29,"maximum":89.49,"gross_charge":110.47,"discounted_cash":32.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.29,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0758-01","type":"NDC"}],"standard_charges":[{"minimum":3.74,"maximum":89.49,"gross_charge":110.47,"discounted_cash":32.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.74,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.74,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.1,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0758-25","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0758-25","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":80.86,"maximum":109.16,"gross_charge":134.76,"discounted_cash":39.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.86,"methodology":"fee schedule"}]}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION","code_information":[{"code":"J3430","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.74,"maximum":109.16,"gross_charge":134.76,"discounted_cash":39.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.74,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.74,"standard_charge_algorithm": "Lesser of $3.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":60.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":94.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":80.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-1077-01","type":"NDC"}],"standard_charges":[{"minimum":83.06,"maximum":112.13,"gross_charge":138.42,"discounted_cash":40.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.06,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"39822-1077-01","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":112.13,"gross_charge":138.42,"discounted_cash":40.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":62.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":96.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":83.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.69,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0466-71","type":"NDC"}],"standard_charges":[{"minimum":341.13,"maximum":460.52,"gross_charge":568.54,"discounted_cash":168.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":460.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":460.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":460.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":369.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":397.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":341.13,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47781-0466-71","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":460.52,"gross_charge":568.54,"discounted_cash":168.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":460.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":460.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":460.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":363.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":255.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":397.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":341.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.71,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0029-80","type":"NDC"}],"standard_charges":[{"minimum":70.02,"maximum":94.52,"gross_charge":116.69,"discounted_cash":34.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.02,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0029-80","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":94.52,"gross_charge":116.69,"discounted_cash":34.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":70.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.34,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0027-30","type":"NDC"}],"standard_charges":[{"minimum":121.2,"maximum":163.62,"gross_charge":201.99,"discounted_cash":59.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.2,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0027-30","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":163.62,"gross_charge":201.99,"discounted_cash":59.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0131-01","type":"NDC"}],"standard_charges":[{"minimum":183.96,"maximum":248.35,"gross_charge":306.6,"discounted_cash":90.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":199.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.96,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0131-01","type":"NDC"}],"standard_charges":[{"minimum":1.16,"maximum":248.35,"gross_charge":306.6,"discounted_cash":90.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":248.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":248.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":196.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":137.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":214.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":183.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.32,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.03,"maximum":89.14,"gross_charge":110.04,"discounted_cash":32.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.03,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.16,"maximum":89.14,"gross_charge":110.04,"discounted_cash":32.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":70.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":49.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":77.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.01,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":72.9,"maximum":98.41,"gross_charge":121.49,"discounted_cash":35.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"}]}]},{"description":"VORICONAZOLE 200 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J3465","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.16,"maximum":98.41,"gross_charge":121.49,"discounted_cash":35.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":98.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.16,"standard_charge_algorithm": "Lesser of $1.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.3,"methodology":"fee schedule"}]}]},{"description":"HYALURONIDASE HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3473","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"18657-0117-02","type":"NDC"}],"standard_charges":[{"minimum":151.44,"maximum":204.44,"gross_charge":252.39,"discounted_cash":74.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":164.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":176.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.44,"methodology":"fee schedule"}]}]},{"description":"HYALURONIDASE HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3473","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"18657-0117-02","type":"NDC"}],"standard_charges":[{"minimum":0.41,"maximum":204.44,"gross_charge":252.39,"discounted_cash":74.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":204.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":161.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.41,"standard_charge_algorithm": "Lesser of $0.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.41,"standard_charge_algorithm": "Lesser of $0.41 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":113.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":176.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":151.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.48,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0410-24","type":"NDC"}],"standard_charges":[{"minimum":40.11,"maximum":54.15,"gross_charge":66.85,"discounted_cash":19.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44567-0410-24","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":54.15,"gross_charge":66.85,"discounted_cash":19.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.37,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0108-26","type":"NDC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0108-26","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0567-00","type":"NDC"}],"standard_charges":[{"minimum":39.86,"maximum":53.81,"gross_charge":66.43,"discounted_cash":19.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0567-00","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":53.81,"gross_charge":66.43,"discounted_cash":19.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.29,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.32,"maximum":49.03,"gross_charge":60.53,"discounted_cash":17.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":49.03,"gross_charge":60.53,"discounted_cash":17.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.22,"maximum":67.79,"gross_charge":83.69,"discounted_cash":24.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.86,"maximum":67.79,"gross_charge":83.69,"discounted_cash":24.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.74,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-02","type":"NDC"}],"standard_charges":[{"minimum":32.13,"maximum":43.37,"gross_charge":53.54,"discounted_cash":15.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-02","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":43.37,"gross_charge":53.54,"discounted_cash":15.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":43.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":24.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.71,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-09","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-09","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-1000-01","type":"NDC"}],"standard_charges":[{"minimum":45.52,"maximum":61.45,"gross_charge":75.86,"discounted_cash":22.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51754-1000-01","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":61.45,"gross_charge":75.86,"discounted_cash":22.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":53.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.18,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-03","type":"NDC"}],"standard_charges":[{"minimum":35.45,"maximum":47.85,"gross_charge":59.07,"discounted_cash":17.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-03","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":47.85,"gross_charge":59.07,"discounted_cash":17.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-11","type":"NDC"}],"standard_charges":[{"minimum":35.94,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"}]}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0064-11","type":"NDC"}],"standard_charges":[{"minimum":0.86,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.86,"standard_charge_algorithm": "Lesser of $0.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.07,"maximum":48.69,"gross_charge":60.11,"discounted_cash":17.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":48.69,"gross_charge":60.11,"discounted_cash":17.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.03,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.34,"maximum":50.4,"gross_charge":62.22,"discounted_cash":18.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":50.4,"gross_charge":62.22,"discounted_cash":18.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.45,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.63,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0965-03","type":"NDC"}],"standard_charges":[{"minimum":35.04,"maximum":47.3,"gross_charge":58.39,"discounted_cash":17.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0965-03","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":47.3,"gross_charge":58.39,"discounted_cash":17.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.68,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0965-20","type":"NDC"}],"standard_charges":[{"minimum":35.97,"maximum":48.56,"gross_charge":59.95,"discounted_cash":17.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0965-20","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":48.56,"gross_charge":59.95,"discounted_cash":17.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0967-01","type":"NDC"}],"standard_charges":[{"minimum":37.41,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0967-01","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":50.51,"gross_charge":62.35,"discounted_cash":18.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.47,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":39.33,"maximum":53.09,"gross_charge":65.54,"discounted_cash":19.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":53.09,"gross_charge":65.54,"discounted_cash":19.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.11,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":40.57,"maximum":54.77,"gross_charge":67.61,"discounted_cash":20.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":54.77,"gross_charge":67.61,"discounted_cash":20.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0108-16","type":"NDC"}],"standard_charges":[{"minimum":113.62,"maximum":153.39,"gross_charge":189.36,"discounted_cash":56.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.62,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0108-16","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":153.39,"gross_charge":189.36,"discounted_cash":56.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":153.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":121.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":85.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":132.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":113.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.88,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.15,"maximum":47.45,"gross_charge":58.58,"discounted_cash":17.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":47.45,"gross_charge":58.58,"discounted_cash":17.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.5,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.72,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.88,"maximum":56.54,"gross_charge":69.8,"discounted_cash":20.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.88,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":56.54,"gross_charge":69.8,"discounted_cash":20.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.96,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.75,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28.34,"maximum":38.25,"gross_charge":47.22,"discounted_cash":13.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.34,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":38.25,"gross_charge":47.22,"discounted_cash":13.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE INTRAVENOUS SOLUTION","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":25.19,"maximum":34,"gross_charge":41.97,"discounted_cash":12.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":34,"gross_charge":41.97,"discounted_cash":12.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":26.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.4,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV","code_information":[{"code":"J3480","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.18,"standard_charge_algorithm": "Lesser of $0.18 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0061-11","type":"NDC"}],"standard_charges":[{"minimum":69.77,"maximum":94.18,"gross_charge":116.27,"discounted_cash":34.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.77,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0061-11","type":"NDC"}],"standard_charges":[{"minimum":12.4,"maximum":94.18,"gross_charge":116.27,"discounted_cash":34.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":94.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":94.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":94.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":52.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":81.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":69.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.26,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72205-0205-07","type":"NDC"}],"standard_charges":[{"minimum":115.38,"maximum":155.77,"gross_charge":192.3,"discounted_cash":56.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.38,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72205-0205-07","type":"NDC"}],"standard_charges":[{"minimum":12.4,"maximum":155.77,"gross_charge":192.3,"discounted_cash":56.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":155.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":86.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":134.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":115.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.46,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0160-01","type":"NDC"}],"standard_charges":[{"minimum":71.13,"maximum":96.03,"gross_charge":118.55,"discounted_cash":35.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":77.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.13,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0160-01","type":"NDC"}],"standard_charges":[{"minimum":12.4,"maximum":96.03,"gross_charge":118.55,"discounted_cash":35.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":75.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":53.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":82.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":71.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.71,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":181.7,"maximum":245.3,"gross_charge":302.83,"discounted_cash":89.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":245.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":245.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":196.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":211.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.7,"methodology":"fee schedule"}]}]},{"description":"ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION","code_information":[{"code":"J3486","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.4,"maximum":245.3,"gross_charge":302.83,"discounted_cash":89.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":245.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":245.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":245.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":193.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.4,"standard_charge_algorithm": "Lesser of $12.40 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":136.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":211.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":181.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.57,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0242-31","type":"NDC"}],"standard_charges":[{"minimum":74.82,"maximum":101,"gross_charge":124.69,"discounted_cash":36.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":87.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.82,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0242-31","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":101,"gross_charge":124.69,"discounted_cash":36.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":101,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":87.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.94,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0801-66","type":"NDC"}],"standard_charges":[{"minimum":159.95,"maximum":215.93,"gross_charge":266.57,"discounted_cash":78.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":215.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":215.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":215.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":173.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":186.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.95,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0801-66","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":215.93,"gross_charge":266.57,"discounted_cash":78.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":215.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":215.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":215.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":170.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":119.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":186.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.32,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0233-11","type":"NDC"}],"standard_charges":[{"minimum":35.64,"maximum":48.12,"gross_charge":59.4,"discounted_cash":17.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0233-11","type":"NDC"}],"standard_charges":[{"minimum":8.91,"maximum":48.12,"gross_charge":59.4,"discounted_cash":17.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.88,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0685-07","type":"NDC"}],"standard_charges":[{"minimum":47.06,"maximum":63.53,"gross_charge":78.43,"discounted_cash":23.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.06,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0685-07","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":63.53,"gross_charge":78.43,"discounted_cash":23.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.69,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48.4,"maximum":65.34,"gross_charge":80.66,"discounted_cash":23.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.4,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.45,"maximum":65.34,"gross_charge":80.66,"discounted_cash":23.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.14,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0688-52","type":"NDC"}],"standard_charges":[{"minimum":120.44,"maximum":162.59,"gross_charge":200.72,"discounted_cash":59.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":130.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.44,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0688-52","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":162.59,"gross_charge":200.72,"discounted_cash":59.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":162.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.15,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0966-00","type":"NDC"}],"standard_charges":[{"minimum":726.16,"maximum":980.32,"gross_charge":1210.26,"discounted_cash":358.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":786.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.16,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0966-00","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":980.32,"gross_charge":1210.26,"discounted_cash":358.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":774.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":544.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":847.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.06,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0619-10","type":"NDC"}],"standard_charges":[{"minimum":126.5,"maximum":170.78,"gross_charge":210.83,"discounted_cash":62.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":147.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.5,"methodology":"fee schedule"}]}]},{"description":"ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0619-10","type":"NDC"}],"standard_charges":[{"minimum":9.45,"maximum":170.78,"gross_charge":210.83,"discounted_cash":62.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":170.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":170.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":170.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":134.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9.45,"standard_charge_algorithm": "Lesser of $9.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":147.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":126.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.17,"methodology":"fee schedule"}]}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0163-00","type":"NDC"}],"standard_charges":[{"minimum":163.61,"maximum":220.87,"gross_charge":272.67,"discounted_cash":80.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":177.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":190.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.61,"methodology":"fee schedule"}]}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0163-00","type":"NDC"}],"standard_charges":[{"minimum":40.91,"maximum":220.87,"gross_charge":272.67,"discounted_cash":80.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":220.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":174.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":136.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":136.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":122.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":190.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":163.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.54,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-AAZG 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0592-10","type":"NDC"}],"standard_charges":[{"minimum":4088.91,"maximum":5520.03,"gross_charge":6814.85,"discounted_cash":2017.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5520.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5520.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5520.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4429.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4770.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4088.91,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-AAZG 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0592-10","type":"NDC"}],"standard_charges":[{"minimum":1022.23,"maximum":5520.03,"gross_charge":6814.85,"discounted_cash":2017.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5520.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5520.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5520.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4361.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3407.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3407.43,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3066.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4770.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4088.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1294.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1022.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1362.97,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-AAZG 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0590-04","type":"NDC"}],"standard_charges":[{"minimum":1762.44,"maximum":2379.3,"gross_charge":2937.4,"discounted_cash":869.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2379.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2379.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2379.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1909.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2056.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1762.44,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-AAZG 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J3590","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0590-04","type":"NDC"}],"standard_charges":[{"minimum":440.61,"maximum":2379.3,"gross_charge":2937.4,"discounted_cash":869.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2379.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2379.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2379.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1879.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1468.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1468.7,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1321.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2056.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1762.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":440.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":587.48,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.04,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.04,"standard_charge_algorithm": "Lesser of $3.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.04,"standard_charge_algorithm": "Lesser of $3.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS","code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS","code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.04,"standard_charge_algorithm": "Lesser of $3.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.04,"standard_charge_algorithm": "Lesser of $3.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.04,"standard_charge_algorithm": "Lesser of $3.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.04,"standard_charge_algorithm": "Lesser of $3.04 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":16.84,"maximum":16.84,"gross_charge":20.78,"discounted_cash":6.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.84,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":16.84,"gross_charge":20.78,"discounted_cash":6.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.16,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.17,"maximum":4.27,"gross_charge":5.27,"discounted_cash":1.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.8,"maximum":4.27,"gross_charge":5.27,"discounted_cash":1.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.26,"maximum":5.76,"gross_charge":7.1,"discounted_cash":2.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":5.76,"gross_charge":7.1,"discounted_cash":2.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.43,"maximum":5.97,"gross_charge":7.37,"discounted_cash":2.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.11,"maximum":5.97,"gross_charge":7.37,"discounted_cash":2.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.21,"maximum":7.04,"gross_charge":8.68,"discounted_cash":2.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.31,"maximum":7.04,"gross_charge":8.68,"discounted_cash":2.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.74,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.37,"maximum":7.25,"gross_charge":8.94,"discounted_cash":2.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.35,"maximum":7.25,"gross_charge":8.94,"discounted_cash":2.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.79,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.78,"maximum":9.16,"gross_charge":11.3,"discounted_cash":3.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":9.16,"gross_charge":11.3,"discounted_cash":3.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.17,"maximum":9.68,"gross_charge":11.94,"discounted_cash":3.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":9.68,"gross_charge":11.94,"discounted_cash":3.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.32,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.83,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.11,"maximum":5.55,"gross_charge":6.84,"discounted_cash":2.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.03,"maximum":5.55,"gross_charge":6.84,"discounted_cash":2.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.19,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.67,"maximum":11.71,"gross_charge":14.45,"discounted_cash":4.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.53,"maximum":11.71,"gross_charge":14.45,"discounted_cash":4.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.53,"standard_charge_algorithm": "Lesser of $1.53 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.89,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"J7042","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"J7042","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"J7042","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"J7042","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.07,"standard_charge_algorithm": "Lesser of $1.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.95,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IV NON-DEHP","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IVPB ADD-VANTAGE","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.19,"maximum":5.66,"gross_charge":6.98,"discounted_cash":2.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IVPB ADD-VANTAGE","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":5.66,"gross_charge":6.98,"discounted_cash":2.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IVPB ADD-VANTAGE","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.72,"maximum":9.08,"gross_charge":11.2,"discounted_cash":3.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 0.9 % IVPB ADD-VANTAGE","code_information":[{"code":"J7050","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.76,"maximum":9.08,"gross_charge":11.2,"discounted_cash":3.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.76,"standard_charge_algorithm": "Lesser of $0.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.57,"maximum":48.01,"gross_charge":59.27,"discounted_cash":17.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":48.01,"gross_charge":59.27,"discounted_cash":17.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.94,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":48.52,"gross_charge":59.9,"discounted_cash":17.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":36.58,"maximum":49.38,"gross_charge":60.96,"discounted_cash":18.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":49.38,"gross_charge":60.96,"discounted_cash":18.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":39.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.2,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37.84,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":51.08,"gross_charge":63.06,"discounted_cash":18.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.63,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":56.2,"gross_charge":69.38,"discounted_cash":20.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":56.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.89,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":57.9,"gross_charge":71.48,"discounted_cash":21.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":45.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.3,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.91,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER FLUSH","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":60.63,"gross_charge":74.85,"discounted_cash":22.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.97,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.95,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.99,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.19,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.12,"maximum":20.42,"gross_charge":25.2,"discounted_cash":7.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.12,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IV BOLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":20.42,"gross_charge":25.2,"discounted_cash":7.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV MINIBAG PLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6,"maximum":8.1,"gross_charge":9.99,"discounted_cash":2.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV MINIBAG PLUS","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.5,"maximum":8.1,"gross_charge":9.99,"discounted_cash":2.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV NON-DEHP","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.48,"maximum":4.69,"gross_charge":5.79,"discounted_cash":1.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV NON-DEHP","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.87,"maximum":4.69,"gross_charge":5.79,"discounted_cash":1.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV NON-DEHP","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.26,"maximum":9.8,"gross_charge":12.09,"discounted_cash":3.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV NON-DEHP","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.82,"maximum":9.8,"gross_charge":12.09,"discounted_cash":3.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV NON-DEHP","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV NON-DEHP","code_information":[{"code":"J7060","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.14,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.14,"standard_charge_algorithm": "Lesser of $2.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.32,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.83,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.48,"maximum":4.69,"gross_charge":5.79,"discounted_cash":1.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.87,"maximum":4.69,"gross_charge":5.79,"discounted_cash":1.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.16,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.95,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.99,"maximum":5.33,"gross_charge":6.58,"discounted_cash":1.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.26,"maximum":5.76,"gross_charge":7.1,"discounted_cash":2.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.07,"maximum":5.76,"gross_charge":7.1,"discounted_cash":2.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.42,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.19,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.1,"maximum":9.58,"gross_charge":11.82,"discounted_cash":3.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.78,"maximum":9.58,"gross_charge":11.82,"discounted_cash":3.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.03,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.76,"maximum":14.89,"gross_charge":18.38,"discounted_cash":5.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.68,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.6,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.15,"maximum":17.01,"gross_charge":21,"discounted_cash":6.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.12,"maximum":20.42,"gross_charge":25.2,"discounted_cash":7.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.12,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.78,"maximum":20.42,"gross_charge":25.2,"discounted_cash":7.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.04,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.75,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION","code_information":[{"code":"J7070","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.94,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.27,"standard_charge_algorithm": "Lesser of $4.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"}]}]},{"description":"DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"J7100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":84.96,"maximum":114.7,"gross_charge":141.6,"discounted_cash":41.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":92.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.96,"methodology":"fee schedule"}]}]},{"description":"DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION","code_information":[{"code":"J7100","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.08,"maximum":114.7,"gross_charge":141.6,"discounted_cash":41.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.08,"standard_charge_algorithm": "Lesser of $20.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.08,"standard_charge_algorithm": "Lesser of $20.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.32,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION","code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION","code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.19,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION","code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS INTRAVENOUS SOLUTION","code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS IV BOLUS","code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"LACTATED RINGERS IV BOLUS","code_information":[{"code":"J7120","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.83,"standard_charge_algorithm": "Lesser of $2.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND LACTATED RINGERS IV BOLUS","code_information":[{"code":"J7121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.31,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND LACTATED RINGERS IV BOLUS","code_information":[{"code":"J7121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.58,"maximum":8.52,"gross_charge":10.51,"discounted_cash":3.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.76,"standard_charge_algorithm": "Lesser of $6.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.76,"standard_charge_algorithm": "Lesser of $6.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND LACTATED RINGERS IV BOLUS","code_information":[{"code":"J7121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.46,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"}]}]},{"description":"DEXTROSE 5 % AND LACTATED RINGERS IV BOLUS","code_information":[{"code":"J7121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.37,"maximum":12.77,"gross_charge":15.76,"discounted_cash":4.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6.76,"standard_charge_algorithm": "Lesser of $6.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.76,"standard_charge_algorithm": "Lesser of $6.76 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0530-21","type":"NDC"}],"standard_charges":[{"minimum":7.88,"maximum":10.64,"gross_charge":13.13,"discounted_cash":3.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0530-21","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":10.64,"gross_charge":13.13,"discounted_cash":3.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.09,"standard_charge_algorithm": "Lesser of $0.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.09,"standard_charge_algorithm": "Lesser of $0.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION SOLUTION","code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":21.26,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"}]}]},{"description":"SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION SOLUTION","code_information":[{"code":"J7131","type":"HCPCS"},{"code":"0258","type":"RC"}],"standard_charges":[{"minimum":0.09,"maximum":21.26,"gross_charge":26.24,"discounted_cash":7.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.09,"standard_charge_algorithm": "Lesser of $0.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.09,"standard_charge_algorithm": "Lesser of $0.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"}]}]},{"description":"HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"minimum":206.84,"maximum":279.24,"gross_charge":344.73,"discounted_cash":102.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":279.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":279.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":224.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":241.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.84,"methodology":"fee schedule"}]}]},{"description":"HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"minimum":51.71,"maximum":279.24,"gross_charge":344.73,"discounted_cash":102.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":279.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":279.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":279.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":220.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":172.37,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":155.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":241.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.95,"methodology":"fee schedule"}]}]},{"description":"HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0396-01","type":"NDC"}],"standard_charges":[{"minimum":206.15,"maximum":278.3,"gross_charge":343.58,"discounted_cash":101.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":278.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":278.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":223.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":240.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.15,"methodology":"fee schedule"}]}]},{"description":"HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0396-01","type":"NDC"}],"standard_charges":[{"minimum":51.54,"maximum":278.3,"gross_charge":343.58,"discounted_cash":101.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":278.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":278.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":278.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":219.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":171.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":171.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":154.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":240.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":206.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.72,"methodology":"fee schedule"}]}]},{"description":"HUMAN PROTHROMBIN COMPLEX4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"minimum":219.33,"maximum":296.09,"gross_charge":365.54,"discounted_cash":108.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":237.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":255.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.33,"methodology":"fee schedule"}]}]},{"description":"HUMAN PROTHROMBIN COMPLEX4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"minimum":54.84,"maximum":296.09,"gross_charge":365.54,"discounted_cash":108.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":296.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":296.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":296.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":233.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":182.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":182.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":164.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":255.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":219.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.11,"methodology":"fee schedule"}]}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7186","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-4604-02","type":"NDC"}],"standard_charges":[{"minimum":1.19,"maximum":289.94,"gross_charge":357.94,"discounted_cash":105.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":232.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":2.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.26,"methodology":"fee schedule"}]}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1500 (600 VWF) UNIT/10 ML INTRAVENOUS SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7186","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-4604-02","type":"NDC"}],"standard_charges":[{"minimum":1.07,"maximum":289.94,"gross_charge":357.94,"discounted_cash":105.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":229.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.2,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.83,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.29,"standard_charge_algorithm": "Lesser of $1.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.29,"standard_charge_algorithm": "Lesser of $1.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":161.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.1,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.13,"methodology":"case rate"}]}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0625-01","type":"NDC"}],"standard_charges":[{"minimum":1.44,"maximum":291.14,"gross_charge":359.42,"discounted_cash":106.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":233.63,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":251.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.53,"methodology":"fee schedule"}]}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0625-01","type":"NDC"}],"standard_charges":[{"minimum":1.29,"maximum":291.14,"gross_charge":359.42,"discounted_cash":106.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":230.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.46,"standard_charge_algorithm": "Lesser of $1.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.46,"standard_charge_algorithm": "Lesser of $1.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":161.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":251.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":215.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.37,"methodology":"case rate"}]}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1200 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0616-02","type":"NDC"}],"standard_charges":[{"minimum":1.44,"maximum":291.78,"gross_charge":360.21,"discounted_cash":106.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":234.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":252.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.53,"methodology":"fee schedule"}]}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1200 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63833-0616-02","type":"NDC"}],"standard_charges":[{"minimum":1.29,"maximum":291.78,"gross_charge":360.21,"discounted_cash":106.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":291.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":291.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":291.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":230.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.21,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.46,"standard_charge_algorithm": "Lesser of $1.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.46,"standard_charge_algorithm": "Lesser of $1.46 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":162.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":252.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.37,"methodology":"case rate"}]}]},{"description":"COAGULATION FACTOR VIIA RECOMB 1 MG (1000 MCG) INTRAVENOUS SOLUTION","code_information":[{"code":"J7189","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.52,"maximum":13106.42,"gross_charge":16180.76,"discounted_cash":4789.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13106.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13106.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13106.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10517.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11326.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9708.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.67,"methodology":"fee schedule"}]}]},{"description":"COAGULATION FACTOR VIIA RECOMB 1 MG (1000 MCG) INTRAVENOUS SOLUTION","code_information":[{"code":"J7189","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.26,"maximum":13106.42,"gross_charge":16180.76,"discounted_cash":4789.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13106.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13106.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13106.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10355.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.86,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.66,"standard_charge_algorithm": "Lesser of $2.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.66,"standard_charge_algorithm": "Lesser of $2.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7281.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11326.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9708.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3074.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3236.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2427.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3236.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.42,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.4,"methodology":"case rate"}]}]},{"description":"COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7195","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58394-0633-03","type":"NDC"}],"standard_charges":[{"minimum":1.84,"maximum":292.04,"gross_charge":360.54,"discounted_cash":106.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":292.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":234.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":252.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.95,"methodology":"fee schedule"}]}]},{"description":"COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7195","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"58394-0633-03","type":"NDC"}],"standard_charges":[{"minimum":1.65,"maximum":292.04,"gross_charge":360.54,"discounted_cash":106.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":292.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":292.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":292.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":230.75,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.75,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.84,"standard_charge_algorithm": "Lesser of $1.84 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":162.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":252.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":216.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":72.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.65,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.75,"methodology":"case rate"}]}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0602-50","type":"NDC"}],"standard_charges":[{"minimum":225.61,"maximum":304.57,"gross_charge":376.01,"discounted_cash":111.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":244.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.61,"methodology":"fee schedule"}]}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0602-50","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":304.57,"gross_charge":376.01,"discounted_cash":111.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":240.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.96,"standard_charge_algorithm": "Lesser of $3.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.96,"standard_charge_algorithm": "Lesser of $3.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":169.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":263.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.74,"methodology":"case rate"}]}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0603-20","type":"NDC"}],"standard_charges":[{"minimum":225.38,"maximum":304.27,"gross_charge":375.63,"discounted_cash":111.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":244.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":262.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.38,"methodology":"fee schedule"}]}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0603-20","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":304.27,"gross_charge":375.63,"discounted_cash":111.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":304.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":304.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":304.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":240.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.96,"standard_charge_algorithm": "Lesser of $3.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.96,"standard_charge_algorithm": "Lesser of $3.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":262.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":225.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.74,"methodology":"case rate"}]}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0605-21","type":"NDC"}],"standard_charges":[{"minimum":226.71,"maximum":306.06,"gross_charge":377.85,"discounted_cash":111.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":245.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":264.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.71,"methodology":"fee schedule"}]}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"13533-0605-21","type":"NDC"}],"standard_charges":[{"minimum":3.53,"maximum":306.06,"gross_charge":377.85,"discounted_cash":111.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":241.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":3.96,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3.87,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.96,"standard_charge_algorithm": "Lesser of $3.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.96,"standard_charge_algorithm": "Lesser of $3.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":170.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":264.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":226.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":56.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.53,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.74,"methodology":"case rate"}]}]},{"description":"ANTI-INHIBITOR COAGULANT COMPLEX 651 UNIT-1200 UNIT INTRAVENOUS SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7198","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64193-0424-02","type":"NDC"}],"standard_charges":[{"minimum":2.39,"maximum":281.4,"gross_charge":347.4,"discounted_cash":102.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":225.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.53,"methodology":"fee schedule"}]}]},{"description":"ANTI-INHIBITOR COAGULANT COMPLEX 651 UNIT-1200 UNIT INTRAVENOUS SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7198","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64193-0424-02","type":"NDC"}],"standard_charges":[{"minimum":2.14,"maximum":281.4,"gross_charge":347.4,"discounted_cash":102.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":281.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":222.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.49,"standard_charge_algorithm": "Lesser of $2.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.49,"standard_charge_algorithm": "Lesser of $2.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":156.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":243.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":208.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.27,"methodology":"case rate"}]}]},{"description":"ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1300 UNIT INTRAVENOUS SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7198","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64193-0424-02","type":"NDC"}],"standard_charges":[{"minimum":2.39,"maximum":297.03,"gross_charge":366.7,"discounted_cash":108.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":297.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":297.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":238.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"HSTechnology","plan_name":"Commercial|All Plans","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":256.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.53,"methodology":"fee schedule"}]}]},{"description":"ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1300 UNIT INTRAVENOUS SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7198","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64193-0424-02","type":"NDC"}],"standard_charges":[{"minimum":2.14,"maximum":297.03,"gross_charge":366.7,"discounted_cash":108.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":297.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":297.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":234.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2.27,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":3.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.49,"standard_charge_algorithm": "Lesser of $2.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.49,"standard_charge_algorithm": "Lesser of $2.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":165.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":256.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2.27,"methodology":"case rate"}]}]},{"description":"CYCLOSPORINE 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0134-00","type":"NDC"}],"standard_charges":[{"minimum":204.37,"maximum":275.9,"gross_charge":340.61,"discounted_cash":100.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":275.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":221.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":238.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.37,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0134-00","type":"NDC"}],"standard_charges":[{"minimum":2.06,"maximum":275.9,"gross_charge":340.61,"discounted_cash":100.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":275.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":275.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":218,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":153.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":238.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.13,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.53,"maximum":12.87,"gross_charge":15.88,"discounted_cash":4.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":12.87,"gross_charge":15.88,"discounted_cash":4.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":283.55,"maximum":382.79,"gross_charge":472.58,"discounted_cash":139.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":307.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":330.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":382.79,"gross_charge":472.58,"discounted_cash":139.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":302.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":212.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":330.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.52,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":458.88,"maximum":619.48,"gross_charge":764.79,"discounted_cash":226.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":619.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":619.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":619.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":497.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":535.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.88,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":619.48,"gross_charge":764.79,"discounted_cash":226.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":619.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":619.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":619.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":489.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":344.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":535.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":458.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.96,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0839-30","type":"NDC"}],"standard_charges":[{"minimum":1.37,"maximum":1.84,"gross_charge":2.27,"discounted_cash":0.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"23155-0839-30","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":2.06,"gross_charge":2.27,"discounted_cash":0.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.46,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0460-01","type":"NDC"}],"standard_charges":[{"minimum":1.27,"maximum":1.71,"gross_charge":2.11,"discounted_cash":0.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0460-01","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":2.06,"gross_charge":2.11,"discounted_cash":0.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0460-47","type":"NDC"}],"standard_charges":[{"minimum":35.66,"maximum":48.14,"gross_charge":59.42,"discounted_cash":17.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0460-47","type":"NDC"}],"standard_charges":[{"minimum":2.06,"maximum":48.14,"gross_charge":59.42,"discounted_cash":17.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.89,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-4632-03","type":"NDC"}],"standard_charges":[{"minimum":79.25,"maximum":106.98,"gross_charge":132.07,"discounted_cash":39.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":85.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-4632-03","type":"NDC"}],"standard_charges":[{"minimum":2.06,"maximum":106.98,"gross_charge":132.07,"discounted_cash":39.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":106.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":106.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":106.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.78,"maximum":1.05,"gross_charge":1.29,"discounted_cash":0.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.2,"maximum":1.29,"gross_charge":1.29,"discounted_cash":0.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.29,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.29,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.06,"maximum":1.43,"gross_charge":1.76,"discounted_cash":0.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.27,"maximum":1.76,"gross_charge":1.76,"discounted_cash":0.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.76,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.76,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.96,"maximum":8.04,"gross_charge":9.92,"discounted_cash":2.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.49,"maximum":8.04,"gross_charge":9.92,"discounted_cash":2.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.99,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20.99,"maximum":28.33,"gross_charge":34.97,"discounted_cash":10.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.99,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":28.33,"gross_charge":34.97,"discounted_cash":10.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":29.48,"maximum":39.8,"gross_charge":49.13,"discounted_cash":14.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.48,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 100 MG CAPSULE","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":39.8,"gross_charge":49.13,"discounted_cash":14.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":34.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.83,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.74,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.19,"maximum":6.4,"gross_charge":7.89,"discounted_cash":2.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.19,"maximum":83.96,"gross_charge":103.65,"discounted_cash":30.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.19,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":83.96,"gross_charge":103.65,"discounted_cash":30.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.73,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":320.31,"maximum":432.42,"gross_charge":533.84,"discounted_cash":158.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":432.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":432.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":432.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":347,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":373.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":320.31,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION","code_information":[{"code":"J7502","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.06,"maximum":432.42,"gross_charge":533.84,"discounted_cash":158.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":432.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":432.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":432.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":341.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.06,"standard_charge_algorithm": "Lesser of $2.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":240.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":373.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":320.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.77,"methodology":"fee schedule"}]}]},{"description":"ANTITHYMOCYTE GLOBULIN-ATG SKIN TEST 1:1000 IN NS 0.1 ML","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7504","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77888-8005-53","type":"NDC"}],"standard_charges":[{"minimum":43.4,"maximum":58.58,"gross_charge":72.32,"discounted_cash":21.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"}]}]},{"description":"ANTITHYMOCYTE GLOBULIN-ATG SKIN TEST 1:1000 IN NS 0.1 ML","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7504","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77888-8005-53","type":"NDC"}],"standard_charges":[{"minimum":10.85,"maximum":6690.51,"gross_charge":72.32,"discounted_cash":21.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4355.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4355.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3591.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4057.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3659.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6690.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":72.32,"standard_charge_algorithm": "Lesser of $3143.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":72.32,"standard_charge_algorithm": "Lesser of $3143.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4186.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4029.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4108.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4303.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4147.33,"methodology":"case rate"}]}]},{"description":"LYMPHOCYTEANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7504","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9368.99,"maximum":12648.14,"gross_charge":15614.98,"discounted_cash":4622.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12648.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12648.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12648.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10149.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10930.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9368.99,"methodology":"fee schedule"}]}]},{"description":"LYMPHOCYTEANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7504","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2342.25,"maximum":12648.14,"gross_charge":15614.98,"discounted_cash":4622.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12648.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12648.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12648.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9993.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4355.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4355.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":3591.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4057.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3659.22,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6690.51,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3143.85,"standard_charge_algorithm": "Lesser of $3143.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3143.85,"standard_charge_algorithm": "Lesser of $3143.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7026.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10930.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9368.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2966.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3123,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2342.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3123,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3912.58,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4186.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4029.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4108.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4303.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4147.33,"methodology":"case rate"}]}]},{"description":"TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0041-01","type":"NDC"}],"standard_charges":[{"minimum":7.1,"maximum":9.59,"gross_charge":11.83,"discounted_cash":3.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0041-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":9.59,"gross_charge":11.83,"discounted_cash":3.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64380-0720-06","type":"NDC"}],"standard_charges":[{"minimum":12.56,"maximum":16.96,"gross_charge":20.93,"discounted_cash":6.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64380-0720-06","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":16.96,"gross_charge":20.93,"discounted_cash":6.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.19,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0685-01","type":"NDC"}],"standard_charges":[{"minimum":7.82,"maximum":10.56,"gross_charge":13.03,"discounted_cash":3.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0685-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":10.56,"gross_charge":13.03,"discounted_cash":3.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.61,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0099-01","type":"NDC"}],"standard_charges":[{"minimum":15.93,"maximum":21.5,"gross_charge":26.54,"discounted_cash":7.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.93,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0099-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":21.5,"gross_charge":26.54,"discounted_cash":7.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.31,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0042-01","type":"NDC"}],"standard_charges":[{"minimum":11.66,"maximum":15.74,"gross_charge":19.43,"discounted_cash":5.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0042-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":15.74,"gross_charge":19.43,"discounted_cash":5.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0526-01","type":"NDC"}],"standard_charges":[{"minimum":43.47,"maximum":58.69,"gross_charge":72.45,"discounted_cash":21.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.47,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55111-0526-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":58.69,"gross_charge":72.45,"discounted_cash":21.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.49,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0450-11","type":"NDC"}],"standard_charges":[{"minimum":72.1,"maximum":97.33,"gross_charge":120.16,"discounted_cash":35.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":78.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.1,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0450-11","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":97.33,"gross_charge":120.16,"discounted_cash":35.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":76.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":54.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":84.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.04,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0761-01","type":"NDC"}],"standard_charges":[{"minimum":25.11,"maximum":33.9,"gross_charge":41.84,"discounted_cash":12.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72572-0761-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":33.9,"gross_charge":41.84,"discounted_cash":12.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":51.51,"maximum":69.54,"gross_charge":85.85,"discounted_cash":25.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.51,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 1 MG CAPSULE IMMEDIATE-RELEASE","code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.35,"maximum":69.54,"gross_charge":85.85,"discounted_cash":25.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":60.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.17,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0100-01","type":"NDC"}],"standard_charges":[{"minimum":50.19,"maximum":67.76,"gross_charge":83.65,"discounted_cash":24.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0100-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":67.76,"gross_charge":83.65,"discounted_cash":24.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0043-01","type":"NDC"}],"standard_charges":[{"minimum":56.01,"maximum":75.62,"gross_charge":93.35,"discounted_cash":27.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.01,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG CAPSULE IMMEDIATE-RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0043-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":75.62,"gross_charge":93.35,"discounted_cash":27.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":42.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.67,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG CAPSULE IMMEDIATE-RELEASE","code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":281.18,"maximum":379.6,"gross_charge":468.63,"discounted_cash":138.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":304.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":328.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.18,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG CAPSULE IMMEDIATE-RELEASE","code_information":[{"code":"J7507","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.35,"maximum":379.6,"gross_charge":468.63,"discounted_cash":138.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":299.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.35,"standard_charge_algorithm": "Lesser of $0.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":210.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":328.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.73,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 16 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0003-14","type":"NDC"}],"standard_charges":[{"minimum":58.95,"maximum":79.59,"gross_charge":98.25,"discounted_cash":29.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.95,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 16 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0003-14","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":79.59,"gross_charge":98.25,"discounted_cash":29.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":58.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.65,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 16 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0918-18","type":"NDC"}],"standard_charges":[{"minimum":67.77,"maximum":91.49,"gross_charge":112.95,"discounted_cash":33.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.77,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 16 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0918-18","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":91.49,"gross_charge":112.95,"discounted_cash":33.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":79.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.59,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42806-0400-01","type":"NDC"}],"standard_charges":[{"minimum":13.28,"maximum":17.93,"gross_charge":22.13,"discounted_cash":6.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42806-0400-01","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":17.93,"gross_charge":22.13,"discounted_cash":6.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.43,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0001-06","type":"NDC"}],"standard_charges":[{"minimum":19.35,"maximum":26.12,"gross_charge":32.24,"discounted_cash":9.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0001-06","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":26.12,"gross_charge":32.24,"discounted_cash":9.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0916-01","type":"NDC"}],"standard_charges":[{"minimum":23.85,"maximum":32.19,"gross_charge":39.74,"discounted_cash":11.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0916-01","type":"NDC"}],"standard_charges":[{"minimum":0.32,"maximum":32.19,"gross_charge":39.74,"discounted_cash":11.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.95,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16.83,"maximum":22.72,"gross_charge":28.04,"discounted_cash":8.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":22.72,"gross_charge":28.04,"discounted_cash":8.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":17.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.61,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":62.85,"maximum":84.85,"gross_charge":104.75,"discounted_cash":31.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.85,"methodology":"fee schedule"}]}]},{"description":"METHYLPREDNISOLONE 4 MG TABLET","code_information":[{"code":"J7509","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":84.85,"gross_charge":104.75,"discounted_cash":31.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50383-0042-24","type":"NDC"}],"standard_charges":[{"minimum":4.55,"maximum":6.14,"gross_charge":7.57,"discounted_cash":2.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50383-0042-24","type":"NDC"}],"standard_charges":[{"minimum":0.25,"maximum":6.14,"gross_charge":7.57,"discounted_cash":2.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69238-2122-05","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69238-2122-05","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.18,"maximum":0.25,"gross_charge":0.3,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.05,"maximum":0.25,"gross_charge":0.3,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.49,"maximum":0.66,"gross_charge":0.81,"discounted_cash":0.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"PREDNISOLONE 15 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7510","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.13,"maximum":0.66,"gross_charge":0.81,"discounted_cash":0.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $0.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59651-0484-01","type":"NDC"}],"standard_charges":[{"minimum":3.26,"maximum":4.4,"gross_charge":5.43,"discounted_cash":1.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59651-0484-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":4.4,"gross_charge":5.43,"discounted_cash":1.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.09,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0171-06","type":"NDC"}],"standard_charges":[{"minimum":7.7,"maximum":10.4,"gross_charge":12.83,"discounted_cash":3.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0171-06","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":10.4,"gross_charge":12.83,"discounted_cash":3.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.57,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.16,"maximum":13.72,"gross_charge":16.93,"discounted_cash":5.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":13.72,"gross_charge":16.93,"discounted_cash":5.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.39,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":11.18,"maximum":15.1,"gross_charge":18.63,"discounted_cash":5.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 1 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":15.1,"gross_charge":18.63,"discounted_cash":5.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.73,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0134-01","type":"NDC"}],"standard_charges":[{"minimum":7.22,"maximum":9.75,"gross_charge":12.03,"discounted_cash":3.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0134-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":9.75,"gross_charge":12.03,"discounted_cash":3.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.41,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0134-11","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0134-11","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70954-0059-10","type":"NDC"}],"standard_charges":[{"minimum":4.88,"maximum":6.59,"gross_charge":8.13,"discounted_cash":2.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70954-0059-10","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":6.59,"gross_charge":8.13,"discounted_cash":2.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.63,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.04,"maximum":9.51,"gross_charge":11.73,"discounted_cash":3.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":9.51,"gross_charge":11.73,"discounted_cash":3.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.14,"maximum":12.34,"gross_charge":15.23,"discounted_cash":4.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 10 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":12.34,"gross_charge":15.23,"discounted_cash":4.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59651-0488-01","type":"NDC"}],"standard_charges":[{"minimum":8.6,"maximum":11.61,"gross_charge":14.33,"discounted_cash":4.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59651-0488-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":11.61,"gross_charge":14.33,"discounted_cash":4.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.87,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0175-06","type":"NDC"}],"standard_charges":[{"minimum":11.3,"maximum":15.26,"gross_charge":18.83,"discounted_cash":5.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0175-06","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":15.26,"gross_charge":18.83,"discounted_cash":5.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.77,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0145-11","type":"NDC"}],"standard_charges":[{"minimum":0.2,"maximum":0.27,"gross_charge":0.33,"discounted_cash":0.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0145-11","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":0.27,"gross_charge":0.33,"discounted_cash":0.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.64,"maximum":10.32,"gross_charge":12.73,"discounted_cash":3.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":10.32,"gross_charge":12.73,"discounted_cash":3.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.98,"maximum":13.48,"gross_charge":16.63,"discounted_cash":4.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 20 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":13.48,"gross_charge":16.63,"discounted_cash":4.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.33,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0122-01","type":"NDC"}],"standard_charges":[{"minimum":9.92,"maximum":13.39,"gross_charge":16.53,"discounted_cash":4.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0122-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":13.39,"gross_charge":16.53,"discounted_cash":4.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.31,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0122-11","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.24,"gross_charge":0.29,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0122-11","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":0.24,"gross_charge":0.29,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.48,"maximum":11.45,"gross_charge":14.13,"discounted_cash":4.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":11.45,"gross_charge":14.13,"discounted_cash":4.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.83,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.67,"maximum":0.9,"gross_charge":1.11,"discounted_cash":0.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":0.9,"gross_charge":1.11,"discounted_cash":0.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30.4,"maximum":41.04,"gross_charge":50.66,"discounted_cash":15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 5 MG/5 ML ORAL SOLUTION","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":41.04,"gross_charge":50.66,"discounted_cash":15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.14,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59651-0489-01","type":"NDC"}],"standard_charges":[{"minimum":12.02,"maximum":16.23,"gross_charge":20.03,"discounted_cash":5.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 50 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59651-0489-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":16.23,"gross_charge":20.03,"discounted_cash":5.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.01,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 50 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17.49,"maximum":23.61,"gross_charge":29.14,"discounted_cash":8.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"}]}]},{"description":"PREDNISONE 50 MG TABLET","code_information":[{"code":"J7512","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":23.61,"gross_charge":29.14,"discounted_cash":8.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.83,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0133-00","type":"NDC"}],"standard_charges":[{"minimum":51.12,"maximum":69.02,"gross_charge":85.2,"discounted_cash":25.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-0133-00","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":69.02,"gross_charge":85.2,"discounted_cash":25.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":69.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":51.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.04,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0458-01","type":"NDC"}],"standard_charges":[{"minimum":0.54,"maximum":0.73,"gross_charge":0.89,"discounted_cash":0.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0458-01","type":"NDC"}],"standard_charges":[{"minimum":0.14,"maximum":0.75,"gross_charge":0.89,"discounted_cash":0.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0458-47","type":"NDC"}],"standard_charges":[{"minimum":13.73,"maximum":18.53,"gross_charge":22.87,"discounted_cash":6.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51862-0458-47","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":18.53,"gross_charge":22.87,"discounted_cash":6.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.58,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-4630-03","type":"NDC"}],"standard_charges":[{"minimum":18.2,"maximum":24.56,"gross_charge":30.32,"discounted_cash":8.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-4630-03","type":"NDC"}],"standard_charges":[{"minimum":0.75,"maximum":24.56,"gross_charge":30.32,"discounted_cash":8.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":0.39,"gross_charge":0.48,"discounted_cash":0.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.08,"maximum":0.48,"gross_charge":0.48,"discounted_cash":0.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.48,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.48,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.41,"maximum":0.55,"gross_charge":0.67,"discounted_cash":0.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.11,"maximum":0.67,"gross_charge":0.67,"discounted_cash":0.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.67,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.67,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.4,"maximum":8.64,"gross_charge":10.66,"discounted_cash":3.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.75,"maximum":8.64,"gross_charge":10.66,"discounted_cash":3.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.14,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.8,"maximum":13.23,"gross_charge":16.33,"discounted_cash":4.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE MODIFIED (NEORAL) 25 MG CAPSULE","code_information":[{"code":"J7515","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.75,"maximum":13.23,"gross_charge":16.33,"discounted_cash":4.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.75,"standard_charge_algorithm": "Lesser of $0.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.27,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7516","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":106.42,"maximum":143.67,"gross_charge":177.36,"discounted_cash":52.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":124.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":106.42,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7516","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":26.61,"maximum":143.67,"gross_charge":177.36,"discounted_cash":52.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":113.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.15,"standard_charge_algorithm": "Lesser of $70.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.15,"standard_charge_algorithm": "Lesser of $70.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":79.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":124.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":106.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.48,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7516","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":107.86,"maximum":145.61,"gross_charge":179.76,"discounted_cash":53.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.86,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7516","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":26.97,"maximum":145.61,"gross_charge":179.76,"discounted_cash":53.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":145.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":145.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":145.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.15,"standard_charge_algorithm": "Lesser of $70.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.15,"standard_charge_algorithm": "Lesser of $70.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":80.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":125.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":107.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.96,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7516","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":174.67,"maximum":235.8,"gross_charge":291.11,"discounted_cash":86.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":189.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":203.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.67,"methodology":"fee schedule"}]}]},{"description":"CYCLOSPORINE 250 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7516","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43.67,"maximum":235.8,"gross_charge":291.11,"discounted_cash":86.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":235.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":235.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":235.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":186.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":70.15,"standard_charge_algorithm": "Lesser of $70.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":70.15,"standard_charge_algorithm": "Lesser of $70.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":131,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":203.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":174.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.23,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0094-01","type":"NDC"}],"standard_charges":[{"minimum":8,"maximum":10.8,"gross_charge":13.33,"discounted_cash":3.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0094-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":10.8,"gross_charge":13.33,"discounted_cash":3.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0557-11","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":0.35,"gross_charge":0.42,"discounted_cash":0.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0557-11","type":"NDC"}],"standard_charges":[{"minimum":0.07,"maximum":0.35,"gross_charge":0.42,"discounted_cash":0.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0721-01","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0721-01","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0494-01","type":"NDC"}],"standard_charges":[{"minimum":26.31,"maximum":35.52,"gross_charge":43.84,"discounted_cash":12.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.31,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0494-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":35.52,"gross_charge":43.84,"discounted_cash":12.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70748-0186-01","type":"NDC"}],"standard_charges":[{"minimum":21.93,"maximum":29.6,"gross_charge":36.54,"discounted_cash":10.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.93,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70748-0186-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":29.6,"gross_charge":36.54,"discounted_cash":10.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":23.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.31,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":26.43,"maximum":35.68,"gross_charge":44.04,"discounted_cash":13.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG CAPSULE","code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":35.68,"gross_charge":44.04,"discounted_cash":13.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0019-01","type":"NDC"}],"standard_charges":[{"minimum":11.66,"maximum":15.74,"gross_charge":19.43,"discounted_cash":5.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0019-01","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":15.74,"gross_charge":19.43,"discounted_cash":5.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.89,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64380-0725-06","type":"NDC"}],"standard_charges":[{"minimum":20.97,"maximum":28.31,"gross_charge":34.94,"discounted_cash":10.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64380-0725-06","type":"NDC"}],"standard_charges":[{"minimum":0.26,"maximum":28.31,"gross_charge":34.94,"discounted_cash":10.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET","code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":60.51,"maximum":81.69,"gross_charge":100.85,"discounted_cash":29.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.51,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG TABLET","code_information":[{"code":"J7517","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":81.69,"gross_charge":100.85,"discounted_cash":29.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.17,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0508-01","type":"NDC"}],"standard_charges":[{"minimum":2.44,"maximum":3.29,"gross_charge":4.06,"discounted_cash":1.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0508-01","type":"NDC"}],"standard_charges":[{"minimum":0.61,"maximum":3.29,"gross_charge":4.06,"discounted_cash":1.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.82,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-2965-07","type":"NDC"}],"standard_charges":[{"minimum":20.54,"maximum":27.72,"gross_charge":34.22,"discounted_cash":10.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.54,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-2965-07","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":27.72,"gross_charge":34.22,"discounted_cash":10.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.85,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67877-0426-12","type":"NDC"}],"standard_charges":[{"minimum":13.26,"maximum":17.9,"gross_charge":22.09,"discounted_cash":6.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67877-0426-12","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":17.9,"gross_charge":22.09,"discounted_cash":6.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.42,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0907-11","type":"NDC"}],"standard_charges":[{"minimum":2.1,"maximum":2.84,"gross_charge":3.5,"discounted_cash":1.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0907-11","type":"NDC"}],"standard_charges":[{"minimum":0.53,"maximum":2.84,"gross_charge":3.5,"discounted_cash":1.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.7,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0907-21","type":"NDC"}],"standard_charges":[{"minimum":60.74,"maximum":81.99,"gross_charge":101.22,"discounted_cash":29.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.74,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0907-21","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":81.99,"gross_charge":101.22,"discounted_cash":29.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":81.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":81.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":81.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":64.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":70.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":60.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0172-23","type":"NDC"}],"standard_charges":[{"minimum":12.18,"maximum":16.44,"gross_charge":20.29,"discounted_cash":6.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"}]}]},{"description":"MYCOPHENOLATE SODIUM 180 MG TABLETDELAYED RELEASE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70436-0172-23","type":"NDC"}],"standard_charges":[{"minimum":1.21,"maximum":16.44,"gross_charge":20.29,"discounted_cash":6.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.21,"standard_charge_algorithm": "Lesser of $1.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.06,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG/ML ORAL SOLUTION","code_information":[{"code":"J7520","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4398.96,"maximum":5938.6,"gross_charge":7331.6,"discounted_cash":2170.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5938.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5938.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5938.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4765.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5132.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4398.96,"methodology":"fee schedule"}]}]},{"description":"SIROLIMUS 1 MG/ML ORAL SOLUTION","code_information":[{"code":"J7520","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.85,"maximum":5938.6,"gross_charge":7331.6,"discounted_cash":2170.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5938.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5938.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5938.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4692.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.85,"standard_charge_algorithm": "Lesser of $3.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3299.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5132.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4398.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1393.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1466.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1099.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1466.32,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7525","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":639.45,"maximum":863.25,"gross_charge":1065.74,"discounted_cash":315.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":863.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":863.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":863.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":692.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":746.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":639.45,"methodology":"fee schedule"}]}]},{"description":"TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J7525","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":159.87,"maximum":863.25,"gross_charge":1065.74,"discounted_cash":315.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":863.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":863.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":863.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":682.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":254.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":248.74,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":258.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":253.43,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":389.93,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":263.97,"standard_charge_algorithm": "Lesser of $263.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":263.97,"standard_charge_algorithm": "Lesser of $263.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":479.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":746.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":639.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":228.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":243.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":234.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":239.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":250.83,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":241.71,"methodology":"case rate"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0690-30","type":"NDC"}],"standard_charges":[{"minimum":3.35,"maximum":4.52,"gross_charge":5.58,"discounted_cash":1.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0690-30","type":"NDC"}],"standard_charges":[{"minimum":0.84,"maximum":5.58,"gross_charge":5.58,"discounted_cash":1.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.58,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.58,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.12,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0692-10","type":"NDC"}],"standard_charges":[{"minimum":3.5,"maximum":4.73,"gross_charge":5.83,"discounted_cash":1.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0692-10","type":"NDC"}],"standard_charges":[{"minimum":0.88,"maximum":5.83,"gross_charge":5.83,"discounted_cash":1.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.83,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.83,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0694-04","type":"NDC"}],"standard_charges":[{"minimum":2.35,"maximum":3.17,"gross_charge":3.91,"discounted_cash":1.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0694-04","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":3.91,"gross_charge":3.91,"discounted_cash":1.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.91,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.91,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.77,"maximum":9.13,"gross_charge":11.27,"discounted_cash":3.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"}]}]},{"description":"ACETYLCYSTEINE 20 % ORAL SOLUTION","code_information":[{"code":"J7608","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.7,"maximum":9.13,"gross_charge":11.27,"discounted_cash":3.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8.36,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8.36,"standard_charge_algorithm": "Lesser of $8.36 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"}]}]},{"description":"NINTEDANIB 150 MG CAPSULE","code_information":[{"code":"J8499","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":54891.18,"maximum":74103.09,"gross_charge":91485.29,"discounted_cash":27079.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74103.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59465.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64039.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54891.18,"methodology":"fee schedule"}]}]},{"description":"NINTEDANIB 150 MG CAPSULE","code_information":[{"code":"J8499","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13722.8,"maximum":74103.09,"gross_charge":91485.29,"discounted_cash":27079.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74103.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74103.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58550.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45742.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45742.65,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41168.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64039.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":54891.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17382.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18297.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13722.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18297.06,"methodology":"fee schedule"}]}]},{"description":"CAPECITABINE 500 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8522","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0510-05","type":"NDC"}],"standard_charges":[{"minimum":322.68,"maximum":435.62,"gross_charge":537.8,"discounted_cash":159.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":349.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":376.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":322.68,"methodology":"fee schedule"}]}]},{"description":"CAPECITABINE 500 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8522","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0510-05","type":"NDC"}],"standard_charges":[{"minimum":80.67,"maximum":435.62,"gross_charge":537.8,"discounted_cash":159.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":344.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":268.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":268.9,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":242.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":376.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":322.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.56,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 25 MG CAPSULE","code_information":[{"code":"J8530","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":302.79,"maximum":408.76,"gross_charge":504.64,"discounted_cash":149.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":328.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":353.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.79,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 25 MG CAPSULE","code_information":[{"code":"J8530","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.66,"maximum":408.76,"gross_charge":504.64,"discounted_cash":149.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":408.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":322.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.66,"standard_charge_algorithm": "Lesser of $0.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.66,"standard_charge_algorithm": "Lesser of $0.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":227.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":353.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":302.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.93,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 50 MG CAPSULE","code_information":[{"code":"J8530","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":543.5,"maximum":733.72,"gross_charge":905.82,"discounted_cash":268.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":733.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":733.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":733.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":588.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":634.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":543.5,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 50 MG CAPSULE","code_information":[{"code":"J8530","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.66,"maximum":733.72,"gross_charge":905.82,"discounted_cash":268.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":733.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":733.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":733.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":579.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.66,"standard_charge_algorithm": "Lesser of $0.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.66,"standard_charge_algorithm": "Lesser of $0.66 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":407.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":634.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":543.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.17,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 0.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0212-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 0.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0212-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 0.5 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.72,"maximum":7.72,"gross_charge":9.53,"discounted_cash":2.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 0.5 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":7.72,"gross_charge":9.53,"discounted_cash":2.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.91,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 0.5 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8.12,"maximum":10.96,"gross_charge":13.53,"discounted_cash":4.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 0.5 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":10.96,"gross_charge":13.53,"discounted_cash":4.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.71,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-2056-01","type":"NDC"}],"standard_charges":[{"minimum":20.97,"maximum":28.31,"gross_charge":34.94,"discounted_cash":10.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-2056-01","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":28.31,"gross_charge":34.94,"discounted_cash":10.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.99,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0188-01","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":0.39,"gross_charge":0.47,"discounted_cash":0.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0188-01","type":"NDC"}],"standard_charges":[{"minimum":0.08,"maximum":0.39,"gross_charge":0.47,"discounted_cash":0.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.81,"maximum":37.54,"gross_charge":46.34,"discounted_cash":13.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":37.54,"gross_charge":46.34,"discounted_cash":13.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.17,"maximum":46.13,"gross_charge":56.94,"discounted_cash":16.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.17,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 2 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":46.13,"gross_charge":56.94,"discounted_cash":16.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.39,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"48102-0047-11","type":"NDC"}],"standard_charges":[{"minimum":0.63,"maximum":0.86,"gross_charge":1.05,"discounted_cash":0.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"48102-0047-11","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.86,"gross_charge":1.05,"discounted_cash":0.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"48102-0047-20","type":"NDC"}],"standard_charges":[{"minimum":55.17,"maximum":74.48,"gross_charge":91.95,"discounted_cash":27.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"48102-0047-20","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":74.48,"gross_charge":91.95,"discounted_cash":27.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":74.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":64.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.39,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"48102-0051-01","type":"NDC"}],"standard_charges":[{"minimum":52.83,"maximum":71.33,"gross_charge":88.05,"discounted_cash":26.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.83,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"48102-0051-01","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":71.33,"gross_charge":88.05,"discounted_cash":26.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":61.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":52.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.61,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0718-01","type":"NDC"}],"standard_charges":[{"minimum":50.25,"maximum":67.84,"gross_charge":83.75,"discounted_cash":24.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0718-01","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":67.84,"gross_charge":83.75,"discounted_cash":24.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.75,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0718-11","type":"NDC"}],"standard_charges":[{"minimum":0.59,"maximum":0.79,"gross_charge":0.97,"discounted_cash":0.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0718-11","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":0.79,"gross_charge":0.97,"discounted_cash":0.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.2,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":59.01,"maximum":79.67,"gross_charge":98.35,"discounted_cash":29.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":63.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"}]}]},{"description":"DEXAMETHASONE 4 MG TABLET","code_information":[{"code":"J8540","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":79.67,"gross_charge":98.35,"discounted_cash":29.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":62.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":44.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":68.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.67,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 50 MG CAPSULE","code_information":[{"code":"J8560","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":827.37,"maximum":1116.95,"gross_charge":1378.94,"discounted_cash":408.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1116.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1116.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1116.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":896.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":965.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":827.37,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 50 MG CAPSULE","code_information":[{"code":"J8560","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":76.61,"maximum":1116.95,"gross_charge":1378.94,"discounted_cash":408.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1116.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1116.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1116.95,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":882.53,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":76.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":85.91,"standard_charge_algorithm": "Lesser of $85.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":85.91,"standard_charge_algorithm": "Lesser of $85.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":620.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":965.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":827.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":262,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":275.79,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42291-0505-01","type":"NDC"}],"standard_charges":[{"minimum":11.12,"maximum":15.01,"gross_charge":18.53,"discounted_cash":5.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42291-0505-01","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":15.01,"gross_charge":18.53,"discounted_cash":5.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0235-83","type":"NDC"}],"standard_charges":[{"minimum":18.33,"maximum":24.74,"gross_charge":30.54,"discounted_cash":9.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0235-83","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":24.74,"gross_charge":30.54,"discounted_cash":9.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.11,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0527-11","type":"NDC"}],"standard_charges":[{"minimum":0.5,"maximum":0.68,"gross_charge":0.83,"discounted_cash":0.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0527-11","type":"NDC"}],"standard_charges":[{"minimum":0.13,"maximum":0.68,"gross_charge":0.83,"discounted_cash":0.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0527-15","type":"NDC"}],"standard_charges":[{"minimum":21.15,"maximum":28.55,"gross_charge":35.24,"discounted_cash":10.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0527-15","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":28.55,"gross_charge":35.24,"discounted_cash":10.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.05,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0670-01","type":"NDC"}],"standard_charges":[{"minimum":1.56,"maximum":2.11,"gross_charge":2.6,"discounted_cash":0.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0670-01","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":2.11,"gross_charge":2.6,"discounted_cash":0.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.52,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0670-05","type":"NDC"}],"standard_charges":[{"minimum":29.76,"maximum":40.18,"gross_charge":49.6,"discounted_cash":14.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0670-05","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":40.18,"gross_charge":49.6,"discounted_cash":14.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.92,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0775-01","type":"NDC"}],"standard_charges":[{"minimum":28.83,"maximum":38.92,"gross_charge":48.04,"discounted_cash":14.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0775-01","type":"NDC"}],"standard_charges":[{"minimum":0.27,"maximum":38.92,"gross_charge":48.04,"discounted_cash":14.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":97.06,"maximum":131.03,"gross_charge":161.76,"discounted_cash":47.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":105.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.06,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.27,"maximum":131.03,"gross_charge":161.76,"discounted_cash":47.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":103.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":72.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":97.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.36,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":129.11,"maximum":174.3,"gross_charge":215.18,"discounted_cash":63.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":139.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":150.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.11,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM 2.5 MG TABLET","code_information":[{"code":"J8610","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.27,"maximum":174.3,"gross_charge":215.18,"discounted_cash":63.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":174.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":174.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":174.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":137.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.27,"standard_charge_algorithm": "Lesser of $0.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":96.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":150.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":129.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.04,"methodology":"fee schedule"}]}]},{"description":"TEMOZOLOMIDE 100 MG CAPSULE","code_information":[{"code":"J8700","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":220.92,"maximum":298.25,"gross_charge":368.2,"discounted_cash":108.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":239.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":257.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.92,"methodology":"fee schedule"}]}]},{"description":"TEMOZOLOMIDE 100 MG CAPSULE","code_information":[{"code":"J8700","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":298.25,"gross_charge":368.2,"discounted_cash":108.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":298.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":235.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":165.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":257.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":220.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.64,"methodology":"fee schedule"}]}]},{"description":"TEMOZOLOMIDE 20 MG CAPSULE","code_information":[{"code":"J8700","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":44.25,"maximum":59.73,"gross_charge":73.74,"discounted_cash":21.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.25,"methodology":"fee schedule"}]}]},{"description":"TEMOZOLOMIDE 20 MG CAPSULE","code_information":[{"code":"J8700","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":59.73,"gross_charge":73.74,"discounted_cash":21.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":59.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.75,"methodology":"fee schedule"}]}]},{"description":"TEMOZOLOMIDE 5 MG CAPSULE","code_information":[{"code":"J8700","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34.08,"maximum":46,"gross_charge":56.79,"discounted_cash":16.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.08,"methodology":"fee schedule"}]}]},{"description":"TEMOZOLOMIDE 5 MG CAPSULE","code_information":[{"code":"J8700","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":46,"gross_charge":56.79,"discounted_cash":16.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.36,"methodology":"fee schedule"}]}]},{"description":"CABOZANTINIB 60 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42388-0023-26","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CABOZANTINIB 60 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42388-0023-26","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"IBRUTINIB 420 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57962-0420-28","type":"NDC"}],"standard_charges":[{"minimum":8357.2,"maximum":11282.22,"gross_charge":13928.66,"discounted_cash":4122.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11282.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11282.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11282.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9053.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9750.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8357.2,"methodology":"fee schedule"}]}]},{"description":"IBRUTINIB 420 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57962-0420-28","type":"NDC"}],"standard_charges":[{"minimum":2089.3,"maximum":11282.22,"gross_charge":13928.66,"discounted_cash":4122.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11282.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11282.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11282.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8914.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":6964.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6964.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6267.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9750.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8357.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2646.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2785.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2089.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2785.74,"methodology":"fee schedule"}]}]},{"description":"MIDOSTAURIN 25 MG CAPSULE","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12927.84,"maximum":17452.59,"gross_charge":21546.4,"discounted_cash":6377.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17452.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17452.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17452.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14005.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15082.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12927.84,"methodology":"fee schedule"}]}]},{"description":"MIDOSTAURIN 25 MG CAPSULE","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3231.96,"maximum":17452.59,"gross_charge":21546.4,"discounted_cash":6377.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17452.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17452.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17452.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13789.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10773.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10773.2,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9695.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":15082.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12927.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4093.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4309.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3231.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4309.28,"methodology":"fee schedule"}]}]},{"description":"RUXOLITINIB 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50881-0010-60","type":"NDC"}],"standard_charges":[{"minimum":77775.75,"maximum":104997.26,"gross_charge":129626.24,"discounted_cash":38369.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104997.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104997.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104997.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84257.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90738.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77775.75,"methodology":"fee schedule"}]}]},{"description":"RUXOLITINIB 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50881-0010-60","type":"NDC"}],"standard_charges":[{"minimum":19443.94,"maximum":104997.26,"gross_charge":129626.24,"discounted_cash":38369.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104997.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104997.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104997.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82960.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":64813.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":64813.12,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58331.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90738.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77775.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24628.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25925.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19443.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25925.25,"methodology":"fee schedule"}]}]},{"description":"VEMURAFENIB 240 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0090-02","type":"NDC"}],"standard_charges":[{"minimum":3434.52,"maximum":4636.61,"gross_charge":5724.2,"discounted_cash":1694.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4636.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4636.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4636.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3720.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4006.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3434.52,"methodology":"fee schedule"}]}]},{"description":"VEMURAFENIB 240 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0090-02","type":"NDC"}],"standard_charges":[{"minimum":858.63,"maximum":4636.61,"gross_charge":5724.2,"discounted_cash":1694.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4636.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4636.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4636.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3663.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2862.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2862.1,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2575.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4006.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3434.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1087.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":858.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1144.84,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 10 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":106.97,"maximum":144.41,"gross_charge":178.28,"discounted_cash":52.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":115.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":124.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":106.97,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 10 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":26.75,"maximum":144.41,"gross_charge":178.28,"discounted_cash":52.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":144.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":144.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":144.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":114.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":89.14,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":80.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":124.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":106.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":35.66,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 100 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":76.43,"maximum":103.17,"gross_charge":127.37,"discounted_cash":37.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.43,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 100 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.11,"maximum":103.17,"gross_charge":127.37,"discounted_cash":37.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":103.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":81.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":89.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":76.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 100 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9162.5,"maximum":12369.37,"gross_charge":15270.82,"discounted_cash":4520.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12369.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12369.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12369.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9926.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10689.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9162.5,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 100 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2290.63,"maximum":12369.37,"gross_charge":15270.82,"discounted_cash":4520.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12369.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12369.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12369.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9773.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":7635.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":7635.41,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6871.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10689.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9162.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2901.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3054.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2290.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3054.17,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 50 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":267.33,"maximum":360.89,"gross_charge":445.54,"discounted_cash":131.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":360.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":360.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":289.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":311.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.33,"methodology":"fee schedule"}]}]},{"description":"VENETOCLAX 50 MG TABLET","code_information":[{"code":"J8999","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.84,"maximum":360.89,"gross_charge":445.54,"discounted_cash":131.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":360.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":360.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":360.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":285.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":222.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":222.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":200.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":311.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":267.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.11,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0883-05","type":"NDC"}],"standard_charges":[{"minimum":250.58,"maximum":338.29,"gross_charge":417.63,"discounted_cash":123.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":338.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":338.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":271.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":292.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.58,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0883-05","type":"NDC"}],"standard_charges":[{"minimum":2.75,"maximum":338.29,"gross_charge":417.63,"discounted_cash":123.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":338.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":338.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":338.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":267.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":187.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":292.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":250.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.53,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":252.03,"maximum":340.25,"gross_charge":420.05,"discounted_cash":124.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":340.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":273.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":294.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":252.03,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":340.25,"gross_charge":420.05,"discounted_cash":124.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":340.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":340.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":340.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":268.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":189.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":294.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":252.03,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.01,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":260.63,"maximum":351.84,"gross_charge":434.37,"discounted_cash":128.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":351.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":282.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":304.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":260.63,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 10 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":351.84,"gross_charge":434.37,"discounted_cash":128.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":351.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":351.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":351.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":278,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":195.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":304.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":260.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.88,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.88,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 2 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0883-10","type":"NDC"}],"standard_charges":[{"minimum":272.83,"maximum":368.32,"gross_charge":454.71,"discounted_cash":134.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":368.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":368.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":368.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":295.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":318.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.83,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 2 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0883-10","type":"NDC"}],"standard_charges":[{"minimum":2.75,"maximum":368.32,"gross_charge":454.71,"discounted_cash":134.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":368.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":368.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":368.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":291.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":204.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":318.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.95,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 2 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0208-25","type":"NDC"}],"standard_charges":[{"minimum":349.32,"maximum":471.58,"gross_charge":582.19,"discounted_cash":172.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":471.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":471.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":471.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":378.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":407.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":349.32,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 2 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0208-25","type":"NDC"}],"standard_charges":[{"minimum":2.75,"maximum":471.58,"gross_charge":582.19,"discounted_cash":172.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":471.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":471.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":471.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":372.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":261.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":407.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":349.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.44,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":414.09,"maximum":559.02,"gross_charge":690.14,"discounted_cash":204.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":559.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":559.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":559.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":448.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":483.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.09,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":559.02,"gross_charge":690.14,"discounted_cash":204.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":559.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":559.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":559.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":441.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":310.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":483.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":131.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.03,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":270.1,"maximum":364.63,"gross_charge":450.16,"discounted_cash":133.25,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":292.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":315.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":270.1,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":364.63,"gross_charge":450.16,"discounted_cash":133.25,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":288.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":202.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":315.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":270.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.04,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":281.25,"maximum":379.68,"gross_charge":468.74,"discounted_cash":138.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":304.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":328.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.25,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9000","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.75,"maximum":379.68,"gross_charge":468.74,"discounted_cash":138.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":379.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":379.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":379.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":300,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.75,"standard_charge_algorithm": "Lesser of $2.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":210.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":328.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.75,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0600-10","type":"NDC"}],"standard_charges":[{"minimum":1840.61,"maximum":2484.83,"gross_charge":3067.68,"discounted_cash":908.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2484.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2484.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2484.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1994,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2147.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1840.61,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"14789-0600-10","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":2484.83,"gross_charge":3067.68,"discounted_cash":908.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2484.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2484.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2484.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1963.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1380.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2147.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1840.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":582.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":460.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":613.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"methodology":"case rate"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0637-03","type":"NDC"}],"standard_charges":[{"minimum":2623.14,"maximum":3541.24,"gross_charge":4371.89,"discounted_cash":1294.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3541.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3541.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3541.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2841.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3060.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2623.14,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0637-03","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":3541.24,"gross_charge":4371.89,"discounted_cash":1294.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3541.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3541.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3541.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2798.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1967.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3060.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2623.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":830.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.38,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":655.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":874.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"methodology":"case rate"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0997-10","type":"NDC"}],"standard_charges":[{"minimum":490.49,"maximum":662.16,"gross_charge":817.48,"discounted_cash":241.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":662.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":662.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":662.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":531.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":572.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":490.49,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0997-10","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":662.16,"gross_charge":817.48,"discounted_cash":241.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":662.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":662.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":662.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":523.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":367.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":572.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":490.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"methodology":"case rate"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0720-02","type":"NDC"}],"standard_charges":[{"minimum":713.93,"maximum":963.8,"gross_charge":1189.87,"discounted_cash":352.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":773.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":832.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":713.93,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0720-02","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":963.8,"gross_charge":1189.87,"discounted_cash":352.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":963.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":963.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":963.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":761.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":535.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":832.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":713.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":237.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"methodology":"case rate"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0720-10","type":"NDC"}],"standard_charges":[{"minimum":559.53,"maximum":755.37,"gross_charge":932.55,"discounted_cash":276.04,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":755.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":755.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":755.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":606.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":652.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":559.53,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69918-0720-10","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":755.37,"gross_charge":932.55,"discounted_cash":276.04,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":755.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":755.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":755.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":596.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":419.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":652.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":559.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":177.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"methodology":"case rate"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1483-01","type":"NDC"}],"standard_charges":[{"minimum":425.94,"maximum":575.02,"gross_charge":709.9,"discounted_cash":210.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":461.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.94,"methodology":"fee schedule"}]}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1483-01","type":"NDC"}],"standard_charges":[{"minimum":4.28,"maximum":575.02,"gross_charge":709.9,"discounted_cash":210.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":575.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":575.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":575.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":454.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.68,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":7.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":17.37,"standard_charge_algorithm": "Lesser of $17.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":319.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":496.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":425.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":134.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.58,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.41,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.49,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.54,"methodology":"case rate"}]}]},{"description":"ATEZOLIZUMAB 1200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9022","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0917-01","type":"NDC"}],"standard_charges":[{"minimum":46959.18,"maximum":63394.89,"gross_charge":78265.29,"discounted_cash":23166.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63394.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63394.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63394.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50872.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54785.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46959.18,"methodology":"fee schedule"}]}]},{"description":"ATEZOLIZUMAB 1200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9022","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0917-01","type":"NDC"}],"standard_charges":[{"minimum":79.92,"maximum":63394.89,"gross_charge":78265.29,"discounted_cash":23166.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":63394.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":63394.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":63394.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50089.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":88.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":88.22,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":87.39,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":86.62,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":136.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":92.74,"standard_charge_algorithm": "Lesser of $92.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92.74,"standard_charge_algorithm": "Lesser of $92.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35219.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54785.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46959.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14870.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15653.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11739.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15653.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":79.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":85.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":82.32,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":83.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":87.91,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":84.72,"methodology":"case rate"}]}]},{"description":"AZACITIDINE 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0465-62","type":"NDC"}],"standard_charges":[{"minimum":329.18,"maximum":444.4,"gross_charge":548.63,"discounted_cash":162.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":356.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":384.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.18,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 10 MG/ML INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0465-62","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":444.4,"gross_charge":548.63,"discounted_cash":162.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":351.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":246.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":384.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.73,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0096-01","type":"NDC"}],"standard_charges":[{"minimum":530.81,"maximum":716.59,"gross_charge":884.67,"discounted_cash":261.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":716.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":716.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":716.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":575.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":619.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":530.81,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0096-01","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":716.59,"gross_charge":884.67,"discounted_cash":261.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":716.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":716.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":716.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":566.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":398.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":619.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":530.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":176.94,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0201-01","type":"NDC"}],"standard_charges":[{"minimum":409.77,"maximum":553.19,"gross_charge":682.95,"discounted_cash":202.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":553.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":553.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":553.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":443.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":478.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":409.77,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 100 MG SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72485-0201-01","type":"NDC"}],"standard_charges":[{"minimum":0.57,"maximum":553.19,"gross_charge":682.95,"discounted_cash":202.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":553.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":553.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":553.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":437.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":307.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":478.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":409.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.59,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 100 MG SOLUTION FOR INJECTION","code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":304.95,"maximum":411.68,"gross_charge":508.24,"discounted_cash":150.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":330.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":355.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":304.95,"methodology":"fee schedule"}]}]},{"description":"AZACITIDINE 100 MG SOLUTION FOR INJECTION","code_information":[{"code":"J9025","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.57,"maximum":411.68,"gross_charge":508.24,"discounted_cash":150.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":411.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":325.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.57,"standard_charge_algorithm": "Lesser of $0.57 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":228.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":355.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":304.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.57,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9027","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6166-00","type":"NDC"}],"standard_charges":[{"minimum":1226.09,"maximum":1655.22,"gross_charge":2043.48,"discounted_cash":604.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1655.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1655.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1655.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1328.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1430.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1226.09,"methodology":"fee schedule"}]}]},{"description":"CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9027","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60505-6166-00","type":"NDC"}],"standard_charges":[{"minimum":8.46,"maximum":1655.22,"gross_charge":2043.48,"discounted_cash":604.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1655.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1655.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1655.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1307.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.39,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":32.51,"standard_charge_algorithm": "Lesser of $32.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":32.51,"standard_charge_algorithm": "Lesser of $32.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":919.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1430.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1226.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":388.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":408.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.17,"methodology":"case rate"}]}]},{"description":"BCG LIVE 50 MG INTRAVESICAL SUSPENSION","code_information":[{"code":"J9030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":886.73,"maximum":1197.09,"gross_charge":1477.88,"discounted_cash":437.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1197.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1197.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1197.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":960.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1034.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":886.73,"methodology":"fee schedule"}]}]},{"description":"BCG LIVE 50 MG INTRAVESICAL SUSPENSION","code_information":[{"code":"J9030","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.21,"maximum":1197.09,"gross_charge":1477.88,"discounted_cash":437.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1197.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1197.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1197.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":945.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.21,"standard_charge_algorithm": "Lesser of $3.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.21,"standard_charge_algorithm": "Lesser of $3.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":665.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1034.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":886.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":221.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":295.58,"methodology":"fee schedule"}]}]},{"description":"BENDAMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9033","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0391-20","type":"NDC"}],"standard_charges":[{"minimum":4546.8,"maximum":6138.18,"gross_charge":7577.99,"discounted_cash":2243.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6138.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6138.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6138.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4925.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5304.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4546.8,"methodology":"fee schedule"}]}]},{"description":"BENDAMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9033","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0391-20","type":"NDC"}],"standard_charges":[{"minimum":1.11,"maximum":6138.18,"gross_charge":7577.99,"discounted_cash":2243.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6138.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6138.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6138.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4849.92,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":9.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.9,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":18.68,"standard_charge_algorithm": "Lesser of $18.68 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3410.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5304.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4546.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1439.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1515.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1136.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1515.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1.17,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1.22,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1.18,"methodology":"case rate"}]}]},{"description":"BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9034","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0348-04","type":"NDC"}],"standard_charges":[{"minimum":9532.44,"maximum":12868.8,"gross_charge":15887.4,"discounted_cash":4702.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12868.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12868.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12868.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10326.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11121.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9532.44,"methodology":"fee schedule"}]}]},{"description":"BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9034","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0348-04","type":"NDC"}],"standard_charges":[{"minimum":12.14,"maximum":12868.8,"gross_charge":15887.4,"discounted_cash":4702.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12868.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12868.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12868.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10167.94,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":20.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":19.71,"standard_charge_algorithm": "Lesser of $19.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":19.71,"standard_charge_algorithm": "Lesser of $19.71 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7149.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11121.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9532.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3018.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3177.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2383.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3177.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":12.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.99,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":13.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.87,"methodology":"case rate"}]}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0060-01","type":"NDC"}],"standard_charges":[{"minimum":3739.77,"maximum":5048.69,"gross_charge":6232.95,"discounted_cash":1844.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5048.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5048.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5048.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4051.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4363.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3739.77,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0060-01","type":"NDC"}],"standard_charges":[{"minimum":65.02,"maximum":5048.69,"gross_charge":6232.95,"discounted_cash":1844.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5048.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5048.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5048.69,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3989.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":73.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":74.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":111.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.79,"standard_charge_algorithm": "Lesser of $78.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.79,"standard_charge_algorithm": "Lesser of $78.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2804.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4363.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3739.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1184.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":934.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1246.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":69.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":66.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":71.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":68.92,"methodology":"case rate"}]}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0061-01","type":"NDC"}],"standard_charges":[{"minimum":14273.98,"maximum":19269.87,"gross_charge":23789.96,"discounted_cash":7041.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19269.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19269.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19269.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15463.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16652.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14273.98,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0061-01","type":"NDC"}],"standard_charges":[{"minimum":65.02,"maximum":19269.87,"gross_charge":23789.96,"discounted_cash":7041.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19269.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19269.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19269.87,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15225.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":73.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":73.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":74.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":73.83,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.47,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":111.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.79,"standard_charge_algorithm": "Lesser of $78.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.79,"standard_charge_algorithm": "Lesser of $78.79 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10705.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16652.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14273.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4520.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4758,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3568.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4758,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.02,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":69.57,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":66.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":71.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":68.92,"methodology":"case rate"}]}]},{"description":"BLINATUMOMAB 35 MCG INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9039","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0160-01","type":"NDC"}],"standard_charges":[{"minimum":22896.24,"maximum":30909.93,"gross_charge":38160.4,"discounted_cash":11295.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30909.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30909.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30909.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":24804.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":26712.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22896.24,"methodology":"fee schedule"}]}]},{"description":"BLINATUMOMAB 35 MCG INTRAVENOUS KIT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9039","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0160-01","type":"NDC"}],"standard_charges":[{"minimum":136.14,"maximum":30909.93,"gross_charge":38160.4,"discounted_cash":11295.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":30909.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":30909.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":30909.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":24422.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":152.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":152.51,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":145.57,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":154.82,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":148.32,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":232.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":149.06,"standard_charge_algorithm": "Lesser of $149.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":149.06,"standard_charge_algorithm": "Lesser of $149.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":17172.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":26712.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22896.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7250.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":7632.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5724.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":7632.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":136.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":145.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":140.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":142.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":149.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":144.31,"methodology":"case rate"}]}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0106-10","type":"NDC"}],"standard_charges":[{"minimum":317.07,"maximum":428.04,"gross_charge":528.44,"discounted_cash":156.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":428.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":428.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":428.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":343.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":369.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317.07,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0106-10","type":"NDC"}],"standard_charges":[{"minimum":27.47,"maximum":428.04,"gross_charge":528.44,"discounted_cash":156.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":428.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":428.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":428.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":338.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":237.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":369.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":317.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.69,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":336.85,"maximum":454.75,"gross_charge":561.41,"discounted_cash":166.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":364.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.85,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.47,"maximum":454.75,"gross_charge":561.41,"discounted_cash":166.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":454.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":454.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":454.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":359.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":252.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":392.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":336.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.29,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0908-01","type":"NDC"}],"standard_charges":[{"minimum":387.96,"maximum":523.75,"gross_charge":646.6,"discounted_cash":191.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":523.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":523.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":523.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":420.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":452.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.96,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0908-01","type":"NDC"}],"standard_charges":[{"minimum":27.47,"maximum":523.75,"gross_charge":646.6,"discounted_cash":191.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":523.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":523.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":523.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":413.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":290.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":452.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":387.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.99,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.32,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":383.07,"maximum":517.14,"gross_charge":638.44,"discounted_cash":188.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":517.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":517.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":517.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":414.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":446.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.07,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.47,"maximum":517.14,"gross_charge":638.44,"discounted_cash":188.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":517.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":517.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":517.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":408.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":287.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":446.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":383.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.69,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":695.86,"maximum":939.41,"gross_charge":1159.76,"discounted_cash":343.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":939.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":939.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":939.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":753.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":811.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.86,"methodology":"fee schedule"}]}]},{"description":"BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION","code_information":[{"code":"J9040","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.47,"maximum":939.41,"gross_charge":1159.76,"discounted_cash":343.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":939.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":939.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":939.41,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":742.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":521.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":811.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":695.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":220.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.97,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":231.96,"methodology":"fee schedule"}]}]},{"description":"BORTEZOMIB 1 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63020-0049-01","type":"NDC"}],"standard_charges":[{"minimum":7291.36,"maximum":9843.34,"gross_charge":12152.26,"discounted_cash":3597.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9843.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9843.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9843.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7898.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8506.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7291.36,"methodology":"fee schedule"}]}]},{"description":"BORTEZOMIB 1 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63020-0049-01","type":"NDC"}],"standard_charges":[{"minimum":1.76,"maximum":9843.34,"gross_charge":12152.26,"discounted_cash":3597.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9843.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9843.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9843.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7777.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.88,"standard_charge_algorithm": "Lesser of $27.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.88,"standard_charge_algorithm": "Lesser of $27.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5468.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8506.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7291.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2308.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1822.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2430.46,"methodology":"fee schedule"}]}]},{"description":"BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70710-1411-01","type":"NDC"}],"standard_charges":[{"minimum":346.1,"maximum":467.24,"gross_charge":576.83,"discounted_cash":170.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":467.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":467.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":467.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":374.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":403.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":346.1,"methodology":"fee schedule"}]}]},{"description":"BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70710-1411-01","type":"NDC"}],"standard_charges":[{"minimum":1.76,"maximum":467.24,"gross_charge":576.83,"discounted_cash":170.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":467.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":467.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":467.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":369.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1.96,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.88,"standard_charge_algorithm": "Lesser of $27.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.88,"standard_charge_algorithm": "Lesser of $27.88 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":259.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":403.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":346.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.37,"methodology":"fee schedule"}]}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9042","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51144-0050-01","type":"NDC"}],"standard_charges":[{"minimum":50026.18,"maximum":67535.34,"gross_charge":83376.96,"discounted_cash":24679.59,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67535.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67535.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67535.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54195.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58363.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50026.18,"methodology":"fee schedule"}]}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9042","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51144-0050-01","type":"NDC"}],"standard_charges":[{"minimum":222.55,"maximum":67535.34,"gross_charge":83376.96,"discounted_cash":24679.59,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67535.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67535.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67535.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53361.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":248.93,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":230.61,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":244.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":234.96,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":380.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":232.51,"standard_charge_algorithm": "Lesser of $232.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":232.51,"standard_charge_algorithm": "Lesser of $232.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37519.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58363.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50026.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15841.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16675.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12506.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16675.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":222.55,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":238.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":229.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":233.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":244.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":235.9,"methodology":"case rate"}]}]},{"description":"CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION","code_information":[{"code":"J9043","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":61337.32,"maximum":82805.38,"gross_charge":102228.86,"discounted_cash":30259.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82805.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82805.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82805.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66448.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71560.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61337.32,"methodology":"fee schedule"}]}]},{"description":"CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION","code_information":[{"code":"J9043","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":198.21,"maximum":82805.38,"gross_charge":102228.86,"discounted_cash":30259.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":82805.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":82805.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":82805.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65426.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":224.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":224.09,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":210.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":219.56,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":214.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":338.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":221.08,"standard_charge_algorithm": "Lesser of $221.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":221.08,"standard_charge_algorithm": "Lesser of $221.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46002.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":71560.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61337.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19423.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20445.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15334.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20445.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":198.21,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":212.08,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":204.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":208.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":218.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":210.1,"methodology":"case rate"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0295-12","type":"NDC"}],"standard_charges":[{"minimum":397.3,"maximum":536.35,"gross_charge":662.16,"discounted_cash":196,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":536.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":536.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":430.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":463.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":397.3,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0295-12","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":536.35,"gross_charge":662.16,"discounted_cash":196,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":536.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":536.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":536.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":423.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":297.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":463.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":397.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.44,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0295-34","type":"NDC"}],"standard_charges":[{"minimum":312.64,"maximum":422.06,"gross_charge":521.06,"discounted_cash":154.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":338.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":364.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.64,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0295-34","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":422.06,"gross_charge":521.06,"discounted_cash":154.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":422.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":422.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":422.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":234.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":364.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":312.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.22,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0172-60","type":"NDC"}],"standard_charges":[{"minimum":376.16,"maximum":507.81,"gross_charge":626.92,"discounted_cash":185.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":407.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":438.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.16,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0172-60","type":"NDC"}],"standard_charges":[{"minimum":3.02,"maximum":507.81,"gross_charge":626.92,"discounted_cash":185.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":507.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":507.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":507.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":401.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":282.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":438.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":376.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.39,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":247.41,"maximum":334,"gross_charge":412.34,"discounted_cash":122.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":268.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":288.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.41,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.02,"maximum":334,"gross_charge":412.34,"discounted_cash":122.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":334,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":334,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":334,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":263.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":185.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":288.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.47,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":305.1,"maximum":411.89,"gross_charge":508.5,"discounted_cash":150.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":411.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":411.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":330.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":355.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":305.1,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.02,"maximum":411.89,"gross_charge":508.5,"discounted_cash":150.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":411.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":411.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":411.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":325.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":228.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":355.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":305.1,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.7,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":330.15,"maximum":445.71,"gross_charge":550.25,"discounted_cash":162.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":357.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.15,"methodology":"fee schedule"}]}]},{"description":"CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9045","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.02,"maximum":445.71,"gross_charge":550.25,"discounted_cash":162.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":445.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":445.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":445.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":352.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":3.02,"standard_charge_algorithm": "Lesser of $3.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":247.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":385.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":330.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.05,"methodology":"fee schedule"}]}]},{"description":"CARFILZOMIB 10 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76075-0103-01","type":"NDC"}],"standard_charges":[{"minimum":2525.32,"maximum":3409.18,"gross_charge":4208.86,"discounted_cash":1245.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3409.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3409.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3409.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2735.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2946.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2525.32,"methodology":"fee schedule"}]}]},{"description":"CARFILZOMIB 10 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76075-0103-01","type":"NDC"}],"standard_charges":[{"minimum":46.35,"maximum":3409.18,"gross_charge":4208.86,"discounted_cash":1245.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3409.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3409.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3409.18,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2693.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":47.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":79.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.74,"standard_charge_algorithm": "Lesser of $49.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.74,"standard_charge_algorithm": "Lesser of $49.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1893.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2946.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2525.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":799.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":841.78,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":631.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":841.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":50.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":49.13,"methodology":"case rate"}]}]},{"description":"CARFILZOMIB 30 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76075-0102-01","type":"NDC"}],"standard_charges":[{"minimum":7119.17,"maximum":9610.88,"gross_charge":11865.28,"discounted_cash":3512.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9610.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9610.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9610.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7712.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8305.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7119.17,"methodology":"fee schedule"}]}]},{"description":"CARFILZOMIB 30 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76075-0102-01","type":"NDC"}],"standard_charges":[{"minimum":46.35,"maximum":9610.88,"gross_charge":11865.28,"discounted_cash":3512.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9610.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9610.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9610.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7593.78,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":47.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":79.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.74,"standard_charge_algorithm": "Lesser of $49.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.74,"standard_charge_algorithm": "Lesser of $49.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5339.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8305.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7119.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2254.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1779.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2373.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":50.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":49.13,"methodology":"case rate"}]}]},{"description":"CARFILZOMIB 60 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76075-0101-01","type":"NDC"}],"standard_charges":[{"minimum":14010.06,"maximum":18913.58,"gross_charge":23350.09,"discounted_cash":6911.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18913.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18913.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18913.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15177.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16345.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14010.06,"methodology":"fee schedule"}]}]},{"description":"CARFILZOMIB 60 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76075-0101-01","type":"NDC"}],"standard_charges":[{"minimum":46.35,"maximum":18913.58,"gross_charge":23350.09,"discounted_cash":6911.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18913.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18913.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18913.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14944.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":47.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":50.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":47.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":79.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":49.74,"standard_charge_algorithm": "Lesser of $49.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":49.74,"standard_charge_algorithm": "Lesser of $49.74 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10507.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16345.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14010.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4436.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4670.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3502.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4670.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":49.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":47.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":48.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":50.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":49.13,"methodology":"case rate"}]}]},{"description":"CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9055","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66733-0948-23","type":"NDC"}],"standard_charges":[{"minimum":3699.28,"maximum":4994.03,"gross_charge":6165.46,"discounted_cash":1824.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4994.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4994.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4994.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4007.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4315.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3699.28,"methodology":"fee schedule"}]}]},{"description":"CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9055","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66733-0948-23","type":"NDC"}],"standard_charges":[{"minimum":69.31,"maximum":4994.03,"gross_charge":6165.46,"discounted_cash":1824.98,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4994.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4994.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4994.03,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3945.9,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":77.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":73.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":118.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.07,"standard_charge_algorithm": "Lesser of $78.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.07,"standard_charge_algorithm": "Lesser of $78.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2774.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4315.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3699.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1171.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":924.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1233.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":69.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":74.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":71.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":72.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":76.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":73.47,"methodology":"case rate"}]}]},{"description":"CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9055","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66733-0958-23","type":"NDC"}],"standard_charges":[{"minimum":7170.19,"maximum":9679.76,"gross_charge":11950.31,"discounted_cash":3537.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9679.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9679.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9679.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7767.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8365.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7170.19,"methodology":"fee schedule"}]}]},{"description":"CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9055","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"66733-0958-23","type":"NDC"}],"standard_charges":[{"minimum":69.31,"maximum":9679.76,"gross_charge":11950.31,"discounted_cash":3537.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9679.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9679.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9679.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7648.2,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":77.1,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":73.72,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":77.06,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":75.11,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":118.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":78.07,"standard_charge_algorithm": "Lesser of $78.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":78.07,"standard_charge_algorithm": "Lesser of $78.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5377.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8365.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7170.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2270.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2390.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1792.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2390.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":69.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":74.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":71.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":72.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":76.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":73.47,"methodology":"case rate"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0288-38","type":"NDC"}],"standard_charges":[{"minimum":354.83,"maximum":479.01,"gross_charge":591.37,"discounted_cash":175.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":384.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":413.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354.83,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0288-38","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":479.01,"gross_charge":591.37,"discounted_cash":175.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":479.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":479.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":479.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":378.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.17,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.17,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":266.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":413.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":354.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.28,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.28,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0253-51","type":"NDC"}],"standard_charges":[{"minimum":292.7,"maximum":395.15,"gross_charge":487.83,"discounted_cash":144.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":317.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":341.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.7,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0253-51","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":395.15,"gross_charge":487.83,"discounted_cash":144.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":395.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":395.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":395.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":312.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.17,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.17,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":219.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":341.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.57,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0103-65","type":"NDC"}],"standard_charges":[{"minimum":366.72,"maximum":495.08,"gross_charge":611.2,"discounted_cash":180.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":495.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":495.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":495.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":397.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":427.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":366.72,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0103-65","type":"NDC"}],"standard_charges":[{"minimum":2.17,"maximum":495.08,"gross_charge":611.2,"discounted_cash":180.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":495.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":495.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":495.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":391.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.17,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.17,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":275.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":427.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":366.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.24,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0253-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72266-0253-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9061","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0501-00","type":"NDC"}],"standard_charges":[{"minimum":15573.35,"maximum":21024.02,"gross_charge":25955.57,"discounted_cash":7682.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21024.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21024.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21024.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16871.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18168.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15573.35,"methodology":"fee schedule"}]}]},{"description":"AMIVANTAMAB-VMJW 50 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9061","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0501-00","type":"NDC"}],"standard_charges":[{"minimum":3893.34,"maximum":21024.02,"gross_charge":25955.57,"discounted_cash":7682.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21024.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21024.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21024.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16611.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12977.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12977.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11680.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18168.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15573.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4931.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5191.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3893.34,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5191.12,"methodology":"fee schedule"}]}]},{"description":"CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9065","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0140-10","type":"NDC"}],"standard_charges":[{"minimum":272.42,"maximum":367.77,"gross_charge":454.03,"discounted_cash":134.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":367.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":367.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":295.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":317.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.42,"methodology":"fee schedule"}]}]},{"description":"CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9065","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0140-10","type":"NDC"}],"standard_charges":[{"minimum":9.12,"maximum":367.77,"gross_charge":454.03,"discounted_cash":134.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":367.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":367.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":367.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":290.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":204.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":317.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":272.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.67,"methodology":"case rate"}]}]},{"description":"CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9065","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0450-10","type":"NDC"}],"standard_charges":[{"minimum":389.3,"maximum":525.55,"gross_charge":648.82,"discounted_cash":192.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":525.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":525.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":421.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":454.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":389.3,"methodology":"fee schedule"}]}]},{"description":"CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9065","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0450-10","type":"NDC"}],"standard_charges":[{"minimum":9.12,"maximum":525.55,"gross_charge":648.82,"discounted_cash":192.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":525.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":525.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":525.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":415.25,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.77,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":15.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":27.47,"standard_charge_algorithm": "Lesser of $27.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":291.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":454.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":389.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":9.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":9.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":9.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":9.58,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":10.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":9.67,"methodology":"case rate"}]}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9074","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":726.26,"maximum":980.45,"gross_charge":1210.43,"discounted_cash":358.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":980.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":786.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":847.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.26,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9074","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":181.57,"maximum":980.45,"gross_charge":1210.43,"discounted_cash":358.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":980.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":980.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":980.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":774.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":605.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":605.22,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":544.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":847.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":726.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":229.99,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":181.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.09,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9074","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":498.51,"maximum":672.99,"gross_charge":830.84,"discounted_cash":245.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":672.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":672.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":672.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":540.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":581.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":498.51,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9074","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":124.63,"maximum":672.99,"gross_charge":830.84,"discounted_cash":245.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":672.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":672.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":672.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":531.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":415.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":415.42,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":373.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":581.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":498.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.17,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":166.17,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0936-01","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0936-01","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0944-01","type":"NDC"}],"standard_charges":[{"minimum":1121.14,"maximum":1513.54,"gross_charge":1868.56,"discounted_cash":553.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1513.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1513.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1513.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1214.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1308,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1121.14,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0944-01","type":"NDC"}],"standard_charges":[{"minimum":280.29,"maximum":1513.54,"gross_charge":1868.56,"discounted_cash":553.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1513.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1513.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1513.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1195.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":934.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":934.28,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":840.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1308,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1121.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.03,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":373.72,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0955-01","type":"NDC"}],"standard_charges":[{"minimum":617.52,"maximum":833.65,"gross_charge":1029.19,"discounted_cash":304.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":833.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":833.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":668.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":720.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.52,"methodology":"fee schedule"}]}]},{"description":"CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0955-01","type":"NDC"}],"standard_charges":[{"minimum":154.38,"maximum":833.65,"gross_charge":1029.19,"discounted_cash":304.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":833.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":833.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":833.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":658.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":514.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":514.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":463.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":720.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":617.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":205.84,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0305-38","type":"NDC"}],"standard_charges":[{"minimum":248.88,"maximum":335.99,"gross_charge":414.8,"discounted_cash":122.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":269.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":290.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":248.88,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0305-38","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":335.99,"gross_charge":414.8,"discounted_cash":122.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":335.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":335.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":335.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":265.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":186.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":290.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":248.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.96,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 100 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0120-20","type":"NDC"}],"standard_charges":[{"minimum":277.63,"maximum":374.8,"gross_charge":462.71,"discounted_cash":136.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":300.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":323.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.63,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 100 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0120-20","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":374.8,"gross_charge":462.71,"discounted_cash":136.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":374.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":374.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":374.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":296.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":208.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":323.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":277.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.55,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0223-20","type":"NDC"}],"standard_charges":[{"minimum":281.78,"maximum":380.4,"gross_charge":469.62,"discounted_cash":139.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":305.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":328.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.78,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0223-20","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":380.4,"gross_charge":469.62,"discounted_cash":139.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":380.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":380.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":380.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":300.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":211.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":328.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":281.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.93,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0319-22","type":"NDC"}],"standard_charges":[{"minimum":292.44,"maximum":394.79,"gross_charge":487.39,"discounted_cash":144.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":316.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":341.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.44,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0319-22","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":394.79,"gross_charge":487.39,"discounted_cash":144.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":394.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":394.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":394.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":311.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":219.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":341.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":292.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.48,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0109-20","type":"NDC"}],"standard_charges":[{"minimum":294.64,"maximum":397.76,"gross_charge":491.06,"discounted_cash":145.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":319.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":343.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.64,"methodology":"fee schedule"}]}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0109-20","type":"NDC"}],"standard_charges":[{"minimum":1.15,"maximum":397.76,"gross_charge":491.06,"discounted_cash":145.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":397.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":397.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":397.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":314.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.15,"standard_charge_algorithm": "Lesser of $1.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":220.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":343.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":294.64,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.22,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":98.22,"methodology":"fee schedule"}]}]},{"description":"DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55292-0811-55","type":"NDC"}],"standard_charges":[{"minimum":10136.3,"maximum":13684,"gross_charge":16893.82,"discounted_cash":5000.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13684,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13684,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13684,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10980.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11825.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10136.3,"methodology":"fee schedule"}]}]},{"description":"DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9120","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55292-0811-55","type":"NDC"}],"standard_charges":[{"minimum":258.2,"maximum":13684,"gross_charge":16893.82,"discounted_cash":5000.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13684,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13684,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13684,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10812.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":324.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":668.9,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":405.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":681.52,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":441.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":629.86,"standard_charge_algorithm": "Lesser of $629.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":629.86,"standard_charge_algorithm": "Lesser of $629.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7602.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11825.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10136.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3209.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3378.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2534.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3378.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":258.2,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":276.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":265.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":271.11,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":284.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":273.69,"methodology":"case rate"}]}]},{"description":"DACARBAZINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0127-10","type":"NDC"}],"standard_charges":[{"minimum":264.9,"maximum":357.61,"gross_charge":441.49,"discounted_cash":130.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":357.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":286.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":309.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.9,"methodology":"fee schedule"}]}]},{"description":"DACARBAZINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0127-10","type":"NDC"}],"standard_charges":[{"minimum":4.61,"maximum":357.61,"gross_charge":441.49,"discounted_cash":130.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":357.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":357.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":357.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":282.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":198.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":309.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":264.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.3,"methodology":"fee schedule"}]}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0128-00","type":"NDC"}],"standard_charges":[{"minimum":253.97,"maximum":342.86,"gross_charge":423.28,"discounted_cash":125.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":342.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":342.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":275.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":296.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":253.97,"methodology":"fee schedule"}]}]},{"description":"DACARBAZINE 200 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0128-00","type":"NDC"}],"standard_charges":[{"minimum":4.61,"maximum":342.86,"gross_charge":423.28,"discounted_cash":125.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":342.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":342.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":342.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":270.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":190.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":296.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":253.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.66,"methodology":"fee schedule"}]}]},{"description":"DARATUMUMAB 1800 MG-HYALURONIDASE-FIHJ 30000 UNIT/15 ML SUBCUT SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9144","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0503-01","type":"NDC"}],"standard_charges":[{"minimum":46576.22,"maximum":62877.9,"gross_charge":77627.03,"discounted_cash":22977.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62877.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62877.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62877.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50457.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54338.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46576.22,"methodology":"fee schedule"}]}]},{"description":"DARATUMUMAB 1800 MG-HYALURONIDASE-FIHJ 30000 UNIT/15 ML SUBCUT SOLN","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9144","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0503-01","type":"NDC"}],"standard_charges":[{"minimum":47.38,"maximum":62877.9,"gross_charge":77627.03,"discounted_cash":22977.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":62877.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":62877.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":62877.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":49681.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.39,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":49.05,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":81.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.85,"standard_charge_algorithm": "Lesser of $52.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.85,"standard_charge_algorithm": "Lesser of $52.85 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":34932.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":54338.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":46576.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14749.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15525.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11644.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15525.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":47.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":50.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":48.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":49.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":52.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":50.22,"methodology":"case rate"}]}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9145","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0502-05","type":"NDC"}],"standard_charges":[{"minimum":2964.24,"maximum":4001.72,"gross_charge":4940.39,"discounted_cash":1462.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3211.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3458.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2964.24,"methodology":"fee schedule"}]}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9145","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0502-05","type":"NDC"}],"standard_charges":[{"minimum":60.46,"maximum":4001.72,"gross_charge":4940.39,"discounted_cash":1462.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4001.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4001.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4001.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3161.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":65.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":61.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":103.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.07,"standard_charge_algorithm": "Lesser of $67.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.07,"standard_charge_algorithm": "Lesser of $67.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2223.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3458.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2964.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":938.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":741.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":988.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":60.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":64.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":62.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":63.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":66.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":64.09,"methodology":"case rate"}]}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9145","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0502-20","type":"NDC"}],"standard_charges":[{"minimum":11222.55,"maximum":15150.44,"gross_charge":18704.24,"discounted_cash":5536.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15150.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15150.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15150.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12157.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13092.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11222.55,"methodology":"fee schedule"}]}]},{"description":"DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9145","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57894-0502-20","type":"NDC"}],"standard_charges":[{"minimum":60.46,"maximum":15150.44,"gross_charge":18704.24,"discounted_cash":5536.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15150.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15150.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15150.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11970.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":65.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":65.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":61.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":65.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":62.87,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":103.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":67.07,"standard_charge_algorithm": "Lesser of $67.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":67.07,"standard_charge_algorithm": "Lesser of $67.07 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8416.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13092.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11222.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3553.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3740.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2805.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3740.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":60.46,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":64.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":62.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":63.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":66.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":64.09,"methodology":"case rate"}]}]},{"description":"DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9150","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42658-0021-01","type":"NDC"}],"standard_charges":[{"minimum":455.73,"maximum":615.23,"gross_charge":759.54,"discounted_cash":224.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":615.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":615.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":615.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":493.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":531.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.73,"methodology":"fee schedule"}]}]},{"description":"DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9150","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42658-0021-01","type":"NDC"}],"standard_charges":[{"minimum":23.52,"maximum":615.23,"gross_charge":759.54,"discounted_cash":224.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":615.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":615.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":615.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":486.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.61,"standard_charge_algorithm": "Lesser of $52.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.61,"standard_charge_algorithm": "Lesser of $52.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":341.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":531.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":455.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.02,"methodology":"case rate"}]}]},{"description":"DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9150","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":482.55,"maximum":651.45,"gross_charge":804.25,"discounted_cash":238.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":522.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":562.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.55,"methodology":"fee schedule"}]}]},{"description":"DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9150","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":23.52,"maximum":651.45,"gross_charge":804.25,"discounted_cash":238.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":651.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":514.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.61,"standard_charge_algorithm": "Lesser of $52.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.61,"standard_charge_algorithm": "Lesser of $52.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":361.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":562.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":482.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.02,"methodology":"case rate"}]}]},{"description":"DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9150","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":718.47,"maximum":969.94,"gross_charge":1197.45,"discounted_cash":354.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":969.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":969.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":969.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":778.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":838.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":718.47,"methodology":"fee schedule"}]}]},{"description":"DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9150","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":23.52,"maximum":969.94,"gross_charge":1197.45,"discounted_cash":354.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":969.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":969.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":969.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":766.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":40.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":52.61,"standard_charge_algorithm": "Lesser of $52.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":52.61,"standard_charge_algorithm": "Lesser of $52.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":538.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":838.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":718.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":227.52,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":179.62,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":239.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":23.6,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.02,"methodology":"case rate"}]}]},{"description":"DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68727-0745-02","type":"NDC"}],"standard_charges":[{"minimum":45170.66,"maximum":60980.39,"gross_charge":75284.42,"discounted_cash":22284.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60980.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60980.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60980.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48934.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52699.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45170.66,"methodology":"fee schedule"}]}]},{"description":"DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68727-0745-02","type":"NDC"}],"standard_charges":[{"minimum":222.63,"maximum":60980.39,"gross_charge":75284.42,"discounted_cash":22284.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60980.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60980.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60980.39,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48182.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":248.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":231.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":246.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":236.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":380.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":243.2,"standard_charge_algorithm": "Lesser of $243.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":243.2,"standard_charge_algorithm": "Lesser of $243.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33877.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":52699.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":45170.66,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14304.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15056.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11292.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15056.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":222.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":238.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":229.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":233.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":244.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":235.99,"methodology":"case rate"}]}]},{"description":"DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68727-0745-05","type":"NDC"}],"standard_charges":[{"minimum":39993.48,"maximum":53991.19,"gross_charge":66655.79,"discounted_cash":19730.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53991.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53991.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53991.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43326.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46659.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39993.48,"methodology":"fee schedule"}]}]},{"description":"DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9153","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68727-0745-05","type":"NDC"}],"standard_charges":[{"minimum":222.63,"maximum":53991.19,"gross_charge":66655.79,"discounted_cash":19730.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53991.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53991.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53991.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42659.71,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":248.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":248.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":231.76,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":246.16,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":236.14,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":380.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":243.2,"standard_charge_algorithm": "Lesser of $243.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":243.2,"standard_charge_algorithm": "Lesser of $243.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29995.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46659.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39993.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12664.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13331.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9998.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13331.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":222.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":238.21,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":229.31,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":233.76,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":244.89,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":235.99,"methodology":"case rate"}]}]},{"description":"DEGARELIX 120 MG SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9155","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-8403-01","type":"NDC"}],"standard_charges":[{"minimum":2322.57,"maximum":3135.47,"gross_charge":3870.95,"discounted_cash":1145.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3135.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3135.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3135.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2516.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2709.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2322.57,"methodology":"fee schedule"}]}]},{"description":"DEGARELIX 120 MG SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9155","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55566-8403-01","type":"NDC"}],"standard_charges":[{"minimum":3.9,"maximum":3135.47,"gross_charge":3870.95,"discounted_cash":1145.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3135.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3135.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3135.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2477.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":4.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":6.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.61,"standard_charge_algorithm": "Lesser of $4.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1741.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2709.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2322.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":735.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":580.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":774.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.9,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":4.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":4.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":4.09,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":4.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":4.13,"methodology":"case rate"}]}]},{"description":"DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0245-01","type":"NDC"}],"standard_charges":[{"minimum":303.76,"maximum":410.08,"gross_charge":506.26,"discounted_cash":149.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":329.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":354.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.76,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0245-01","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":410.08,"gross_charge":506.26,"discounted_cash":149.86,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":410.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":410.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":410.08,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":324.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":227.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":354.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":303.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":96.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.26,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2656.76,"maximum":3586.62,"gross_charge":4427.92,"discounted_cash":1310.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3586.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3586.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3586.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2878.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3099.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2656.76,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.51,"maximum":3586.62,"gross_charge":4427.92,"discounted_cash":1310.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3586.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3586.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3586.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2833.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1992.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3099.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2656.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":841.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":664.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":885.59,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0267-64","type":"NDC"}],"standard_charges":[{"minimum":450.58,"maximum":608.28,"gross_charge":750.96,"discounted_cash":222.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":608.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":608.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":608.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":488.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":525.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":450.58,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0267-64","type":"NDC"}],"standard_charges":[{"minimum":0.51,"maximum":608.28,"gross_charge":750.96,"discounted_cash":222.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":608.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":608.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":608.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":480.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":337.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":525.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":450.58,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.2,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":356.82,"maximum":481.7,"gross_charge":594.69,"discounted_cash":176.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":481.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":481.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":481.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":386.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":416.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.82,"methodology":"fee schedule"}]}]},{"description":"DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9171","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.51,"maximum":481.7,"gross_charge":594.69,"discounted_cash":176.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":481.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":481.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":481.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":380.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.51,"standard_charge_algorithm": "Lesser of $0.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":267.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":416.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":113,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.94,"methodology":"fee schedule"}]}]},{"description":"DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9173","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4388.36,"maximum":5924.28,"gross_charge":7313.92,"discounted_cash":2164.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5924.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5924.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5924.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4754.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5119.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4388.36,"methodology":"fee schedule"}]}]},{"description":"DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9173","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":74.98,"maximum":5924.28,"gross_charge":7313.92,"discounted_cash":2164.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5924.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5924.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5924.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4680.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":83.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":80.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":83.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":82.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":128.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":88.08,"standard_charge_algorithm": "Lesser of $88.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":88.08,"standard_charge_algorithm": "Lesser of $88.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3291.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5119.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4388.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1389.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1462.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1097.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1462.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":74.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":80.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":77.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":78.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":82.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":79.48,"methodology":"case rate"}]}]},{"description":"DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9173","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":18407.05,"maximum":24849.52,"gross_charge":30678.41,"discounted_cash":9080.81,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24849.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24849.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24849.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19940.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21474.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18407.05,"methodology":"fee schedule"}]}]},{"description":"DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9173","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":74.98,"maximum":24849.52,"gross_charge":30678.41,"discounted_cash":9080.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":24849.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":24849.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":24849.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19634.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":83.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":80.71,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":83.42,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":82.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":128.22,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":88.08,"standard_charge_algorithm": "Lesser of $88.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":88.08,"standard_charge_algorithm": "Lesser of $88.08 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13805.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21474.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18407.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5828.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6135.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4601.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6135.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":74.98,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":80.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":77.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":78.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":82.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":79.48,"methodology":"case rate"}]}]},{"description":"ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9179","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0389-01","type":"NDC"}],"standard_charges":[{"minimum":6440.98,"maximum":8695.32,"gross_charge":10734.96,"discounted_cash":3177.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8695.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8695.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8695.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6977.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7514.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6440.98,"methodology":"fee schedule"}]}]},{"description":"ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9179","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62856-0389-01","type":"NDC"}],"standard_charges":[{"minimum":106.17,"maximum":8695.32,"gross_charge":10734.96,"discounted_cash":3177.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8695.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8695.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8695.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6870.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":133.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":133.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":134.02,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":143.96,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":136.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":181.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":142.02,"standard_charge_algorithm": "Lesser of $142.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":142.02,"standard_charge_algorithm": "Lesser of $142.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4830.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7514.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6440.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2039.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1610.25,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2147,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":106.17,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":113.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":109.36,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":111.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":116.79,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":112.54,"methodology":"case rate"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0114-08","type":"NDC"}],"standard_charges":[{"minimum":433.92,"maximum":585.79,"gross_charge":723.19,"discounted_cash":214.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":470.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":506.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.92,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0114-08","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":585.79,"gross_charge":723.19,"discounted_cash":214.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":585.79,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":462.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":325.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":506.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":433.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":108.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":144.64,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0114-31","type":"NDC"}],"standard_charges":[{"minimum":269.44,"maximum":363.74,"gross_charge":449.06,"discounted_cash":132.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":363.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":291.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.44,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0114-31","type":"NDC"}],"standard_charges":[{"minimum":0.95,"maximum":363.74,"gross_charge":449.06,"discounted_cash":132.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":363.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":363.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":363.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":287.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":202.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":314.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.82,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.82,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":266.18,"maximum":359.34,"gross_charge":443.62,"discounted_cash":131.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.18,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":359.34,"gross_charge":443.62,"discounted_cash":131.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":283.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":199.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.73,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":491.19,"maximum":663.11,"gross_charge":818.65,"discounted_cash":242.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":663.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":663.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":663.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":532.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":573.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.19,"methodology":"fee schedule"}]}]},{"description":"ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9181","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.95,"maximum":663.11,"gross_charge":818.65,"discounted_cash":242.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":663.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":663.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":663.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":523.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.95,"standard_charge_algorithm": "Lesser of $0.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":368.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":573.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":491.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":155.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":122.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.73,"methodology":"fee schedule"}]}]},{"description":"FLUDARABINE 25 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0344-18","type":"NDC"}],"standard_charges":[{"minimum":609.37,"maximum":822.65,"gross_charge":1015.61,"discounted_cash":300.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":660.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":710.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":609.37,"methodology":"fee schedule"}]}]},{"description":"FLUDARABINE 25 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0344-18","type":"NDC"}],"standard_charges":[{"minimum":53.22,"maximum":822.65,"gross_charge":1015.61,"discounted_cash":300.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":822.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":822.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":822.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":650,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":168.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":173.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":233.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":91.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":104.2,"standard_charge_algorithm": "Lesser of $104.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.2,"standard_charge_algorithm": "Lesser of $104.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":457.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":710.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":609.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":192.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":203.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.41,"methodology":"case rate"}]}]},{"description":"FLUDARABINE 25 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0192-02","type":"NDC"}],"standard_charges":[{"minimum":479.3,"maximum":647.06,"gross_charge":798.83,"discounted_cash":236.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":647.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":647.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":647.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":519.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":559.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":479.3,"methodology":"fee schedule"}]}]},{"description":"FLUDARABINE 25 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9185","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0192-02","type":"NDC"}],"standard_charges":[{"minimum":53.22,"maximum":647.06,"gross_charge":798.83,"discounted_cash":236.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":647.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":647.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":647.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":511.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":168.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":168.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":173.97,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":233.63,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":91.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":104.2,"standard_charge_algorithm": "Lesser of $104.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":104.2,"standard_charge_algorithm": "Lesser of $104.20 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":359.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":559.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":479.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.22,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.88,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.41,"methodology":"case rate"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0276-11","type":"NDC"}],"standard_charges":[{"minimum":101.37,"maximum":136.85,"gross_charge":168.94,"discounted_cash":50.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":109.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.37,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0276-11","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":136.85,"gross_charge":168.94,"discounted_cash":50.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":136.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":136.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":118.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":101.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.79,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0117-58","type":"NDC"}],"standard_charges":[{"minimum":50.97,"maximum":68.81,"gross_charge":84.95,"discounted_cash":25.15,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":55.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.97,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0117-58","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":68.81,"gross_charge":84.95,"discounted_cash":25.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":68.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":38.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":59.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.99,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68001-0266-24","type":"NDC"}],"standard_charges":[{"minimum":61.97,"maximum":83.65,"gross_charge":103.27,"discounted_cash":30.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.97,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68001-0266-24","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":83.65,"gross_charge":103.27,"discounted_cash":30.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.66,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70700-0188-22","type":"NDC"}],"standard_charges":[{"minimum":62.85,"maximum":84.84,"gross_charge":104.74,"discounted_cash":31.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":68.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.85,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70700-0188-22","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":84.84,"gross_charge":104.74,"discounted_cash":31.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":84.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":67.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":47.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":73.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":62.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":20.95,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0117-68","type":"NDC"}],"standard_charges":[{"minimum":299.31,"maximum":404.07,"gross_charge":498.84,"discounted_cash":147.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":404.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":404.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":324.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":349.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":299.31,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0117-68","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":404.07,"gross_charge":498.84,"discounted_cash":147.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":404.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":404.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":404.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":319.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":224.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":349.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":299.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":99.77,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0117-10","type":"NDC"}],"standard_charges":[{"minimum":238.5,"maximum":321.98,"gross_charge":397.5,"discounted_cash":117.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":321.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":258.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0117-10","type":"NDC"}],"standard_charges":[{"minimum":2.67,"maximum":321.98,"gross_charge":397.5,"discounted_cash":117.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":321.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":321.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":321.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":254.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":178.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":278.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":238.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.5,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":251.15,"maximum":339.05,"gross_charge":418.58,"discounted_cash":123.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":339.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":339.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":293.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.15,"methodology":"fee schedule"}]}]},{"description":"FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9190","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.67,"maximum":339.05,"gross_charge":418.58,"discounted_cash":123.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":339.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":339.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":339.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":267.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.67,"standard_charge_algorithm": "Lesser of $2.67 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":188.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":293.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":251.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.54,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.72,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0205-50","type":"NDC"}],"standard_charges":[{"minimum":417.88,"maximum":564.14,"gross_charge":696.46,"discounted_cash":206.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":564.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":564.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":564.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":452.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":487.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":417.88,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0205-50","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":564.14,"gross_charge":696.46,"discounted_cash":206.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":564.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":564.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":564.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":445.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":313.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":487.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":417.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.33,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.3,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-2004-84","type":"NDC"}],"standard_charges":[{"minimum":268.47,"maximum":362.43,"gross_charge":447.44,"discounted_cash":132.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":290.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":313.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.47,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-2004-84","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":362.43,"gross_charge":447.44,"discounted_cash":132.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":286.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":201.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":313.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.49,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77771-0004-84","type":"NDC"}],"standard_charges":[{"minimum":428.76,"maximum":578.83,"gross_charge":714.6,"discounted_cash":211.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":464.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":500.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":428.76,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77771-0004-84","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":578.83,"gross_charge":714.6,"discounted_cash":211.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":578.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":578.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":578.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":457.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":321.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":500.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":428.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.92,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":308.68,"maximum":416.72,"gross_charge":514.46,"discounted_cash":152.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":416.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":416.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":416.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":334.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":360.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.68,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.16,"maximum":416.72,"gross_charge":514.46,"discounted_cash":152.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":416.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":416.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":416.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":329.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":231.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":360.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":308.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.9,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0618-10","type":"NDC"}],"standard_charges":[{"minimum":344.72,"maximum":465.37,"gross_charge":574.52,"discounted_cash":170.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":373.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":402.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":344.72,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0618-10","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":465.37,"gross_charge":574.52,"discounted_cash":170.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":465.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":465.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":465.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":367.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":258.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":402.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":344.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":114.91,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":503.47,"maximum":679.68,"gross_charge":839.11,"discounted_cash":248.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":679.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":545.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":587.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.47,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.16,"maximum":679.68,"gross_charge":839.11,"discounted_cash":248.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":679.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":679.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":679.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":537.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":377.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":587.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":503.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.83,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":247.28,"maximum":333.83,"gross_charge":412.13,"discounted_cash":122,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":333.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":333.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":288.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.28,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 200 MG/5.26 ML (38 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.16,"maximum":333.83,"gross_charge":412.13,"discounted_cash":122,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":333.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":333.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":333.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":263.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":185.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":288.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":247.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.43,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 38 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-2004-84","type":"NDC"}],"standard_charges":[{"minimum":236.7,"maximum":319.54,"gross_charge":394.49,"discounted_cash":116.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":319.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":256.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.7,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 38 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77770-2004-84","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":319.54,"gross_charge":394.49,"discounted_cash":116.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":319.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":319.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":319.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":252.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":177.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":276.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":236.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":74.96,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":78.9,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 38 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77771-0004-84","type":"NDC"}],"standard_charges":[{"minimum":380.26,"maximum":513.35,"gross_charge":633.76,"discounted_cash":187.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":411.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":380.26,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 38 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"77771-0004-84","type":"NDC"}],"standard_charges":[{"minimum":4.16,"maximum":513.35,"gross_charge":633.76,"discounted_cash":187.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":513.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":405.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":285.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":443.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":380.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.76,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 38 MG/ML CHEMO INJECTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":269.8,"maximum":364.23,"gross_charge":449.66,"discounted_cash":133.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":292.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":314.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.8,"methodology":"fee schedule"}]}]},{"description":"GEMCITABINE 38 MG/ML CHEMO INJECTION","code_information":[{"code":"J9201","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4.16,"maximum":364.23,"gross_charge":449.66,"discounted_cash":133.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":364.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":364.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":364.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":287.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.16,"standard_charge_algorithm": "Lesser of $4.16 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":202.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":314.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":269.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.44,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.94,"methodology":"fee schedule"}]}]},{"description":"GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9202","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70720-0951-30","type":"NDC"}],"standard_charges":[{"minimum":9456.61,"maximum":12766.42,"gross_charge":15761.01,"discounted_cash":4665.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12766.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12766.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12766.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10244.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11032.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9456.61,"methodology":"fee schedule"}]}]},{"description":"GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9202","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70720-0951-30","type":"NDC"}],"standard_charges":[{"minimum":609.01,"maximum":12766.42,"gross_charge":15761.01,"discounted_cash":4665.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12766.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12766.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12766.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10087.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":703.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":703.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":609.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":671.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":620.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1078.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":647.17,"standard_charge_algorithm": "Lesser of $647.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":647.17,"standard_charge_algorithm": "Lesser of $647.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7092.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11032.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9456.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2994.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3152.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2364.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3152.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":630.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":674.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":649.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":661.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":693.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":668.25,"methodology":"case rate"}]}]},{"description":"GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9202","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70720-0950-36","type":"NDC"}],"standard_charges":[{"minimum":3519.78,"maximum":4751.7,"gross_charge":5866.29,"discounted_cash":1736.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4751.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4751.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4751.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3813.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4106.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3519.78,"methodology":"fee schedule"}]}]},{"description":"GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9202","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70720-0950-36","type":"NDC"}],"standard_charges":[{"minimum":609.01,"maximum":4751.7,"gross_charge":5866.29,"discounted_cash":1736.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4751.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4751.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4751.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3754.43,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":703.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":703.06,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":609.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":671.98,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":620.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1078.02,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":647.17,"standard_charge_algorithm": "Lesser of $647.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":647.17,"standard_charge_algorithm": "Lesser of $647.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2639.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4106.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3519.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1114.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":879.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1173.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":630.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":674.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":649.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":661.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":693.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":668.25,"methodology":"case rate"}]}]},{"description":"GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN","code_information":[{"code":"J9203","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":43189.27,"maximum":58305.51,"gross_charge":71982.11,"discounted_cash":21306.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58305.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58305.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58305.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46788.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50387.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43189.27,"methodology":"fee schedule"}]}]},{"description":"GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN","code_information":[{"code":"J9203","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":208.42,"maximum":58305.51,"gross_charge":71982.11,"discounted_cash":21306.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":58305.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":58305.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":58305.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":46068.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":233.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":233.12,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":226.28,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":234,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":230.55,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":356.4,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":242.14,"standard_charge_algorithm": "Lesser of $242.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":242.14,"standard_charge_algorithm": "Lesser of $242.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":32391.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":50387.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":43189.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13676.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14396.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10797.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14396.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":208.42,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":223.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":214.67,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":218.84,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":229.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":220.93,"methodology":"case rate"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0614-85","type":"NDC"}],"standard_charges":[{"minimum":276,"maximum":372.6,"gross_charge":460,"discounted_cash":136.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":299,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":322,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0614-85","type":"NDC"}],"standard_charges":[{"minimum":2.95,"maximum":372.6,"gross_charge":460,"discounted_cash":136.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":372.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":294.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":207,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":322,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0193-05","type":"NDC"}],"standard_charges":[{"minimum":322.22,"maximum":435,"gross_charge":537.03,"discounted_cash":158.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":349.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":375.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":322.22,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0193-05","type":"NDC"}],"standard_charges":[{"minimum":2.95,"maximum":435,"gross_charge":537.03,"discounted_cash":158.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":435,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":343.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":241.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":375.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":322.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":102.04,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.41,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":284.81,"maximum":384.5,"gross_charge":474.68,"discounted_cash":140.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":384.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":384.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":384.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":308.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":332.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.81,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.95,"maximum":384.5,"gross_charge":474.68,"discounted_cash":140.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":384.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":384.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":384.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":303.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":213.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":332.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":284.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.19,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.94,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0614-51","type":"NDC"}],"standard_charges":[{"minimum":47.42,"maximum":64.01,"gross_charge":79.02,"discounted_cash":23.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"}]}]},{"description":"IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0614-51","type":"NDC"}],"standard_charges":[{"minimum":2.95,"maximum":64.01,"gross_charge":79.02,"discounted_cash":23.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.01,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":50.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.95,"standard_charge_algorithm": "Lesser of $2.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":35.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":55.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":47.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.81,"methodology":"fee schedule"}]}]},{"description":"IXABEPILONE 15 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9207","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70020-1910-01","type":"NDC"}],"standard_charges":[{"minimum":8760.05,"maximum":11826.06,"gross_charge":14600.07,"discounted_cash":4321.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11826.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11826.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11826.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9490.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10220.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8760.05,"methodology":"fee schedule"}]}]},{"description":"IXABEPILONE 15 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9207","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70020-1910-01","type":"NDC"}],"standard_charges":[{"minimum":121.77,"maximum":11826.06,"gross_charge":14600.07,"discounted_cash":4321.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11826.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":11826.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":11826.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9344.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":136.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":128.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":135.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":130.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":208.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":131.92,"standard_charge_algorithm": "Lesser of $131.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":131.92,"standard_charge_algorithm": "Lesser of $131.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6570.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10220.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":8760.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2774.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2920.02,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2190.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2920.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":121.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":130.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":125.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":127.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":133.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":129.08,"methodology":"case rate"}]}]},{"description":"IXABEPILONE 45 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9207","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70020-1911-01","type":"NDC"}],"standard_charges":[{"minimum":25823.36,"maximum":34861.53,"gross_charge":43038.92,"discounted_cash":12739.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34861.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34861.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34861.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27975.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30127.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25823.36,"methodology":"fee schedule"}]}]},{"description":"IXABEPILONE 45 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9207","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70020-1911-01","type":"NDC"}],"standard_charges":[{"minimum":121.77,"maximum":34861.53,"gross_charge":43038.92,"discounted_cash":12739.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34861.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34861.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34861.53,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27544.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":136.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":128.07,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":135.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":130.49,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":208.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":131.92,"standard_charge_algorithm": "Lesser of $131.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":131.92,"standard_charge_algorithm": "Lesser of $131.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19367.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30127.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25823.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8177.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8607.79,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6455.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8607.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":121.77,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":130.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":125.42,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":127.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":133.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":129.08,"methodology":"case rate"}]}]},{"description":"IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0925-01","type":"NDC"}],"standard_charges":[{"minimum":345.48,"maximum":466.4,"gross_charge":575.8,"discounted_cash":170.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":374.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":403.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":345.48,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0925-01","type":"NDC"}],"standard_charges":[{"minimum":30.09,"maximum":466.4,"gross_charge":575.8,"discounted_cash":170.44,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":466.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":368.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":259.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":403.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":345.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":115.16,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0142-10","type":"NDC"}],"standard_charges":[{"minimum":333.15,"maximum":449.75,"gross_charge":555.24,"discounted_cash":164.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":449.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":449.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":449.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":360.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":388.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.15,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0142-10","type":"NDC"}],"standard_charges":[{"minimum":30.09,"maximum":449.75,"gross_charge":555.24,"discounted_cash":164.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":449.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":449.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":449.75,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":355.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":249.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":388.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":333.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.05,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0926-02","type":"NDC"}],"standard_charges":[{"minimum":575.09,"maximum":776.37,"gross_charge":958.47,"discounted_cash":283.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":776.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":776.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":776.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":623.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":670.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":575.09,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0926-02","type":"NDC"}],"standard_charges":[{"minimum":30.09,"maximum":776.37,"gross_charge":958.47,"discounted_cash":283.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":776.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":776.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":776.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":613.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":431.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":670.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":575.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":182.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.78,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":191.7,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":570.99,"maximum":770.84,"gross_charge":951.65,"discounted_cash":281.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":770.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":770.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":770.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":618.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":666.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":570.99,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30.09,"maximum":770.84,"gross_charge":951.65,"discounted_cash":281.69,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":770.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":770.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":770.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":609.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":428.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":666.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":570.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":190.33,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":702.12,"maximum":947.86,"gross_charge":1170.19,"discounted_cash":346.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":760.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":819.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":702.12,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30.09,"maximum":947.86,"gross_charge":1170.19,"discounted_cash":346.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":947.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":947.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":947.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":748.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":526.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":819.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":702.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.04,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":175.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":234.04,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 50 MG/ML CHEMO INJECTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":329.18,"maximum":444.4,"gross_charge":548.63,"discounted_cash":162.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":356.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":384.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.18,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 50 MG/ML CHEMO INJECTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30.09,"maximum":444.4,"gross_charge":548.63,"discounted_cash":162.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":444.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":351.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":246.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":384.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":329.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.73,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 50 MG/ML CHEMO INJECTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":390.25,"maximum":526.84,"gross_charge":650.41,"discounted_cash":192.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":526.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":526.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":526.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":422.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":455.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":390.25,"methodology":"fee schedule"}]}]},{"description":"IFOSFAMIDE 50 MG/ML CHEMO INJECTION","code_information":[{"code":"J9208","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30.09,"maximum":526.84,"gross_charge":650.41,"discounted_cash":192.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":526.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":526.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":526.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":416.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":30.09,"standard_charge_algorithm": "Lesser of $30.09 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":292.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":455.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":390.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":123.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.09,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":97.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.09,"methodology":"fee schedule"}]}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9209","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0953-62","type":"NDC"}],"standard_charges":[{"minimum":262.43,"maximum":354.28,"gross_charge":437.38,"discounted_cash":129.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":354.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":354.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":284.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":306.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":262.43,"methodology":"fee schedule"}]}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9209","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10019-0953-62","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":354.28,"gross_charge":437.38,"discounted_cash":129.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":354.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":354.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":354.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":279.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.73,"standard_charge_algorithm": "Lesser of $1.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.73,"standard_charge_algorithm": "Lesser of $1.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":196.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":306.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":262.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.61,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.48,"methodology":"fee schedule"}]}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9209","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0201-10","type":"NDC"}],"standard_charges":[{"minimum":261.29,"maximum":352.74,"gross_charge":435.47,"discounted_cash":128.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":283.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":304.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.29,"methodology":"fee schedule"}]}]},{"description":"MESNA 100 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9209","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0201-10","type":"NDC"}],"standard_charges":[{"minimum":1.73,"maximum":352.74,"gross_charge":435.47,"discounted_cash":128.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":352.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":352.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":352.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":278.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.73,"standard_charge_algorithm": "Lesser of $1.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.73,"standard_charge_algorithm": "Lesser of $1.73 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":195.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":304.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":261.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.1,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":0.25,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":258.2,"maximum":348.56,"gross_charge":430.32,"discounted_cash":127.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":279.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":301.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.2,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.65,"maximum":348.56,"gross_charge":430.32,"discounted_cash":127.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":275.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":193.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":301.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":258.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.07,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":437.31,"maximum":590.37,"gross_charge":728.84,"discounted_cash":215.74,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":590.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":590.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":590.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":473.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":510.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.31,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.65,"maximum":590.37,"gross_charge":728.84,"discounted_cash":215.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":590.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":590.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":590.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":466.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":327.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":510.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":437.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.77,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":521.82,"maximum":704.45,"gross_charge":869.69,"discounted_cash":257.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":704.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":704.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":565.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":608.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":521.82,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.65,"maximum":704.45,"gross_charge":869.69,"discounted_cash":257.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":704.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":704.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":704.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":556.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":391.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":608.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":521.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":130.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":173.94,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":581.92,"maximum":785.59,"gross_charge":969.86,"discounted_cash":287.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":785.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":785.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":785.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":630.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":678.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":581.92,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.65,"maximum":785.59,"gross_charge":969.86,"discounted_cash":287.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":785.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":785.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":785.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":620.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":436.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":678.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":581.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":184.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":193.98,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":714.15,"maximum":964.1,"gross_charge":1190.24,"discounted_cash":352.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":964.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":964.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":964.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":773.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":833.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":714.15,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.65,"maximum":964.1,"gross_charge":1190.24,"discounted_cash":352.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":964.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":964.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":964.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":761.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":535.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":833.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":714.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":226.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.05,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":824.87,"maximum":1113.58,"gross_charge":1374.78,"discounted_cash":406.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":893.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":962.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":824.87,"methodology":"fee schedule"}]}]},{"description":"IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9211","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.65,"maximum":1113.58,"gross_charge":1374.78,"discounted_cash":406.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1113.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":879.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":42.65,"standard_charge_algorithm": "Lesser of $42.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":618.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":962.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":824.87,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":206.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":274.96,"methodology":"fee schedule"}]}]},{"description":"LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62935-0227-10","type":"NDC"}],"standard_charges":[{"minimum":1425.78,"maximum":1924.8,"gross_charge":2376.29,"discounted_cash":703.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1924.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1924.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1924.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1544.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1663.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1425.78,"methodology":"fee schedule"}]}]},{"description":"LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62935-0227-10","type":"NDC"}],"standard_charges":[{"minimum":154.03,"maximum":1924.8,"gross_charge":2376.29,"discounted_cash":703.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1924.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1924.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1924.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1520.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":180.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":181.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":183.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":184.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":263.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":188.11,"standard_charge_algorithm": "Lesser of $188.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":188.11,"standard_charge_algorithm": "Lesser of $188.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1069.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1663.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1425.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":451.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":356.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":475.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":154.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":164.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":158.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":161.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":169.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":163.27,"methodology":"case rate"}]}]},{"description":"LEUPROLIDE 30 MG (4 MONTH) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62935-0303-30","type":"NDC"}],"standard_charges":[{"minimum":1824.88,"maximum":2463.59,"gross_charge":3041.46,"discounted_cash":900.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2463.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2463.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2463.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1976.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2129.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1824.88,"methodology":"fee schedule"}]}]},{"description":"LEUPROLIDE 30 MG (4 MONTH) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62935-0303-30","type":"NDC"}],"standard_charges":[{"minimum":154.03,"maximum":2463.59,"gross_charge":3041.46,"discounted_cash":900.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2463.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2463.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2463.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1946.54,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":180.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":181.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":183.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":184.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":263.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":188.11,"standard_charge_algorithm": "Lesser of $188.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":188.11,"standard_charge_algorithm": "Lesser of $188.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1368.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2129.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":577.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":456.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":608.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":154.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":164.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":158.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":161.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":169.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":163.27,"methodology":"case rate"}]}]},{"description":"LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62935-0753-75","type":"NDC"}],"standard_charges":[{"minimum":627.52,"maximum":847.15,"gross_charge":1045.86,"discounted_cash":309.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":847.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":679.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":732.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":627.52,"methodology":"fee schedule"}]}]},{"description":"LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62935-0753-75","type":"NDC"}],"standard_charges":[{"minimum":154.03,"maximum":847.15,"gross_charge":1045.86,"discounted_cash":309.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":847.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":847.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":669.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":180.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":181.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":183.95,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":184.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":263.39,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":188.11,"standard_charge_algorithm": "Lesser of $188.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":188.11,"standard_charge_algorithm": "Lesser of $188.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":470.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":732.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":627.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":198.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":209.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":154.03,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":164.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":158.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":161.73,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":169.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":163.27,"methodology":"case rate"}]}]},{"description":"LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9223","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68727-0712-01","type":"NDC"}],"standard_charges":[{"minimum":35256.92,"maximum":47596.84,"gross_charge":58761.52,"discounted_cash":17393.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47596.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47596.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47596.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38194.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41133.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35256.92,"methodology":"fee schedule"}]}]},{"description":"LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9223","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68727-0712-01","type":"NDC"}],"standard_charges":[{"minimum":183.31,"maximum":47596.84,"gross_charge":58761.52,"discounted_cash":17393.41,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47596.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47596.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47596.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37607.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":204.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":204.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":200.01,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":206.58,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":203.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":313.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":208.17,"standard_charge_algorithm": "Lesser of $208.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":208.17,"standard_charge_algorithm": "Lesser of $208.17 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26442.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41133.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35256.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11164.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11752.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8814.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11752.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":183.31,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":196.14,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":188.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":192.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":201.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":194.31,"methodology":"case rate"}]}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9227","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3548.51,"maximum":4790.48,"gross_charge":5914.17,"discounted_cash":1750.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4790.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4790.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4790.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3844.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4139.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3548.51,"methodology":"fee schedule"}]}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9227","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":70.5,"maximum":4790.48,"gross_charge":5914.17,"discounted_cash":1750.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4790.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4790.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4790.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3785.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":79.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":76.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":77.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":79.61,"standard_charge_algorithm": "Lesser of $79.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":79.61,"standard_charge_algorithm": "Lesser of $79.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2661.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4139.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3548.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1123.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":887.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1182.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":74.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.73,"methodology":"case rate"}]}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9227","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":16896.68,"maximum":22810.51,"gross_charge":28161.12,"discounted_cash":8335.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22810.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22810.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22810.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18304.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16896.68,"methodology":"fee schedule"}]}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9227","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":70.5,"maximum":22810.51,"gross_charge":28161.12,"discounted_cash":8335.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":22810.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":22810.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":22810.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18023.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":79.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":79.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":76.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.47,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":77.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":120.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":79.61,"standard_charge_algorithm": "Lesser of $79.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":79.61,"standard_charge_algorithm": "Lesser of $79.61 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":12672.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":19712.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":16896.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5350.62,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5632.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4224.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5632.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":70.5,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":75.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":72.61,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":74.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":77.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":74.73,"methodology":"case rate"}]}]},{"description":"IPILIMUMAB 5 MG/ML CHEMO INJECTION","code_information":[{"code":"J9228","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":37823.43,"maximum":51061.63,"gross_charge":63039.04,"discounted_cash":18659.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51061.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51061.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51061.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40975.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44127.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37823.43,"methodology":"fee schedule"}]}]},{"description":"IPILIMUMAB 5 MG/ML CHEMO INJECTION","code_information":[{"code":"J9228","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":161.12,"maximum":51061.63,"gross_charge":63039.04,"discounted_cash":18659.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51061.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":51061.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":51061.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":40344.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":180.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":172.42,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":180.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":175.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":275.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":184.3,"standard_charge_algorithm": "Lesser of $184.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":184.3,"standard_charge_algorithm": "Lesser of $184.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28367.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44127.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":37823.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11977.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12607.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9455.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12607.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":161.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":172.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":165.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":169.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":177.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":170.79,"methodology":"case rate"}]}]},{"description":"IPILIMUMAB 5 MG/ML CHEMO INJECTION","code_information":[{"code":"J9228","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":150608.24,"maximum":203321.13,"gross_charge":251013.73,"discounted_cash":74300.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203321.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203321.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203321.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":163158.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":175709.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150608.24,"methodology":"fee schedule"}]}]},{"description":"IPILIMUMAB 5 MG/ML CHEMO INJECTION","code_information":[{"code":"J9228","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":161.12,"maximum":203321.13,"gross_charge":251013.73,"discounted_cash":74300.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":203321.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":203321.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":203321.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":160648.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":180.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":180.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":172.42,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":180.12,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":175.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":275.52,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":184.3,"standard_charge_algorithm": "Lesser of $184.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":184.3,"standard_charge_algorithm": "Lesser of $184.30 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":112956.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":175709.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":150608.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":47692.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":50202.75,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":37652.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":50202.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":161.12,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":172.4,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":165.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":169.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":177.23,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":170.79,"methodology":"case rate"}]}]},{"description":"INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN","code_information":[{"code":"J9229","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":98200.3,"maximum":132570.4,"gross_charge":163667.16,"discounted_cash":48445.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132570.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132570.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132570.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":106383.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":114567.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98200.3,"methodology":"fee schedule"}]}]},{"description":"INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN","code_information":[{"code":"J9229","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2376.47,"maximum":132570.4,"gross_charge":163667.16,"discounted_cash":48445.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":132570.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":132570.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":132570.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":104746.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2658.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":2658.13,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":2580.15,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2668.26,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2628.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":4063.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2760.93,"standard_charge_algorithm": "Lesser of $2760.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2760.93,"standard_charge_algorithm": "Lesser of $2760.93 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":73650.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":114567.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":98200.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":31096.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":32733.44,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":24550.08,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":32733.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":2376.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":2542.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":2447.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":2495.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":2614.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":2519.06,"methodology":"case rate"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0277-30","type":"NDC"}],"standard_charges":[{"minimum":240.45,"maximum":324.6,"gross_charge":400.74,"discounted_cash":118.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":324.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":324.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":260.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":280.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":240.45,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9250","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0277-30","type":"NDC"}],"standard_charges":[{"minimum":0.31,"maximum":324.6,"gross_charge":400.74,"discounted_cash":118.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":324.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":324.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":324.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":256.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.31,"standard_charge_algorithm": "Lesser of $0.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.31,"standard_charge_algorithm": "Lesser of $0.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":180.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":280.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":240.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.15,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0122-50","type":"NDC"}],"standard_charges":[{"minimum":487.28,"maximum":657.82,"gross_charge":812.12,"discounted_cash":240.39,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":657.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":657.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":657.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":527.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":568.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":487.28,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0122-50","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":657.82,"gross_charge":812.12,"discounted_cash":240.39,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":657.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":657.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":657.82,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":519.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":365.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":568.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":487.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":154.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":121.82,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.43,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0277-35","type":"NDC"}],"standard_charges":[{"minimum":377.65,"maximum":509.83,"gross_charge":629.41,"discounted_cash":186.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":509.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":409.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":440.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.65,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0277-35","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":509.83,"gross_charge":629.41,"discounted_cash":186.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":509.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":509.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":509.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":402.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":283.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":440.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":377.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.89,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0408-41","type":"NDC"}],"standard_charges":[{"minimum":274.73,"maximum":370.88,"gross_charge":457.87,"discounted_cash":135.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":297.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":320.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.73,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0408-41","type":"NDC"}],"standard_charges":[{"minimum":2.96,"maximum":370.88,"gross_charge":457.87,"discounted_cash":135.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":370.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":293.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":206.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":320.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":274.73,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.58,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":242.15,"maximum":326.9,"gross_charge":403.57,"discounted_cash":119.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":262.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":282.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.15,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":326.9,"gross_charge":403.57,"discounted_cash":119.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":326.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":258.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":181.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":282.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":242.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":76.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.54,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":80.72,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":243.92,"maximum":329.29,"gross_charge":406.52,"discounted_cash":120.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":329.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":329.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":329.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":264.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":284.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":243.92,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":329.29,"gross_charge":406.52,"discounted_cash":120.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":329.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":329.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":329.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":260.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":182.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":284.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":243.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.24,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":81.31,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":268.86,"maximum":362.97,"gross_charge":448.1,"discounted_cash":132.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":291.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":313.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.86,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":362.97,"gross_charge":448.1,"discounted_cash":132.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":362.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":362.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":286.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":201.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":313.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":268.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.62,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":374.83,"maximum":506.02,"gross_charge":624.71,"discounted_cash":184.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":506.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":506.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":506.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":406.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":437.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":374.83,"methodology":"fee schedule"}]}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION","code_information":[{"code":"J9260","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.96,"maximum":506.02,"gross_charge":624.71,"discounted_cash":184.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":506.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":506.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":506.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":399.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2.96,"standard_charge_algorithm": "Lesser of $2.96 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":281.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":437.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":374.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":118.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":124.95,"methodology":"fee schedule"}]}]},{"description":"NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9261","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3244.57,"maximum":4380.17,"gross_charge":5407.61,"discounted_cash":1600.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4380.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4380.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4380.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3514.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3785.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3244.57,"methodology":"fee schedule"}]}]},{"description":"NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9261","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":56.49,"maximum":4380.17,"gross_charge":5407.61,"discounted_cash":1600.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4380.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4380.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4380.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3460.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":74.76,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":110.98,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":74.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":113.08,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":96.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":143.95,"standard_charge_algorithm": "Lesser of $143.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":143.95,"standard_charge_algorithm": "Lesser of $143.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2433.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3785.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3244.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1027.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1081.53,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":811.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1081.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":56.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":60.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":58.18,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":59.31,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":62.14,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":59.88,"methodology":"case rate"}]}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0442-20","type":"NDC"}],"standard_charges":[{"minimum":349.37,"maximum":471.64,"gross_charge":582.27,"discounted_cash":172.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":471.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":471.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":471.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":378.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":407.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":349.37,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0442-20","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":471.64,"gross_charge":582.27,"discounted_cash":172.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":471.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":471.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":471.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":372.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":262.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":407.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":349.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":116.46,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0201-20","type":"NDC"}],"standard_charges":[{"minimum":631.62,"maximum":852.68,"gross_charge":1052.69,"discounted_cash":311.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":852.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":852.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":852.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":684.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":736.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":631.62,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0201-20","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":852.68,"gross_charge":1052.69,"discounted_cash":311.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":852.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":852.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":852.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":673.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":473.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":736.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":631.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":200.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":210.54,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0101-20","type":"NDC"}],"standard_charges":[{"minimum":276.75,"maximum":373.62,"gross_charge":461.25,"discounted_cash":136.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":299.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":322.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.75,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0101-20","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":373.62,"gross_charge":461.25,"discounted_cash":136.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":373.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":295.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":207.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":322.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":276.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.19,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":92.25,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0201-10","type":"NDC"}],"standard_charges":[{"minimum":429.99,"maximum":580.49,"gross_charge":716.65,"discounted_cash":212.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":580.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":580.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":465.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":501.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":429.99,"methodology":"fee schedule"}]}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70860-0201-10","type":"NDC"}],"standard_charges":[{"minimum":0.06,"maximum":580.49,"gross_charge":716.65,"discounted_cash":212.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":580.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":580.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":580.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":458.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.06,"standard_charge_algorithm": "Lesser of $0.06 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":322.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":501.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":429.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":136.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.33,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.33,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL-PROTEIN BOUND 5 MG/ML CHEMO INFUSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9264","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68817-0134-50","type":"NDC"}],"standard_charges":[{"minimum":6981.44,"maximum":9424.94,"gross_charge":11635.72,"discounted_cash":3444.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9424.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9424.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9424.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7563.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8145.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6981.44,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL-PROTEIN BOUND 5 MG/ML CHEMO INFUSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9264","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68817-0134-50","type":"NDC"}],"standard_charges":[{"minimum":11.68,"maximum":9424.94,"gross_charge":11635.72,"discounted_cash":3444.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9424.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9424.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9424.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7446.87,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":13.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":19.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.77,"standard_charge_algorithm": "Lesser of $13.77 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5236.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8145.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6981.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2210.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1745.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2327.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":11.68,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":12.5,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":12.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":12.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":12.85,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":12.38,"methodology":"case rate"}]}]},{"description":"PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J9266","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":82188.02,"maximum":110953.83,"gross_charge":136980.03,"discounted_cash":40546.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110953.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110953.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110953.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":89037.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95886.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82188.02,"methodology":"fee schedule"}]}]},{"description":"PEGASPARGASE 750 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"J9266","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":20547.01,"maximum":110953.83,"gross_charge":136980.03,"discounted_cash":40546.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":110953.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":110953.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":110953.83,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":87667.22,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27070.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":27070.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25781.46,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27524.57,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26267.9,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41385.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":26642.02,"standard_charge_algorithm": "Lesser of $26642.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":26642.02,"standard_charge_algorithm": "Lesser of $26642.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":61641.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":95886.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":82188.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26026.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":27396.01,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":20547.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":27396.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24202.14,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25896.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24928.2,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25412.25,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26622.35,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25654.27,"methodology":"case rate"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0137-01","type":"NDC"}],"standard_charges":[{"minimum":340.95,"maximum":460.28,"gross_charge":568.24,"discounted_cash":168.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":460.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":460.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":460.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":369.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":397.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":340.95,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0137-01","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":460.28,"gross_charge":568.24,"discounted_cash":168.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":460.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":460.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":460.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":363.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":255.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":397.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":340.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":107.97,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.65,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":85.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.65,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0613-59","type":"NDC"}],"standard_charges":[{"minimum":639.46,"maximum":863.27,"gross_charge":1065.76,"discounted_cash":315.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":863.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":863.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":863.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":692.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":746.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":639.46,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0613-59","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":863.27,"gross_charge":1065.76,"discounted_cash":315.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":863.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":863.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":863.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":682.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":479.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":746.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":639.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":202.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":213.16,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0342-50","type":"NDC"}],"standard_charges":[{"minimum":514.77,"maximum":694.94,"gross_charge":857.94,"discounted_cash":253.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":694.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":694.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":694.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":557.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":600.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":514.77,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0342-50","type":"NDC"}],"standard_charges":[{"minimum":0.12,"maximum":694.94,"gross_charge":857.94,"discounted_cash":253.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":694.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":694.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":694.94,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":549.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":386.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":600.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":514.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":171.59,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":405.94,"maximum":548.02,"gross_charge":676.56,"discounted_cash":200.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":439.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":473.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":405.94,"methodology":"fee schedule"}]}]},{"description":"PACLITAXEL 6 MG/ML CONCENTRATEINTRAVENOUS","code_information":[{"code":"J9267","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.12,"maximum":548.02,"gross_charge":676.56,"discounted_cash":200.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":548.02,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":433,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.12,"standard_charge_algorithm": "Lesser of $0.12 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":304.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":473.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":405.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":128.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":101.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":135.32,"methodology":"fee schedule"}]}]},{"description":"PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9271","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":25205.18,"maximum":34026.99,"gross_charge":42008.62,"discounted_cash":12434.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34026.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34026.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34026.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27305.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29406.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25205.18,"methodology":"fee schedule"}]}]},{"description":"PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9271","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":53.06,"maximum":34026.99,"gross_charge":42008.62,"discounted_cash":12434.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34026.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34026.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34026.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":26885.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":57.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":57.6,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":55.73,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":57.73,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.73,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.64,"standard_charge_algorithm": "Lesser of $61.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.64,"standard_charge_algorithm": "Lesser of $61.64 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18903.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29406.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25205.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7981.64,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8401.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6301.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8401.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.06,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.24,"methodology":"case rate"}]}]},{"description":"DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9272","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50177.71,"maximum":67739.91,"gross_charge":83629.51,"discounted_cash":24754.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67739.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67739.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67739.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":54359.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58540.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50177.71,"methodology":"fee schedule"}]}]},{"description":"DOSTARLIMAB-GXLY 50 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9272","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12544.43,"maximum":67739.91,"gross_charge":83629.51,"discounted_cash":24754.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":67739.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":67739.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":67739.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":53522.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":41814.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":41814.76,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":37633.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":58540.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":50177.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15889.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16725.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12544.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16725.91,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 20 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0108-11","type":"NDC"}],"standard_charges":[{"minimum":1045.92,"maximum":1412,"gross_charge":1743.2,"discounted_cash":515.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1412,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1412,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1412,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1133.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1220.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1045.92,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 20 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0108-11","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":1412,"gross_charge":1743.2,"discounted_cash":515.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1412,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1412,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1412,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1115.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":784.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1220.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1045.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":331.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":261.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":348.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 20 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0519-20","type":"NDC"}],"standard_charges":[{"minimum":518.51,"maximum":699.99,"gross_charge":864.18,"discounted_cash":255.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":561.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":604.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":518.51,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 20 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0519-20","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":699.99,"gross_charge":864.18,"discounted_cash":255.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":699.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":699.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":699.99,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":553.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":388.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":604.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":518.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":164.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":129.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":172.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 20 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":470.27,"maximum":634.86,"gross_charge":783.77,"discounted_cash":232,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":634.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":509.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":548.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 20 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":22.89,"maximum":634.86,"gross_charge":783.77,"discounted_cash":232,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":634.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":634.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":634.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":501.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":352.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":548.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":470.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":117.57,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":156.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0116-38","type":"NDC"}],"standard_charges":[{"minimum":1676.88,"maximum":2263.78,"gross_charge":2794.79,"discounted_cash":827.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2263.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2263.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2263.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1816.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1956.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1676.88,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0116-38","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":2263.78,"gross_charge":2794.79,"discounted_cash":827.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2263.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2263.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2263.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1788.67,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1257.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1956.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1676.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":531.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.96,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":419.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":558.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0568-00","type":"NDC"}],"standard_charges":[{"minimum":1359.24,"maximum":1834.98,"gross_charge":2265.4,"discounted_cash":670.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1834.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1834.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1834.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1472.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1585.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1359.24,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65219-0568-00","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":1834.98,"gross_charge":2265.4,"discounted_cash":670.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1834.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1834.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1834.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1449.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1019.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1585.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1359.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":430.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":339.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":453.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0520-40","type":"NDC"}],"standard_charges":[{"minimum":1123.74,"maximum":1517.05,"gross_charge":1872.89,"discounted_cash":554.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1517.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1517.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1517.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1217.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1311.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.74,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0520-40","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":1517.05,"gross_charge":1872.89,"discounted_cash":554.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1517.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1517.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1517.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1198.65,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":842.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1311.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1123.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":355.85,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":280.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":374.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":752.48,"maximum":1015.84,"gross_charge":1254.12,"discounted_cash":371.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":815.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":877.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":752.48,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 40 MG INTRAVENOUS SOLUTION","code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":22.89,"maximum":1015.84,"gross_charge":1254.12,"discounted_cash":371.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1015.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1015.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1015.84,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":802.64,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":564.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":877.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":752.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":238.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":250.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0115-05","type":"NDC"}],"standard_charges":[{"minimum":1209.08,"maximum":1632.26,"gross_charge":2015.13,"discounted_cash":596.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1632.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1632.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1632.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1309.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1410.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1209.08,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0115-05","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":1632.26,"gross_charge":2015.13,"discounted_cash":596.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1632.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1632.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1632.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1289.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":906.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1410.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1209.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":382.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":302.27,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":403.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0250-20","type":"NDC"}],"standard_charges":[{"minimum":452.12,"maximum":610.36,"gross_charge":753.52,"discounted_cash":223.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":489.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":527.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.12,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0250-20","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":610.36,"gross_charge":753.52,"discounted_cash":223.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":482.26,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":339.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":527.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.03,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0518-05","type":"NDC"}],"standard_charges":[{"minimum":452.42,"maximum":610.77,"gross_charge":754.03,"discounted_cash":223.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":490.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":527.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.42,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0518-05","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":610.77,"gross_charge":754.03,"discounted_cash":223.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":610.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":610.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":610.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":482.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":339.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":527.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":452.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":143.27,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.81,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":113.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":150.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0137-20","type":"NDC"}],"standard_charges":[{"minimum":889.29,"maximum":1200.54,"gross_charge":1482.14,"discounted_cash":438.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1200.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1200.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":963.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1037.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":889.29,"methodology":"fee schedule"}]}]},{"description":"MITOMYCIN 5 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0137-20","type":"NDC"}],"standard_charges":[{"minimum":22.89,"maximum":1200.54,"gross_charge":1482.14,"discounted_cash":438.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1200.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1200.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1200.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":948.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":46.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":63.35,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":55.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":64.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":39.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":61.35,"standard_charge_algorithm": "Lesser of $61.35 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":666.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1037.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":889.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":281.61,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":222.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":296.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":24.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":23.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":24.03,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":25.18,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":24.26,"methodology":"case rate"}]}]},{"description":"NIVOLUMAB 600 MG-HYALURONIDASE-NVHY 10000 UNIT/5 ML SUBCUT SOLUTION","code_information":[{"code":"J9289","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34540.17,"maximum":46629.23,"gross_charge":57566.95,"discounted_cash":17039.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37418.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40296.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34540.17,"methodology":"fee schedule"}]}]},{"description":"NIVOLUMAB 600 MG-HYALURONIDASE-NVHY 10000 UNIT/5 ML SUBCUT SOLUTION","code_information":[{"code":"J9289","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":8635.05,"maximum":46629.23,"gross_charge":57566.95,"discounted_cash":17039.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36842.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28783.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28783.48,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25905.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40296.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34540.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10937.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8635.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513.39,"methodology":"fee schedule"}]}]},{"description":"MITOXANTRONE 2 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9293","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0343-18","type":"NDC"}],"standard_charges":[{"minimum":569.72,"maximum":769.12,"gross_charge":949.52,"discounted_cash":281.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":769.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":769.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":769.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":617.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":664.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.72,"methodology":"fee schedule"}]}]},{"description":"MITOXANTRONE 2 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9293","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0343-18","type":"NDC"}],"standard_charges":[{"minimum":24.76,"maximum":769.12,"gross_charge":949.52,"discounted_cash":281.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":769.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":769.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":769.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":607.7,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":60.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.27,"standard_charge_algorithm": "Lesser of $60.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.27,"standard_charge_algorithm": "Lesser of $60.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":427.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":664.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":569.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":180.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":142.43,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.25,"methodology":"case rate"}]}]},{"description":"MITOXANTRONE 2 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9293","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0132-10","type":"NDC"}],"standard_charges":[{"minimum":742.52,"maximum":1002.4,"gross_charge":1237.53,"discounted_cash":366.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1002.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1002.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1002.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":804.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":866.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":742.52,"methodology":"fee schedule"}]}]},{"description":"MITOXANTRONE 2 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9293","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0132-10","type":"NDC"}],"standard_charges":[{"minimum":24.76,"maximum":1002.4,"gross_charge":1237.53,"discounted_cash":366.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1002.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1002.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1002.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":792.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":60.82,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":43.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.4,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.27,"standard_charge_algorithm": "Lesser of $60.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.27,"standard_charge_algorithm": "Lesser of $60.27 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":556.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":866.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":742.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":235.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":185.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":247.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.76,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.49,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.25,"methodology":"case rate"}]}]},{"description":"NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9299","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13969.79,"maximum":18859.21,"gross_charge":23282.97,"discounted_cash":6891.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18859.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18859.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18859.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15133.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16298.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13969.79,"methodology":"fee schedule"}]}]},{"description":"NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9299","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28.92,"maximum":18859.21,"gross_charge":23282.97,"discounted_cash":6891.76,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18859.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":18859.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":18859.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":14901.11,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.38,"standard_charge_algorithm": "Lesser of $33.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.38,"standard_charge_algorithm": "Lesser of $33.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10477.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16298.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":13969.79,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4423.77,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4656.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3492.45,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4656.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.66,"methodology":"case rate"}]}]},{"description":"NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9299","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":34540.17,"maximum":46629.23,"gross_charge":57566.94,"discounted_cash":17039.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37418.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40296.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34540.17,"methodology":"fee schedule"}]}]},{"description":"NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9299","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28.92,"maximum":46629.23,"gross_charge":57566.94,"discounted_cash":17039.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46629.23,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36842.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.38,"standard_charge_algorithm": "Lesser of $33.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.38,"standard_charge_algorithm": "Lesser of $33.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25905.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40296.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34540.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10937.72,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513.39,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8635.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11513.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.66,"methodology":"case rate"}]}]},{"description":"NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9299","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5724.95,"maximum":7728.68,"gross_charge":9541.58,"discounted_cash":2824.31,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7728.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7728.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7728.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6202.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6679.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5724.95,"methodology":"fee schedule"}]}]},{"description":"NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9299","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28.92,"maximum":7728.68,"gross_charge":9541.58,"discounted_cash":2824.31,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7728.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7728.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7728.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6106.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":32.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":32.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31.09,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":49.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33.38,"standard_charge_algorithm": "Lesser of $33.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33.38,"standard_charge_algorithm": "Lesser of $33.38 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4293.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6679.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5724.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1812.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1908.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1431.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1908.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":28.92,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":30.94,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":29.79,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":30.37,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":31.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":30.66,"methodology":"case rate"}]}]},{"description":"OBINUTUZUMAB 1000 MG/40 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0070-01","type":"NDC"}],"standard_charges":[{"minimum":35828.82,"maximum":48368.91,"gross_charge":59714.7,"discounted_cash":17675.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48368.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48368.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48368.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38814.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41800.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35828.82,"methodology":"fee schedule"}]}]},{"description":"OBINUTUZUMAB 1000 MG/40 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9301","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0070-01","type":"NDC"}],"standard_charges":[{"minimum":67.24,"maximum":48368.91,"gross_charge":59714.7,"discounted_cash":17675.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":48368.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":48368.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":48368.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38217.41,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":74.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":74.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.34,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":75.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71.67,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":114.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":76.11,"standard_charge_algorithm": "Lesser of $76.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":76.11,"standard_charge_algorithm": "Lesser of $76.11 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26871.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41800.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35828.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11345.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11942.94,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8957.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11942.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":67.24,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":71.95,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":69.26,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":70.6,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":73.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":71.27,"methodology":"case rate"}]}]},{"description":"PANITUMUMAB 20 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9303","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0954-01","type":"NDC"}],"standard_charges":[{"minimum":7270.83,"maximum":9815.62,"gross_charge":12118.04,"discounted_cash":3586.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9815.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9815.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9815.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7876.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8482.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7270.83,"methodology":"fee schedule"}]}]},{"description":"PANITUMUMAB 20 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9303","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0954-01","type":"NDC"}],"standard_charges":[{"minimum":147.45,"maximum":9815.62,"gross_charge":12118.04,"discounted_cash":3586.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9815.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9815.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9815.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7755.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":165.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":165.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":150.66,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":161.68,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":153.5,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":252.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":157.83,"standard_charge_algorithm": "Lesser of $157.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":157.83,"standard_charge_algorithm": "Lesser of $157.83 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5453.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8482.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7270.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2302.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2423.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1817.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2423.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":147.45,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":157.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":151.87,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":154.82,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":162.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":156.3,"methodology":"case rate"}]}]},{"description":"PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0166-10","type":"NDC"}],"standard_charges":[{"minimum":273.45,"maximum":369.15,"gross_charge":455.74,"discounted_cash":134.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":296.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":319.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":273.45,"methodology":"fee schedule"}]}]},{"description":"PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0166-10","type":"NDC"}],"standard_charges":[{"minimum":3.37,"maximum":369.15,"gross_charge":455.74,"discounted_cash":134.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":369.15,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":291.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":205.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":319.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":273.45,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":86.6,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.15,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":91.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.57,"methodology":"case rate"}]}]},{"description":"PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0166-92","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0166-92","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":5.76,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.57,"methodology":"case rate"}]}]},{"description":"PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3684.08,"maximum":4973.51,"gross_charge":6140.13,"discounted_cash":1817.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4973.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4973.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4973.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3991.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4298.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3684.08,"methodology":"fee schedule"}]}]},{"description":"PEMETREXED DISODIUM 100 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.37,"maximum":4973.51,"gross_charge":6140.13,"discounted_cash":1817.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4973.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4973.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4973.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3929.69,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2763.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4298.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3684.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1166.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":921.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1228.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.57,"methodology":"case rate"}]}]},{"description":"PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0167-96","type":"NDC"}],"standard_charges":[{"minimum":422.77,"maximum":570.74,"gross_charge":704.61,"discounted_cash":208.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":458,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":493.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":422.77,"methodology":"fee schedule"}]}]},{"description":"PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"71288-0167-96","type":"NDC"}],"standard_charges":[{"minimum":3.37,"maximum":570.74,"gross_charge":704.61,"discounted_cash":208.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":570.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":570.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":570.74,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":450.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":317.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":493.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":422.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":133.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":140.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.57,"methodology":"case rate"}]}]},{"description":"PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":17506.92,"maximum":23634.34,"gross_charge":29178.19,"discounted_cash":8636.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23634.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23634.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23634.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18965.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20424.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17506.92,"methodology":"fee schedule"}]}]},{"description":"PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION","code_information":[{"code":"J9305","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.37,"maximum":23634.34,"gross_charge":29178.19,"discounted_cash":8636.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23634.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23634.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23634.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18674.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":5.27,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":5.76,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":53.95,"standard_charge_algorithm": "Lesser of $53.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13130.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20424.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17506.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5543.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5835.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4376.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5835.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":3.37,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":3.61,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":3.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":3.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":3.71,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":3.57,"methodology":"case rate"}]}]},{"description":"PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9306","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0145-01","type":"NDC"}],"standard_charges":[{"minimum":28986.08,"maximum":39131.21,"gross_charge":48310.13,"discounted_cash":14299.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39131.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39131.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39131.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31401.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33817.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28986.08,"methodology":"fee schedule"}]}]},{"description":"PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9306","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0145-01","type":"NDC"}],"standard_charges":[{"minimum":14.51,"maximum":39131.21,"gross_charge":48310.13,"discounted_cash":14299.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":39131.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":39131.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":39131.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30918.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":16.19,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":15.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":16.32,"standard_charge_algorithm": "Lesser of $16.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":16.32,"standard_charge_algorithm": "Lesser of $16.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21739.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33817.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28986.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9178.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9662.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7246.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9662.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.51,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.95,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":15.24,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.96,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.38,"methodology":"case rate"}]}]},{"description":"RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9308","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6521.31,"maximum":8803.77,"gross_charge":10868.84,"discounted_cash":3217.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7064.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6521.31,"methodology":"fee schedule"}]}]},{"description":"RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9308","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.59,"maximum":8803.77,"gross_charge":10868.84,"discounted_cash":3217.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8803.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8803.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8803.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6956.06,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":72.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":112.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":74.15,"standard_charge_algorithm": "Lesser of $74.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":74.15,"standard_charge_algorithm": "Lesser of $74.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4890.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7608.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6521.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2065.08,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1630.33,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2173.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":70.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":67.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":72.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":69.53,"methodology":"case rate"}]}]},{"description":"RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9308","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":31693.04,"maximum":42785.6,"gross_charge":52821.72,"discounted_cash":15635.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42785.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42785.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42785.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":34334.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":36975.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31693.04,"methodology":"fee schedule"}]}]},{"description":"RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9308","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":65.59,"maximum":42785.6,"gross_charge":52821.72,"discounted_cash":15635.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42785.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42785.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42785.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":33805.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":72.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":72.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":70.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":72.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":71.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":112.16,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":74.15,"standard_charge_algorithm": "Lesser of $74.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":74.15,"standard_charge_algorithm": "Lesser of $74.15 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23769.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":36975.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":31693.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10036.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10564.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7923.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10564.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":65.59,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":70.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":67.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":68.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":72.15,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":69.53,"methodology":"case rate"}]}]},{"description":"RITUXIMAB 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0051-21","type":"NDC"}],"standard_charges":[{"minimum":2405.96,"maximum":3248.04,"gross_charge":4009.92,"discounted_cash":1186.94,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3248.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3248.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3248.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2606.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2806.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2405.96,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0051-21","type":"NDC"}],"standard_charges":[{"minimum":68.33,"maximum":3248.04,"gross_charge":4009.92,"discounted_cash":1186.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3248.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3248.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3248.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2566.35,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":76.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":80.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":116.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":92.95,"standard_charge_algorithm": "Lesser of $92.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92.95,"standard_charge_algorithm": "Lesser of $92.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1804.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2806.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2405.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":761.89,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":601.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":801.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":68.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":73.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":70.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":71.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":75.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":72.43,"methodology":"case rate"}]}]},{"description":"RITUXIMAB 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0053-06","type":"NDC"}],"standard_charges":[{"minimum":11898.62,"maximum":16063.13,"gross_charge":19831.02,"discounted_cash":5869.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16063.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16063.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16063.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12890.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13881.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11898.62,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0053-06","type":"NDC"}],"standard_charges":[{"minimum":68.33,"maximum":16063.13,"gross_charge":19831.02,"discounted_cash":5869.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16063.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16063.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16063.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12691.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":76.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":76.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":79.2,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.14,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":80.7,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":116.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":92.95,"standard_charge_algorithm": "Lesser of $92.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":92.95,"standard_charge_algorithm": "Lesser of $92.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8923.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13881.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11898.62,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3767.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3966.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2974.66,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3966.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":68.33,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":73.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":70.38,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":71.75,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":75.16,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":72.43,"methodology":"case rate"}]}]},{"description":"SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9317","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55135-0132-01","type":"NDC"}],"standard_charges":[{"minimum":11084.84,"maximum":14964.54,"gross_charge":18474.73,"discounted_cash":5468.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14964.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14964.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14964.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12008.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12932.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11084.84,"methodology":"fee schedule"}]}]},{"description":"SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9317","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55135-0132-01","type":"NDC"}],"standard_charges":[{"minimum":32.01,"maximum":14964.54,"gross_charge":18474.73,"discounted_cash":5468.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14964.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14964.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14964.54,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11823.83,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":35.44,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":34.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":54.74,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.19,"standard_charge_algorithm": "Lesser of $36.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.19,"standard_charge_algorithm": "Lesser of $36.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8313.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12932.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11084.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3510.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3694.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2771.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3694.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":32.01,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":34.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":33.61,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":35.21,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":33.93,"methodology":"case rate"}]}]},{"description":"ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9319","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59572-0984-01","type":"NDC"}],"standard_charges":[{"minimum":14321.96,"maximum":19334.65,"gross_charge":23869.93,"discounted_cash":7065.5,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19334.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19334.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19334.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15515.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16708.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14321.96,"methodology":"fee schedule"}]}]},{"description":"ROMIDEPSIN 10 MG/2 ML INTRAVENOUS POWDER FOR SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9319","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59572-0984-01","type":"NDC"}],"standard_charges":[{"minimum":3580.49,"maximum":19334.65,"gross_charge":23869.93,"discounted_cash":7065.5,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":19334.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":19334.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":19334.65,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":15276.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":11934.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":11934.97,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":10741.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":16708.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":14321.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4535.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4773.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3580.49,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4773.99,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 0.16 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"88823-0529-50","type":"NDC"}],"standard_charges":[{"minimum":171560.13,"maximum":231606.17,"gross_charge":285933.54,"discounted_cash":84636.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231606.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":231606.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231606.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":185856.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":200153.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171560.13,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 0.16 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"88823-0529-50","type":"NDC"}],"standard_charges":[{"minimum":42890.04,"maximum":231606.17,"gross_charge":285933.54,"discounted_cash":84636.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":231606.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":231606.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":231606.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":182997.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":142966.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":142966.77,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":128670.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":200153.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171560.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54327.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57186.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42890.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57186.71,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 0.8 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"88823-0529-30","type":"NDC"}],"standard_charges":[{"minimum":34481.2,"maximum":46549.62,"gross_charge":57468.66,"discounted_cash":17010.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46549.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46549.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46549.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37354.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40228.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34481.2,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 0.8 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"88823-0529-30","type":"NDC"}],"standard_charges":[{"minimum":8620.3,"maximum":46549.62,"gross_charge":57468.66,"discounted_cash":17010.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":46549.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":46549.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":46549.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":36779.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28734.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28734.33,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":25860.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40228.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34481.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":10919.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11493.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8620.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11493.74,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"82705-0002-01","type":"NDC"}],"standard_charges":[{"minimum":5776.86,"maximum":7798.77,"gross_charge":9628.1,"discounted_cash":2849.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7798.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7798.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7798.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6258.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6739.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5776.86,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 4 MG/0.8 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"82705-0002-01","type":"NDC"}],"standard_charges":[{"minimum":1444.22,"maximum":7798.77,"gross_charge":9628.1,"discounted_cash":2849.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7798.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7798.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7798.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6161.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4814.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4814.05,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4332.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6739.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5776.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1829.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.22,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.62,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"82705-0010-01","type":"NDC"}],"standard_charges":[{"minimum":66996.21,"maximum":90444.89,"gross_charge":111660.35,"discounted_cash":33051.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90444.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90444.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90444.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":72579.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78162.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66996.21,"methodology":"fee schedule"}]}]},{"description":"EPCORITAMAB-BYSP 48 MG/0.8 ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"82705-0010-01","type":"NDC"}],"standard_charges":[{"minimum":16749.06,"maximum":90444.89,"gross_charge":111660.35,"discounted_cash":33051.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":90444.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":90444.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":90444.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71462.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":55830.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":55830.18,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50247.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78162.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":66996.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21215.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22332.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16749.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22332.07,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0980-79","type":"NDC"}],"standard_charges":[{"minimum":26683.56,"maximum":36022.8,"gross_charge":44472.59,"discounted_cash":13163.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36022.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36022.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36022.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28907.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31130.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26683.56,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0980-79","type":"NDC"}],"standard_charges":[{"minimum":6670.89,"maximum":36022.8,"gross_charge":44472.59,"discounted_cash":13163.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36022.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36022.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36022.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28462.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":22236.3,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":22236.3,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20012.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31130.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26683.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8449.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8894.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6670.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8894.52,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0981-83","type":"NDC"}],"standard_charges":[{"minimum":39919.61,"maximum":53891.47,"gross_charge":66532.67,"discounted_cash":19693.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53891.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53891.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53891.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43246.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46572.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39919.61,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0981-83","type":"NDC"}],"standard_charges":[{"minimum":9979.91,"maximum":53891.47,"gross_charge":66532.67,"discounted_cash":19693.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53891.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53891.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53891.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42580.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":33266.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":33266.34,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29939.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":46572.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39919.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12641.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13306.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9979.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13306.54,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0982-84","type":"NDC"}],"standard_charges":[{"minimum":53155.65,"maximum":71760.13,"gross_charge":88592.75,"discounted_cash":26223.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71760.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71760.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71760.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":57585.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62014.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53155.65,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0982-84","type":"NDC"}],"standard_charges":[{"minimum":13288.92,"maximum":71760.13,"gross_charge":88592.75,"discounted_cash":26223.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":71760.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":71760.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":71760.13,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":56699.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44296.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44296.38,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":39866.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":62014.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":53155.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":16832.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":17718.55,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13288.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":17718.55,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0983-86","type":"NDC"}],"standard_charges":[{"minimum":79627.74,"maximum":107497.45,"gross_charge":132712.9,"discounted_cash":39283.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107497.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107497.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107497.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":86263.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92899.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79627.74,"methodology":"fee schedule"}]}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50474-0983-86","type":"NDC"}],"standard_charges":[{"minimum":19906.94,"maximum":107497.45,"gross_charge":132712.9,"discounted_cash":39283.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":107497.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":107497.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":107497.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84936.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":66356.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":66356.45,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":59720.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":92899.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":79627.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":25215.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26542.58,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19906.94,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26542.58,"methodology":"fee schedule"}]}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9350","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0159-01","type":"NDC"}],"standard_charges":[{"minimum":2885.12,"maximum":3894.91,"gross_charge":4808.53,"discounted_cash":1423.33,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3894.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3894.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3894.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3125.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3365.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2885.12,"methodology":"fee schedule"}]}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9350","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0159-01","type":"NDC"}],"standard_charges":[{"minimum":721.28,"maximum":3894.91,"gross_charge":4808.53,"discounted_cash":1423.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3894.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3894.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3894.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3077.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2404.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2404.27,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2163.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3365.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2885.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":913.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":721.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":961.71,"methodology":"fee schedule"}]}]},{"description":"TOPOTECAN 1 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9351","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0151-31","type":"NDC"}],"standard_charges":[{"minimum":550.9,"maximum":743.71,"gross_charge":918.16,"discounted_cash":271.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":596.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":642.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":550.9,"methodology":"fee schedule"}]}]},{"description":"TOPOTECAN 1 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9351","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16729-0151-31","type":"NDC"}],"standard_charges":[{"minimum":1.25,"maximum":743.71,"gross_charge":918.16,"discounted_cash":271.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":743.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":743.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":743.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":587.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":413.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":642.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":550.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":174.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":137.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":183.64,"methodology":"fee schedule"}]}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9351","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":328.22,"maximum":443.09,"gross_charge":547.02,"discounted_cash":161.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":355.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":382.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":328.22,"methodology":"fee schedule"}]}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"J9351","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.25,"maximum":443.09,"gross_charge":547.02,"discounted_cash":161.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":443.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":443.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":443.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":350.1,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.25,"standard_charge_algorithm": "Lesser of $1.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":246.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":382.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":328.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":103.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":82.06,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.41,"methodology":"fee schedule"}]}]},{"description":"TRABECTEDIN 0.05 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9352","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12853.01,"maximum":17351.57,"gross_charge":21421.68,"discounted_cash":6340.82,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17351.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17351.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17351.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13924.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14995.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12853.01,"methodology":"fee schedule"}]}]},{"description":"TRABECTEDIN 0.05 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"J9352","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":325.28,"maximum":17351.57,"gross_charge":21421.68,"discounted_cash":6340.82,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17351.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17351.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17351.57,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13709.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":362.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":338.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":344.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":556.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":374.98,"standard_charge_algorithm": "Lesser of $374.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":374.98,"standard_charge_algorithm": "Lesser of $374.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9639.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14995.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12853.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4070.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4284.34,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3213.26,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4284.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":325.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":348.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":335.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":341.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":357.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":344.8,"methodology":"case rate"}]}]},{"description":"TRABECTEDIN 1 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9352","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0610-01","type":"NDC"}],"standard_charges":[{"minimum":15420.54,"maximum":20817.73,"gross_charge":25700.89,"discounted_cash":7607.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20817.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20817.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20817.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16705.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17990.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15420.54,"methodology":"fee schedule"}]}]},{"description":"TRABECTEDIN 1 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9352","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0610-01","type":"NDC"}],"standard_charges":[{"minimum":325.28,"maximum":20817.73,"gross_charge":25700.89,"discounted_cash":7607.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20817.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20817.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20817.73,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16448.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":362.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":362.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":338.4,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":362.07,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":344.78,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":556.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":374.98,"standard_charge_algorithm": "Lesser of $374.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":374.98,"standard_charge_algorithm": "Lesser of $374.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11565.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17990.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15420.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4883.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5140.18,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3855.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5140.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":325.28,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":348.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":335.04,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":341.54,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":357.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":344.8,"methodology":"case rate"}]}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0088-01","type":"NDC"}],"standard_charges":[{"minimum":17375.84,"maximum":23457.38,"gross_charge":28959.72,"discounted_cash":8572.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23457.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23457.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23457.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18823.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20271.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17375.84,"methodology":"fee schedule"}]}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0088-01","type":"NDC"}],"standard_charges":[{"minimum":36.75,"maximum":23457.38,"gross_charge":28959.72,"discounted_cash":8572.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23457.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":23457.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":23457.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":18534.23,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":62.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.33,"standard_charge_algorithm": "Lesser of $40.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.33,"standard_charge_algorithm": "Lesser of $40.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13031.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":20271.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":17375.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5502.35,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5791.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4343.96,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5791.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":37.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38.95,"methodology":"case rate"}]}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0087-01","type":"NDC"}],"standard_charges":[{"minimum":27664.27,"maximum":37346.76,"gross_charge":46107.11,"discounted_cash":13647.71,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37346.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37346.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37346.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29969.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32274.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27664.27,"methodology":"fee schedule"}]}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9354","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0087-01","type":"NDC"}],"standard_charges":[{"minimum":36.75,"maximum":37346.76,"gross_charge":46107.11,"discounted_cash":13647.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37346.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37346.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37346.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29508.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":40.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":38.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":40.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":39.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":62.84,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":40.33,"standard_charge_algorithm": "Lesser of $40.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":40.33,"standard_charge_algorithm": "Lesser of $40.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20748.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32274.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27664.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8760.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9221.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6916.07,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9221.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":36.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":39.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":37.85,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":38.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":40.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":38.95,"methodology":"case rate"}]}]},{"description":"TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9355","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0132-01","type":"NDC"}],"standard_charges":[{"minimum":7094.94,"maximum":9578.17,"gross_charge":11824.89,"discounted_cash":3500.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9578.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9578.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9578.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7686.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8277.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7094.94,"methodology":"fee schedule"}]}]},{"description":"TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9355","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0132-01","type":"NDC"}],"standard_charges":[{"minimum":67.67,"maximum":9578.17,"gross_charge":11824.89,"discounted_cash":3500.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9578.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9578.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9578.17,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7567.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":77.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":80.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":115.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95.37,"standard_charge_algorithm": "Lesser of $95.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":95.37,"standard_charge_algorithm": "Lesser of $95.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5321.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8277.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7094.94,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2246.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2364.98,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1773.74,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2364.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":67.67,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":72.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":69.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":71.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":74.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":71.73,"methodology":"case rate"}]}]},{"description":"TRASTUZUMAB 21 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9355","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0134-68","type":"NDC"}],"standard_charges":[{"minimum":18660.96,"maximum":25192.3,"gross_charge":31101.6,"discounted_cash":9206.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25192.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25192.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25192.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20216.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21771.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18660.96,"methodology":"fee schedule"}]}]},{"description":"TRASTUZUMAB 21 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9355","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0134-68","type":"NDC"}],"standard_charges":[{"minimum":67.67,"maximum":25192.3,"gross_charge":31101.6,"discounted_cash":9206.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":25192.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":25192.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":25192.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":19905.03,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":77.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":77.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":80.47,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":79.55,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":81.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":115.72,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":95.37,"standard_charge_algorithm": "Lesser of $95.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":95.37,"standard_charge_algorithm": "Lesser of $95.37 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":13995.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":21771.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":18660.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":5909.31,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6220.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4665.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6220.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":67.67,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":72.41,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":69.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":71.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":74.44,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":71.73,"methodology":"case rate"}]}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24201-0101-04","type":"NDC"}],"standard_charges":[{"minimum":6287.51,"maximum":8488.14,"gross_charge":10479.18,"discounted_cash":3101.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8488.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8488.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8488.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6811.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7335.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6287.51,"methodology":"fee schedule"}]}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"24201-0101-04","type":"NDC"}],"standard_charges":[{"minimum":1291.49,"maximum":8488.14,"gross_charge":10479.18,"discounted_cash":3101.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8488.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8488.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8488.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6706.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1392.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1392.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1363.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1481.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1389.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2208.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1451.59,"standard_charge_algorithm": "Lesser of $1451.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1451.59,"standard_charge_algorithm": "Lesser of $1451.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4715.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7335.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6287.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1991.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2095.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1571.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2095.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1291.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1381.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1330.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1356.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1420.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1368.98,"methodology":"case rate"}]}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67979-0001-01","type":"NDC"}],"standard_charges":[{"minimum":7781.99,"maximum":10505.68,"gross_charge":12969.97,"discounted_cash":3839.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10505.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10505.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10505.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8430.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9078.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7781.99,"methodology":"fee schedule"}]}]},{"description":"VALRUBICIN 40 MG/ML INTRAVESICAL SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9357","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67979-0001-01","type":"NDC"}],"standard_charges":[{"minimum":1291.49,"maximum":10505.68,"gross_charge":12969.97,"discounted_cash":3839.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10505.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10505.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10505.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8300.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1392.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1392.52,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1363.85,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1481.23,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1389.58,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":2208.45,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1451.59,"standard_charge_algorithm": "Lesser of $1451.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1451.59,"standard_charge_algorithm": "Lesser of $1451.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5836.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9078.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7781.99,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2464.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1945.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2594,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":1291.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":1381.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":1330.23,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":1356.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":1420.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":1368.98,"methodology":"case rate"}]}]},{"description":"VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0278-10","type":"NDC"}],"standard_charges":[{"minimum":436.96,"maximum":589.9,"gross_charge":728.26,"discounted_cash":215.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":473.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":509.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.96,"methodology":"fee schedule"}]}]},{"description":"VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9360","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0278-10","type":"NDC"}],"standard_charges":[{"minimum":4.42,"maximum":589.9,"gross_charge":728.26,"discounted_cash":215.57,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":466.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4.42,"standard_charge_algorithm": "Lesser of $4.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4.42,"standard_charge_algorithm": "Lesser of $4.42 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":327.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":509.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.66,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.66,"methodology":"fee schedule"}]}]},{"description":"VINCRISTINE 1 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0309-06","type":"NDC"}],"standard_charges":[{"minimum":283.89,"maximum":383.25,"gross_charge":473.14,"discounted_cash":140.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":307.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":331.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.89,"methodology":"fee schedule"}]}]},{"description":"VINCRISTINE 1 MG/ML CHEMO INJECTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0309-06","type":"NDC"}],"standard_charges":[{"minimum":5.51,"maximum":383.25,"gross_charge":473.14,"discounted_cash":140.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":383.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":383.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":383.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":302.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.51,"standard_charge_algorithm": "Lesser of $5.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.51,"standard_charge_algorithm": "Lesser of $5.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":212.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":331.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.63,"methodology":"fee schedule"}]}]},{"description":"VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0309-16","type":"NDC"}],"standard_charges":[{"minimum":283.67,"maximum":382.96,"gross_charge":472.78,"discounted_cash":139.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":307.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":330.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.67,"methodology":"fee schedule"}]}]},{"description":"VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9370","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"61703-0309-16","type":"NDC"}],"standard_charges":[{"minimum":5.51,"maximum":382.96,"gross_charge":472.78,"discounted_cash":139.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":382.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":382.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":382.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":302.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":5.51,"standard_charge_algorithm": "Lesser of $5.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":5.51,"standard_charge_algorithm": "Lesser of $5.51 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":212.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":330.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":283.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":89.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":70.92,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.56,"methodology":"fee schedule"}]}]},{"description":"TEPLIZUMAB-MZWV 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9381","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"73650-0316-14","type":"NDC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"TEPLIZUMAB-MZWV 1 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9381","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"73650-0316-14","type":"NDC"}],"standard_charges":[{"minimum":0.04,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9390","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0204-01","type":"NDC"}],"standard_charges":[{"minimum":286.18,"maximum":386.34,"gross_charge":476.96,"discounted_cash":141.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":386.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":386.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":310.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":333.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":286.18,"methodology":"fee schedule"}]}]},{"description":"VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9390","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0204-01","type":"NDC"}],"standard_charges":[{"minimum":10.49,"maximum":386.34,"gross_charge":476.96,"discounted_cash":141.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":386.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":386.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":386.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":305.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":214.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":333.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":286.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":95.4,"methodology":"fee schedule"}]}]},{"description":"VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9390","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0204-05","type":"NDC"}],"standard_charges":[{"minimum":436.56,"maximum":589.35,"gross_charge":727.59,"discounted_cash":215.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":472.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":509.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.56,"methodology":"fee schedule"}]}]},{"description":"VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"J9390","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0204-05","type":"NDC"}],"standard_charges":[{"minimum":10.49,"maximum":589.35,"gross_charge":727.59,"discounted_cash":215.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":589.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":589.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":589.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":465.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.49,"standard_charge_algorithm": "Lesser of $10.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":327.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":509.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":436.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":138.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":109.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":145.52,"methodology":"fee schedule"}]}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE","code_information":[{"code":"J9395","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":4372.05,"maximum":5902.26,"gross_charge":7286.74,"discounted_cash":2156.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5902.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5902.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5902.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4736.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5100.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4372.05,"methodology":"fee schedule"}]}]},{"description":"FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE","code_information":[{"code":"J9395","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.16,"maximum":5902.26,"gross_charge":7286.74,"discounted_cash":2156.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":5902.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":5902.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":5902.26,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":4663.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":6.66,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":8.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":10.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.49,"standard_charge_algorithm": "Lesser of $12.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.49,"standard_charge_algorithm": "Lesser of $12.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3279.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5100.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4372.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1384.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1457.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1093.02,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1457.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.16,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":6.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.34,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":6.47,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":6.78,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":6.53,"methodology":"case rate"}]}]},{"description":"HC SYRINGE COAPTITE 1ML 890300","code_information":[{"code":"L8606","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":479.4,"maximum":647.19,"gross_charge":799,"discounted_cash":236.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":647.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":647.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":647.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":519.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":559.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":479.4,"methodology":"fee schedule"}]}]},{"description":"HC SYRINGE COAPTITE 1ML 890300","code_information":[{"code":"L8606","type":"HCPCS"},{"code":"0278","type":"RC"}],"standard_charges":[{"minimum":119.85,"maximum":647.19,"gross_charge":799,"discounted_cash":236.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":647.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":647.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":647.19,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":511.36,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":269.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":279.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":319.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":359.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":559.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":479.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":151.81,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":119.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":159.8,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB ADMIN COVID 1ST","code_information":[{"code":"M0249","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":1501.74,"maximum":1501.74,"gross_charge":1854,"discounted_cash":548.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1501.74,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB ADMIN COVID 1ST","code_information":[{"code":"M0249","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":278.1,"maximum":1501.74,"gross_charge":1854,"discounted_cash":548.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.8,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB ADMIN COVID 2ND","code_information":[{"code":"M0250","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":1501.74,"maximum":1501.74,"gross_charge":1854,"discounted_cash":548.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1501.74,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB ADMIN COVID 2ND","code_information":[{"code":"M0250","type":"HCPCS"},{"code":"0771","type":"RC"}],"standard_charges":[{"minimum":278.1,"maximum":1501.74,"gross_charge":1854,"discounted_cash":548.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1501.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":352.26,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":278.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":370.8,"methodology":"fee schedule"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"Other Inpatient","type":"LOCAL"}],"standard_charges":[{"minimum":1419,"maximum":1419,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":1419,"methodology":"per diem"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":1419,"methodology":"per diem"}]}]},{"description":"NO ACTIVE CODE DESCRIPTION","code_information":[{"code":"Other Outpatient","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_percentage":81,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_percentage":48,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_percentage":56,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_percentage":64,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_percentage":65,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_percentage":65,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_percentage":19,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_percentage":15,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_percentage":20,"count":"0","methodology":"percent of total billed charges", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]},{"description":"HC LAB CRYOPRECIPITATE","code_information":[{"code":"P9012","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":312.66,"maximum":312.66,"gross_charge":386,"discounted_cash":114.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.66,"methodology":"fee schedule"}]}]},{"description":"HC LAB CRYOPRECIPITATE","code_information":[{"code":"P9012","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":56.83,"maximum":312.66,"gross_charge":386,"discounted_cash":114.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":139.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":139.17,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":91.67,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":211.43,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":222.15,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":97.18,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":77.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":60.81,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":58.53,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":59.67,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":62.51,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":60.24,"methodology":"case rate"}]}]},{"description":"HC LAB LEUKOREDUCED RBC","code_information":[{"code":"P9016","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":762.21,"maximum":762.21,"gross_charge":941,"discounted_cash":278.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":762.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":762.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":762.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB LEUKOREDUCED RBC","code_information":[{"code":"P9016","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":141.15,"maximum":790.86,"gross_charge":941,"discounted_cash":278.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":762.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":762.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":762.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":398.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":398.46,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":276.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":790.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":646.51,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":278.25,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":178.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":188.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":162.72,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":174.11,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":167.6,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":170.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":178.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":172.48,"methodology":"case rate"}]}]},{"description":"COVID-19 CONVALESCENT PLASMA","code_information":[{"code":"P9017","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":686.07,"maximum":686.07,"gross_charge":847,"discounted_cash":250.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":686.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":686.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":686.07,"methodology":"fee schedule"}]}]},{"description":"COVID-19 CONVALESCENT PLASMA","code_information":[{"code":"P9017","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":75.36,"maximum":686.07,"gross_charge":847,"discounted_cash":250.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":686.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":686.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":686.07,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":184.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":122.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":306.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":268.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":128.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":160.93,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":169.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":75.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":80.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":77.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":79.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":82.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":79.88,"methodology":"case rate"}]}]},{"description":"HC LAB PLASMA","code_information":[{"code":"P9017","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":244.62,"maximum":244.62,"gross_charge":302,"discounted_cash":89.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":244.62,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLASMA","code_information":[{"code":"P9017","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":45.3,"maximum":306.15,"gross_charge":302,"discounted_cash":89.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":244.62,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":184.54,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":122.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":306.15,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":268.35,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":128.87,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":45.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":60.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":75.36,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":80.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":77.62,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":79.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":82.9,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":79.88,"methodology":"case rate"}]}]},{"description":"WHOLE BLD PLTS LR EA UNIT","code_information":[{"code":"P9031","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":564.57,"maximum":564.57,"gross_charge":697,"discounted_cash":206.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":564.57,"methodology":"fee schedule"}]}]},{"description":"WHOLE BLD PLTS LR EA UNIT","code_information":[{"code":"P9031","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":104.55,"maximum":584.69,"gross_charge":697,"discounted_cash":206.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":564.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":275.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":275.36,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":200.42,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":584.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":400.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":192.27,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":132.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":104.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":112.44,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":120.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":115.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":118.06,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":123.68,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":119.19,"methodology":"case rate"}]}]},{"description":"HC LAB IRRADIATED PLATELETS","code_information":[{"code":"P9032","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":3597.21,"maximum":3597.21,"gross_charge":4441,"discounted_cash":1314.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3597.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3597.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3597.21,"methodology":"fee schedule"}]}]},{"description":"HC LAB IRRADIATED PLATELETS","code_information":[{"code":"P9032","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":121.39,"maximum":3597.21,"gross_charge":4441,"discounted_cash":1314.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3597.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3597.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3597.21,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":297.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":204.22,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":735.77,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":570.94,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":207.58,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":843.79,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":666.15,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":888.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":121.39,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":129.89,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":125.03,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":127.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":133.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":128.67,"methodology":"case rate"}]}]},{"description":"WHOLE BLD PLTS LR IR EA UNIT","code_information":[{"code":"P9033","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":792.99,"maximum":792.99,"gross_charge":979,"discounted_cash":289.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":792.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":792.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":792.99,"methodology":"fee schedule"}]}]},{"description":"WHOLE BLD PLTS LR IR EA UNIT","code_information":[{"code":"P9033","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":146.85,"maximum":792.99,"gross_charge":979,"discounted_cash":289.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":792.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":792.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":792.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":449.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":449.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":353.16,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":715.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":545.21,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":314.01,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":186.01,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":146.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":195.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":183.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":196.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":189.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":192.81,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":201.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":194.65,"methodology":"case rate"}]}]},{"description":"HC LAB PLATELETS PHERESIS","code_information":[{"code":"P9034","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2812.32,"maximum":2812.32,"gross_charge":3472,"discounted_cash":1027.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2812.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2812.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2812.32,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLATELETS PHERESIS","code_information":[{"code":"P9034","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":2812.32,"gross_charge":3472,"discounted_cash":1027.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2812.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2812.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2812.32,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":869.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":869.45,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":492.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1442.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1363.53,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":607.14,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":659.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":520.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":694.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":355.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":379.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":365.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":372.8,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":390.56,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":376.35,"methodology":"case rate"}]}]},{"description":"HC LAB PLATELETS PHERESIS LR","code_information":[{"code":"P9035","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2911.14,"maximum":2911.14,"gross_charge":3594,"discounted_cash":1063.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2911.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2911.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2911.14,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLATELETS PHERESIS LR","code_information":[{"code":"P9035","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":2911.14,"gross_charge":3594,"discounted_cash":1063.83,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2911.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2911.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2911.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1066.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1066.43,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":723.3,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2081.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1693.92,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":744.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":539.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":718.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":435.49,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":465.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":448.55,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":457.26,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":479.04,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":461.62,"methodology":"case rate"}]}]},{"description":"HC LAB PLATELETS PHRESIS IRRAD","code_information":[{"code":"P9036","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":3033.45,"maximum":3033.45,"gross_charge":3745,"discounted_cash":1108.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3033.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3033.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3033.45,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLATELETS PHRESIS IRRAD","code_information":[{"code":"P9036","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":3033.45,"gross_charge":3745,"discounted_cash":1108.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3033.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3033.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3033.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1286.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1286.56,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":857.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2366.45,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1980.34,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":898.4,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":711.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":749,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":561.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":749,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":525.38,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":562.16,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":541.14,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":551.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":577.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":556.9,"methodology":"case rate"}]}]},{"description":"HC LAB PLATELETS PHRESIS LR IR","code_information":[{"code":"P9037","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":3901.77,"maximum":3901.77,"gross_charge":4817,"discounted_cash":1425.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3901.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3901.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3901.77,"methodology":"fee schedule"}]}]},{"description":"HC LAB PLATELETS PHRESIS LR IR","code_information":[{"code":"P9037","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":3901.77,"gross_charge":4817,"discounted_cash":1425.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3901.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3901.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3901.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1479.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1479.24,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1029.79,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2674.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2270.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1032.96,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":915.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":722.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":963.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":604.07,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":646.35,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":622.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":634.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":664.48,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":640.31,"methodology":"case rate"}]}]},{"description":"HC LAB RED BLOOD CELLS LR IR","code_information":[{"code":"P9040","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":1562.49,"maximum":1562.49,"gross_charge":1929,"discounted_cash":570.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"fee schedule"}]}]},{"description":"HC LAB RED BLOOD CELLS LR IR","code_information":[{"code":"P9040","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":1562.49,"gross_charge":1929,"discounted_cash":570.99,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1562.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":560.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":560.03,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":386.63,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1093.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":943.81,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":391.08,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":366.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":289.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":228.7,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":244.71,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":235.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":240.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":251.57,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":242.42,"methodology":"case rate"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0310-25","type":"NDC"}],"standard_charges":[{"minimum":118.67,"maximum":160.21,"gross_charge":197.78,"discounted_cash":58.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.67,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0310-25","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":160.21,"gross_charge":197.78,"discounted_cash":58.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":126.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0310-50","type":"NDC"}],"standard_charges":[{"minimum":204.55,"maximum":276.14,"gross_charge":340.91,"discounted_cash":100.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":221.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":238.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.55,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0310-50","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":276.14,"gross_charge":340.91,"discounted_cash":100.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":276.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":276.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":276.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":218.19,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":153.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":238.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":204.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":51.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":68.19,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64208-2510-01","type":"NDC"}],"standard_charges":[{"minimum":116.15,"maximum":156.8,"gross_charge":193.57,"discounted_cash":57.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.15,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64208-2510-01","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":156.8,"gross_charge":193.57,"discounted_cash":57.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":87.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5214-02","type":"NDC"}],"standard_charges":[{"minimum":239.91,"maximum":323.88,"gross_charge":399.85,"discounted_cash":118.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":259.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":279.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.91,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5214-02","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":323.88,"gross_charge":399.85,"discounted_cash":118.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":323.88,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":255.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":179.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":279.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":239.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":75.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.97,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5214-09","type":"NDC"}],"standard_charges":[{"minimum":125.61,"maximum":169.58,"gross_charge":209.35,"discounted_cash":61.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":136.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":146.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5214-09","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":169.58,"gross_charge":209.35,"discounted_cash":61.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":133.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":94.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":146.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":125.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.87,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0623-02","type":"NDC"}],"standard_charges":[{"minimum":118.04,"maximum":159.35,"gross_charge":196.72,"discounted_cash":58.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":127.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":137.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.04,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0623-02","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":159.35,"gross_charge":196.72,"discounted_cash":58.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.91,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":88.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":137.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.51,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.35,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0623-03","type":"NDC"}],"standard_charges":[{"minimum":203.29,"maximum":274.44,"gross_charge":338.81,"discounted_cash":100.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":274.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":274.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":274.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":220.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":237.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.29,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0623-03","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":274.44,"gross_charge":338.81,"discounted_cash":100.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":274.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":274.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":274.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":216.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":152.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":237.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":203.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":64.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.77,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76125-0790-26","type":"NDC"}],"standard_charges":[{"minimum":121.2,"maximum":163.62,"gross_charge":201.99,"discounted_cash":59.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.2,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 5 % INTRAVENOUS SOLUTION (WRAPPER)","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9041","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76125-0790-26","type":"NDC"}],"standard_charges":[{"minimum":10.62,"maximum":163.62,"gross_charge":201.99,"discounted_cash":59.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.28,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":10.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.33,"standard_charge_algorithm": "Lesser of $12.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":121.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.38,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.4,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE PLASMA CRYOREDUCED","code_information":[{"code":"P9044","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":297.27,"maximum":297.27,"gross_charge":367,"discounted_cash":108.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":297.27,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE PLASMA CRYOREDUCED","code_information":[{"code":"P9044","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":55.05,"maximum":379.76,"gross_charge":367,"discounted_cash":108.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":322.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":322.48,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":105.88,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":379.76,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":291.54,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":225.19,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":131.69,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":140.91,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":135.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":138.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":144.86,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":139.59,"methodology":"case rate"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0251-05","type":"NDC"}],"standard_charges":[{"minimum":118.67,"maximum":160.21,"gross_charge":197.78,"discounted_cash":58.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.67,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"44206-0251-05","type":"NDC"}],"standard_charges":[{"minimum":29.67,"maximum":160.21,"gross_charge":197.78,"discounted_cash":58.55,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":160.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":126.58,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":89.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.56,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5216-01","type":"NDC"}],"standard_charges":[{"minimum":116.15,"maximum":156.8,"gross_charge":193.57,"discounted_cash":57.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.15,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68516-5216-01","type":"NDC"}],"standard_charges":[{"minimum":29.04,"maximum":156.8,"gross_charge":193.57,"discounted_cash":57.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.89,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":87.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.72,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0643-01","type":"NDC"}],"standard_charges":[{"minimum":118.29,"maximum":159.7,"gross_charge":197.15,"discounted_cash":58.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":128.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.29,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68982-0643-01","type":"NDC"}],"standard_charges":[{"minimum":29.58,"maximum":159.7,"gross_charge":197.15,"discounted_cash":58.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":159.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":159.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":159.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":126.18,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":88.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":138.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":118.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.43,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":39.43,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76125-0792-26","type":"NDC"}],"standard_charges":[{"minimum":120.95,"maximum":163.28,"gross_charge":201.57,"discounted_cash":59.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.95,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76125-0792-26","type":"NDC"}],"standard_charges":[{"minimum":30.24,"maximum":163.28,"gross_charge":201.57,"discounted_cash":59.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":163.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":129.01,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":90.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":141.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":120.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.3,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":40.32,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76179-0025-01","type":"NDC"}],"standard_charges":[{"minimum":138.88,"maximum":187.49,"gross_charge":231.46,"discounted_cash":68.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":150.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":162.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.88,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"76179-0025-01","type":"NDC"}],"standard_charges":[{"minimum":34.72,"maximum":187.49,"gross_charge":231.46,"discounted_cash":68.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":187.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":187.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":187.49,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":148.14,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":104.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":162.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":138.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.3,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN-KJDA 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64208-2512-03","type":"NDC"}],"standard_charges":[{"minimum":116.02,"maximum":156.63,"gross_charge":193.36,"discounted_cash":57.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"}]}]},{"description":"ALBUMIN HUMAN-KJDA 25 % INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64208-2512-03","type":"NDC"}],"standard_charges":[{"minimum":29.01,"maximum":156.63,"gross_charge":193.36,"discounted_cash":57.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.63,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":53.08,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":60.39,"standard_charge_algorithm": "Lesser of $60.39 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":87.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.02,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.68,"methodology":"fee schedule"}]}]},{"description":"HC PLATELETS HLA MATCHED EA UNI","code_information":[{"code":"P9052","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":1219.86,"maximum":1219.86,"gross_charge":1506,"discounted_cash":445.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1219.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1219.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1219.86,"methodology":"fee schedule"}]}]},{"description":"HC PLATELETS HLA MATCHED EA UNI","code_information":[{"code":"P9052","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":3615.87,"gross_charge":1506,"discounted_cash":445.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1219.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1219.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1219.86,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1702.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1702.18,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":1103.58,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":3615.87,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2650.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1188.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":286.14,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":225.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":301.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":695.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":743.77,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":715.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":729.87,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":764.62,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":736.82,"methodology":"case rate"}]}]},{"description":"HC PROC FEE L/R WASHED RBC","code_information":[{"code":"P9054","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":884.52,"maximum":884.52,"gross_charge":1092,"discounted_cash":323.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":884.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":884.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":884.52,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE L/R WASHED RBC","code_information":[{"code":"P9054","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":163.8,"maximum":1277.02,"gross_charge":1092,"discounted_cash":323.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":884.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":884.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":884.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":530.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":530.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":329.56,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":1277.02,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":768.89,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":370.64,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":207.48,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":163.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":218.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":216.75,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":231.92,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":223.25,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":227.59,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":238.43,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":229.75,"methodology":"case rate"}]}]},{"description":"HC PROC FEE IRRAD LEUKO WASH RBC","code_information":[{"code":"P9057","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":1692.09,"maximum":1692.09,"gross_charge":2089,"discounted_cash":618.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1692.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1692.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1692.09,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE IRRAD LEUKO WASH RBC","code_information":[{"code":"P9057","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":1692.09,"gross_charge":2089,"discounted_cash":618.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1692.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1692.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1692.09,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1062.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1062.64,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":754.49,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":960.9,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":1473.23,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":742.04,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":396.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":313.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":417.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":433.94,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":464.32,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":446.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":455.64,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":477.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":459.98,"methodology":"case rate"}]}]},{"description":"HC PROC FEE FROZEN PLASMA 24 HR","code_information":[{"code":"P9059","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":297.27,"maximum":297.27,"gross_charge":367,"discounted_cash":108.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":297.27,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE FROZEN PLASMA 24 HR","code_information":[{"code":"P9059","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":55.05,"maximum":328.1,"gross_charge":367,"discounted_cash":108.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":297.27,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":155.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":155.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":111.13,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":328.1,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":235.98,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":108.69,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":69.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":55.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":73.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":63.56,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":68.01,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":65.47,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":66.74,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":69.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":67.37,"methodology":"case rate"}]}]},{"description":"HC PROC FEE PLT LR PATHGN RDC","code_information":[{"code":"P9073","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":2454.3,"maximum":2454.3,"gross_charge":3030,"discounted_cash":896.88,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2454.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2454.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2454.3,"methodology":"fee schedule"}]}]},{"description":"HC PROC FEE PLT LR PATHGN RDC","code_information":[{"code":"P9073","type":"HCPCS"},{"code":"0390","type":"RC"}],"standard_charges":[{"minimum":214,"maximum":2674.7,"gross_charge":3030,"discounted_cash":896.88,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2454.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2454.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2454.3,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1285.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":1285.74,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":844.19,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2674.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":2117.6,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":897.84,"methodology":"case rate"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":214,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":575.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":606,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":454.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":606,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":525.05,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":561.8,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":540.8,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":551.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":577.55,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":556.55,"methodology":"case rate"}]}]},{"description":"HC PLT BACTERIAL AG TEST","code_information":[{"code":"P9100","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":42.12,"maximum":42.12,"gross_charge":52,"discounted_cash":15.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"}]}]},{"description":"HC PLT BACTERIAL AG TEST","code_information":[{"code":"P9100","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":0.65,"maximum":130.04,"gross_charge":52,"discounted_cash":15.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":42.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":130.04,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":89.24,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":44.88,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":90.82,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":56.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":35.5,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.88,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":53.11,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":56.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":54.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":55.77,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":58.42,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":56.3,"methodology":"case rate"}]}]},{"description":"FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0138","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59338-0775-01","type":"NDC"}],"standard_charges":[{"minimum":414.15,"maximum":559.1,"gross_charge":690.24,"discounted_cash":204.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":559.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":559.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":559.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":448.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":483.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.15,"methodology":"fee schedule"}]}]},{"description":"FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0138","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59338-0775-01","type":"NDC"}],"standard_charges":[{"minimum":0.29,"maximum":559.1,"gross_charge":690.24,"discounted_cash":204.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":559.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":559.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":559.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":441.76,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.36,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":310.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":483.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":414.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.31,"methodology":"case rate"}]}]},{"description":"FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"Q0138","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":567.14,"maximum":765.64,"gross_charge":945.23,"discounted_cash":279.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":765.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":765.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":765.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":614.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":661.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567.14,"methodology":"fee schedule"}]}]},{"description":"FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION","code_information":[{"code":"Q0138","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.29,"maximum":765.64,"gross_charge":945.23,"discounted_cash":279.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":765.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":765.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":765.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":604.95,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.38,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.36,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.6,"standard_charge_algorithm": "Lesser of $0.60 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":425.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":661.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":567.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.31,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.3,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.3,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.32,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.31,"methodology":"case rate"}]}]},{"description":"CHLORPROMAZINE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0047-01","type":"NDC"}],"standard_charges":[{"minimum":34.89,"maximum":47.1,"gross_charge":58.14,"discounted_cash":17.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.89,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0047-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":47.1,"gross_charge":58.14,"discounted_cash":17.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.7,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":34.89,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.63,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69238-1054-01","type":"NDC"}],"standard_charges":[{"minimum":24.69,"maximum":33.33,"gross_charge":41.14,"discounted_cash":12.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69238-1054-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":33.33,"gross_charge":41.14,"discounted_cash":12.18,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":33.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":28.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":24.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.23,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 10 MG TABLET","code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":35.07,"maximum":47.34,"gross_charge":58.44,"discounted_cash":17.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 10 MG TABLET","code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.98,"maximum":47.34,"gross_charge":58.44,"discounted_cash":17.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.69,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0048-01","type":"NDC"}],"standard_charges":[{"minimum":30.09,"maximum":40.62,"gross_charge":50.14,"discounted_cash":14.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0048-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":40.62,"gross_charge":50.14,"discounted_cash":14.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.62,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.03,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0519-01","type":"NDC"}],"standard_charges":[{"minimum":2.51,"maximum":3.38,"gross_charge":4.17,"discounted_cash":1.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"51079-0519-01","type":"NDC"}],"standard_charges":[{"minimum":0.63,"maximum":3.38,"gross_charge":4.17,"discounted_cash":1.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.84,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62332-0736-31","type":"NDC"}],"standard_charges":[{"minimum":11.06,"maximum":14.93,"gross_charge":18.43,"discounted_cash":5.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"62332-0736-31","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":14.93,"gross_charge":18.43,"discounted_cash":5.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.69,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69238-1056-01","type":"NDC"}],"standard_charges":[{"minimum":38.55,"maximum":52.04,"gross_charge":64.24,"discounted_cash":19.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69238-1056-01","type":"NDC"}],"standard_charges":[{"minimum":0.98,"maximum":52.04,"gross_charge":64.24,"discounted_cash":19.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":52.04,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":41.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":28.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":44.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":38.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.85,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":102.17,"maximum":137.92,"gross_charge":170.27,"discounted_cash":50.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":110.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.17,"methodology":"fee schedule"}]}]},{"description":"CHLORPROMAZINE 25 MG TABLET","code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.98,"maximum":137.92,"gross_charge":170.27,"discounted_cash":50.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":137.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":137.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":137.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":108.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.98,"standard_charge_algorithm": "Lesser of $0.98 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":76.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":119.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":102.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":34.06,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0159-01","type":"NDC"}],"standard_charges":[{"minimum":1.52,"maximum":2.05,"gross_charge":2.53,"discounted_cash":0.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"16714-0159-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":2.05,"gross_charge":2.53,"discounted_cash":0.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.51,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0538-30","type":"NDC"}],"standard_charges":[{"minimum":7.39,"maximum":9.98,"gross_charge":12.31,"discounted_cash":3.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"45963-0538-30","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":9.98,"gross_charge":12.31,"discounted_cash":3.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.47,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0621-11","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":0.44,"gross_charge":0.54,"discounted_cash":0.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0621-11","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":0.44,"gross_charge":0.54,"discounted_cash":0.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0621-15","type":"NDC"}],"standard_charges":[{"minimum":12.35,"maximum":16.67,"gross_charge":20.58,"discounted_cash":6.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50268-0621-15","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":16.67,"gross_charge":20.58,"discounted_cash":6.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.12,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57237-0075-30","type":"NDC"}],"standard_charges":[{"minimum":2.75,"maximum":3.71,"gross_charge":4.57,"discounted_cash":1.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"57237-0075-30","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":3.71,"gross_charge":4.57,"discounted_cash":1.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.92,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65862-0187-30","type":"NDC"}],"standard_charges":[{"minimum":3.38,"maximum":4.56,"gross_charge":5.62,"discounted_cash":1.67,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65862-0187-30","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":4.56,"gross_charge":5.62,"discounted_cash":1.67,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.13,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0220-01","type":"NDC"}],"standard_charges":[{"minimum":28.83,"maximum":38.92,"gross_charge":48.04,"discounted_cash":14.22,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0220-01","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":38.92,"gross_charge":48.04,"discounted_cash":14.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":38.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":30.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":33.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.61,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0220-11","type":"NDC"}],"standard_charges":[{"minimum":0.37,"maximum":0.5,"gross_charge":0.61,"discounted_cash":0.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0220-11","type":"NDC"}],"standard_charges":[{"minimum":0.01,"maximum":0.5,"gross_charge":0.61,"discounted_cash":0.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.13,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.57,"maximum":37.22,"gross_charge":45.94,"discounted_cash":13.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"}]}]},{"description":"ONDANSETRON HCL 4 MG TABLET","code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.01,"maximum":37.22,"gross_charge":45.94,"discounted_cash":13.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":37.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.01,"standard_charge_algorithm": "Lesser of $0.01 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.19,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR","code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2.29,"maximum":3.09,"gross_charge":3.81,"discounted_cash":1.13,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"}]}]},{"description":"DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR","code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.32,"maximum":3.09,"gross_charge":3.81,"discounted_cash":1.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.32,"standard_charge_algorithm": "Lesser of $0.32 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0115-06","type":"NDC"}],"standard_charges":[{"minimum":30.81,"maximum":41.59,"gross_charge":51.34,"discounted_cash":15.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":33.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.81,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59746-0115-06","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":41.59,"gross_charge":51.34,"discounted_cash":15.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.27,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-2039-01","type":"NDC"}],"standard_charges":[{"minimum":0.33,"maximum":0.44,"gross_charge":0.54,"discounted_cash":0.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60219-2039-01","type":"NDC"}],"standard_charges":[{"minimum":0.09,"maximum":0.47,"gross_charge":0.54,"discounted_cash":0.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69452-0310-20","type":"NDC"}],"standard_charges":[{"minimum":19.41,"maximum":26.2,"gross_charge":32.34,"discounted_cash":9.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":21.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69452-0310-20","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":26.2,"gross_charge":32.34,"discounted_cash":9.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":26.2,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":20.7,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.47,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0169-01","type":"NDC"}],"standard_charges":[{"minimum":26.49,"maximum":35.76,"gross_charge":44.14,"discounted_cash":13.07,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.49,"methodology":"fee schedule"}]}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"72603-0169-01","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":35.76,"gross_charge":44.14,"discounted_cash":13.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.47,"standard_charge_algorithm": "Lesser of $0.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.83,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42043-0390-21","type":"NDC"}],"standard_charges":[{"minimum":12.68,"maximum":17.12,"gross_charge":21.13,"discounted_cash":6.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42043-0390-21","type":"NDC"}],"standard_charges":[{"minimum":1.65,"maximum":17.12,"gross_charge":21.13,"discounted_cash":6.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":14.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42043-0390-40","type":"NDC"}],"standard_charges":[{"minimum":0.71,"maximum":0.96,"gross_charge":1.18,"discounted_cash":0.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"42043-0390-40","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":1.18,"gross_charge":1.18,"discounted_cash":0.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.18,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.18,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.23,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69452-0350-01","type":"NDC"}],"standard_charges":[{"minimum":3.63,"maximum":4.9,"gross_charge":6.04,"discounted_cash":1.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69452-0350-01","type":"NDC"}],"standard_charges":[{"minimum":0.91,"maximum":4.9,"gross_charge":6.04,"discounted_cash":1.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69452-0350-60","type":"NDC"}],"standard_charges":[{"minimum":1.86,"maximum":2.51,"gross_charge":3.09,"discounted_cash":0.92,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"69452-0350-60","type":"NDC"}],"standard_charges":[{"minimum":0.47,"maximum":2.51,"gross_charge":3.09,"discounted_cash":0.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.62,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.76,"maximum":2.37,"gross_charge":2.92,"discounted_cash":0.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"}]}]},{"description":"GRANISETRON HCL 1 MG TABLET","code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.44,"maximum":2.37,"gross_charge":2.92,"discounted_cash":0.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.65,"standard_charge_algorithm": "Lesser of $1.65 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.44,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.59,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10702-0002-01","type":"NDC"}],"standard_charges":[{"minimum":2.3,"maximum":3.11,"gross_charge":3.83,"discounted_cash":1.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"10702-0002-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":3.11,"gross_charge":3.83,"discounted_cash":1.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.11,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.73,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.58,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"53746-0745-01","type":"NDC"}],"standard_charges":[{"minimum":4.82,"maximum":6.51,"gross_charge":8.03,"discounted_cash":2.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"53746-0745-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":6.51,"gross_charge":8.03,"discounted_cash":2.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.61,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0660-01","type":"NDC"}],"standard_charges":[{"minimum":26.67,"maximum":36,"gross_charge":44.44,"discounted_cash":13.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0660-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":36,"gross_charge":44.44,"discounted_cash":13.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.67,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.89,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0660-11","type":"NDC"}],"standard_charges":[{"minimum":0.35,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"60687-0660-11","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.47,"gross_charge":0.57,"discounted_cash":0.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65162-0745-10","type":"NDC"}],"standard_charges":[{"minimum":2.12,"maximum":2.86,"gross_charge":3.53,"discounted_cash":1.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"65162-0745-10","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":2.86,"gross_charge":3.53,"discounted_cash":1.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.71,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68001-0161-00","type":"NDC"}],"standard_charges":[{"minimum":3.32,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 12.5 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68001-0161-00","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":4.48,"gross_charge":5.53,"discounted_cash":1.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.11,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0155-11","type":"NDC"}],"standard_charges":[{"minimum":0.18,"maximum":0.24,"gross_charge":0.29,"discounted_cash":0.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68084-0155-11","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":0.24,"gross_charge":0.29,"discounted_cash":0.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.24,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0041-01","type":"NDC"}],"standard_charges":[{"minimum":2.72,"maximum":3.67,"gross_charge":4.53,"discounted_cash":1.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0041-01","type":"NDC"}],"standard_charges":[{"minimum":0.05,"maximum":3.67,"gross_charge":4.53,"discounted_cash":1.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":5.6,"maximum":7.56,"gross_charge":9.33,"discounted_cash":2.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.05,"maximum":7.56,"gross_charge":9.33,"discounted_cash":2.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.87,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.14,"maximum":12.34,"gross_charge":15.23,"discounted_cash":4.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"}]}]},{"description":"PROMETHAZINE 25 MG TABLET","code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.05,"maximum":12.34,"gross_charge":15.23,"discounted_cash":4.51,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.05,"standard_charge_algorithm": "Lesser of $0.05 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.9,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.05,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64980-0290-01","type":"NDC"}],"standard_charges":[{"minimum":20.49,"maximum":27.66,"gross_charge":34.14,"discounted_cash":10.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":22.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64980-0290-01","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":27.66,"gross_charge":34.14,"discounted_cash":10.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.83,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0591-01","type":"NDC"}],"standard_charges":[{"minimum":20.19,"maximum":27.25,"gross_charge":33.64,"discounted_cash":9.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68382-0591-01","type":"NDC"}],"standard_charges":[{"minimum":0.62,"maximum":27.25,"gross_charge":33.64,"discounted_cash":9.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":15.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":23.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":20.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.73,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9.2,"maximum":12.42,"gross_charge":15.33,"discounted_cash":4.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.62,"maximum":12.42,"gross_charge":15.33,"discounted_cash":4.54,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":6.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.07,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":25.53,"maximum":34.46,"gross_charge":42.54,"discounted_cash":12.6,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.62,"maximum":34.46,"gross_charge":42.54,"discounted_cash":12.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":29.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.39,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.51,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":27.33,"maximum":36.89,"gross_charge":45.54,"discounted_cash":13.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.33,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.62,"maximum":36.89,"gross_charge":45.54,"discounted_cash":13.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":29.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":20.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":31.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.11,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":77.98,"maximum":105.27,"gross_charge":129.96,"discounted_cash":38.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":84.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.98,"methodology":"fee schedule"}]}]},{"description":"PERPHENAZINE 2 MG TABLET","code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.62,"maximum":105.27,"gross_charge":129.96,"discounted_cash":38.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":105.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.62,"standard_charge_algorithm": "Lesser of $0.62 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.98,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":26,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0249","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0136-01","type":"NDC"}],"standard_charges":[{"minimum":5777.9,"maximum":7800.16,"gross_charge":9629.82,"discounted_cash":2850.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7800.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7800.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7800.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6259.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6740.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5777.9,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0249","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0136-01","type":"NDC"}],"standard_charges":[{"minimum":1444.48,"maximum":7800.16,"gross_charge":9629.82,"discounted_cash":2850.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7800.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7800.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7800.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6163.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4814.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4814.91,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4333.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6740.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5777.9,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1829.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1444.48,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1925.97,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0249","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0137-01","type":"NDC"}],"standard_charges":[{"minimum":11344.42,"maximum":15314.97,"gross_charge":18907.36,"discounted_cash":5596.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15314.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15314.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15314.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12289.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13235.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11344.42,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0249","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0137-01","type":"NDC"}],"standard_charges":[{"minimum":2836.11,"maximum":15314.97,"gross_charge":18907.36,"discounted_cash":5596.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15314.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15314.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15314.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12100.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":9453.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":9453.68,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8508.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13235.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11344.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3592.4,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3781.48,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2836.11,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3781.48,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0249","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0135-01","type":"NDC"}],"standard_charges":[{"minimum":2438.06,"maximum":3291.38,"gross_charge":4063.42,"discounted_cash":1202.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3291.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3291.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3291.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2641.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2844.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2438.06,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q0249","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"50242-0135-01","type":"NDC"}],"standard_charges":[{"minimum":609.52,"maximum":3291.38,"gross_charge":4063.42,"discounted_cash":1202.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3291.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3291.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3291.38,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2600.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2031.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2031.71,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1828.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2844.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2438.06,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":772.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.69,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":609.52,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":812.69,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0403-02","type":"NDC"}],"standard_charges":[{"minimum":39.42,"maximum":53.22,"gross_charge":65.7,"discounted_cash":19.45,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.42,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0403-02","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":53.22,"gross_charge":65.7,"discounted_cash":19.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":53.22,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":29.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":45.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.86,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.14,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0729-02","type":"NDC"}],"standard_charges":[{"minimum":44.53,"maximum":60.12,"gross_charge":74.21,"discounted_cash":21.97,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":48.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.53,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0729-02","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":60.12,"gross_charge":74.21,"discounted_cash":21.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":47.5,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":33.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":44.53,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.1,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.85,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0516-25","type":"NDC"}],"standard_charges":[{"minimum":67.46,"maximum":91.07,"gross_charge":112.43,"discounted_cash":33.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.46,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0516-25","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":91.07,"gross_charge":112.43,"discounted_cash":33.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":91.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":71.96,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":50.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":78.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":67.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.37,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.49,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0621-54","type":"NDC"}],"standard_charges":[{"minimum":35.13,"maximum":47.43,"gross_charge":58.55,"discounted_cash":17.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.13,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0621-54","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":47.43,"gross_charge":58.55,"discounted_cash":17.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":40.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.13,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.71,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.15,"maximum":0.21,"gross_charge":0.25,"discounted_cash":0.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.04,"maximum":4.8,"gross_charge":0.25,"discounted_cash":0.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":0.21,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.25,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":0.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":0.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.04,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.05,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.11,"maximum":55.5,"gross_charge":68.51,"discounted_cash":20.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.59,"maximum":55.5,"gross_charge":68.51,"discounted_cash":20.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":47.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.71,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.19,"maximum":55.6,"gross_charge":68.64,"discounted_cash":20.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":44.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.59,"maximum":55.6,"gross_charge":68.64,"discounted_cash":20.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":55.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":43.93,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":30.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":41.19,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":10.3,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0798-10","type":"NDC"}],"standard_charges":[{"minimum":55.77,"maximum":75.29,"gross_charge":92.95,"discounted_cash":27.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"25021-0798-10","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":75.29,"gross_charge":92.95,"discounted_cash":27.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":18.59,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0403-04","type":"NDC"}],"standard_charges":[{"minimum":84.8,"maximum":114.47,"gross_charge":141.32,"discounted_cash":41.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":91.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63323-0403-04","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":114.47,"gross_charge":141.32,"discounted_cash":41.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":90.45,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":63.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":98.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":84.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":26.86,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.27,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0730-02","type":"NDC"}],"standard_charges":[{"minimum":91.49,"maximum":123.51,"gross_charge":152.48,"discounted_cash":45.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":99.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":106.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.49,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64679-0730-02","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":123.51,"gross_charge":152.48,"discounted_cash":45.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":123.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":123.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":123.51,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":97.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":68.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":106.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":91.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":28.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.5,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0517-00","type":"NDC"}],"standard_charges":[{"minimum":68.96,"maximum":93.1,"gross_charge":114.93,"discounted_cash":34.02,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":74.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.96,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0517-00","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":93.1,"gross_charge":114.93,"discounted_cash":34.02,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":93.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":73.56,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":68.96,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":22.99,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0622-64","type":"NDC"}],"standard_charges":[{"minimum":35.22,"maximum":47.55,"gross_charge":58.7,"discounted_cash":17.38,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":38.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"68462-0622-64","type":"NDC"}],"standard_charges":[{"minimum":1.59,"maximum":47.55,"gross_charge":58.7,"discounted_cash":17.38,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":47.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":41.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.74,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":77.27,"maximum":104.32,"gross_charge":128.78,"discounted_cash":38.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":83.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.27,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.59,"maximum":104.32,"gross_charge":128.78,"discounted_cash":38.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":104.32,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":82.42,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":57.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":90.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":77.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":24.47,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":25.76,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":131.6,"maximum":177.66,"gross_charge":219.33,"discounted_cash":64.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":142.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":153.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"}]}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION","code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1.59,"maximum":177.66,"gross_charge":219.33,"discounted_cash":64.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":177.66,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":140.38,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":4.8,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":2.5,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":3.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1.59,"standard_charge_algorithm": "Lesser of $1.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":98.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":153.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":131.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":41.68,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.87,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":32.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.87,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0283-35","type":"NDC"}],"standard_charges":[{"minimum":913.74,"maximum":1233.55,"gross_charge":1522.9,"discounted_cash":450.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1233.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1233.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1233.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":989.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1066.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.74,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"43598-0283-35","type":"NDC"}],"standard_charges":[{"minimum":85.48,"maximum":1233.55,"gross_charge":1522.9,"discounted_cash":450.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1233.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1233.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1233.55,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":974.66,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":136.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.48,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":138.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":229.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":126.55,"standard_charge_algorithm": "Lesser of $126.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":126.55,"standard_charge_algorithm": "Lesser of $126.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":685.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1066.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":913.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":134.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":143.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":138.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":141.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":147.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":142.54,"methodology":"case rate"}]}]},{"description":"DOXORUBICIN PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0049-40","type":"NDC"}],"standard_charges":[{"minimum":992.7,"maximum":1340.14,"gross_charge":1654.49,"discounted_cash":489.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1340.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1340.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1075.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1158.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":992.7,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"47335-0049-40","type":"NDC"}],"standard_charges":[{"minimum":85.48,"maximum":1340.14,"gross_charge":1654.49,"discounted_cash":489.73,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1340.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1340.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1340.14,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1058.88,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":136.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.48,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":138.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":229.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":126.55,"standard_charge_algorithm": "Lesser of $126.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":126.55,"standard_charge_algorithm": "Lesser of $126.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":744.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1158.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":992.7,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":134.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":143.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":138.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":141.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":147.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":142.54,"methodology":"case rate"}]}]},{"description":"DOXORUBICIN PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0960-01","type":"NDC"}],"standard_charges":[{"minimum":5593.86,"maximum":7551.72,"gross_charge":9323.1,"discounted_cash":2759.64,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7551.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7551.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7551.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6060.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6526.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5593.86,"methodology":"fee schedule"}]}]},{"description":"DOXORUBICIN PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"59676-0960-01","type":"NDC"}],"standard_charges":[{"minimum":85.48,"maximum":7551.72,"gross_charge":9323.1,"discounted_cash":2759.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7551.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7551.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7551.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5966.79,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":136.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":136.05,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":85.48,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":138.8,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":87.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":229.94,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":126.55,"standard_charge_algorithm": "Lesser of $126.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":126.55,"standard_charge_algorithm": "Lesser of $126.55 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4195.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6526.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5593.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":125.29,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":168.28,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":152.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":134.47,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":143.88,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":138.5,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":141.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":147.92,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":142.54,"methodology":"case rate"}]}]},{"description":"HC APLIGRAF PER CENTIMETR","code_information":[{"code":"Q4101","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":48,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"}]}]},{"description":"HC APLIGRAF PER CENTIMETR","code_information":[{"code":"Q4101","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12,"maximum":64.8,"gross_charge":80,"discounted_cash":23.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":64.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":51.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.49,"standard_charge_algorithm": "Lesser of $34.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.49,"standard_charge_algorithm": "Lesser of $34.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":15.2,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"}]}]},{"description":"HC OASIS MATRIX 8213-1000-37","code_information":[{"code":"Q4102","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":316.8,"maximum":427.68,"gross_charge":528,"discounted_cash":156.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":343.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"}]}]},{"description":"HC OASIS MATRIX 8213-1000-37","code_information":[{"code":"Q4102","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":13.59,"maximum":427.68,"gross_charge":528,"discounted_cash":156.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":427.68,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":337.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":237.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":369.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":316.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":100.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":79.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":105.6,"methodology":"fee schedule"}]}]},{"description":"HC OASIS PER SQ CNT 8213-1000-33","code_information":[{"code":"Q4102","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15.6,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.9,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"}]}]},{"description":"HC OASIS PER SQ CNT 8213-1000-33","code_information":[{"code":"Q4102","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":3.9,"maximum":21.06,"gross_charge":26,"discounted_cash":7.7,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5.2,"methodology":"fee schedule"}]}]},{"description":"OASIS WND 3X3.5CM 8213-1000-33","code_information":[{"code":"Q4102","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":26.4,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.4,"methodology":"fee schedule"}]}]},{"description":"OASIS WND 3X3.5CM 8213-1000-33","code_information":[{"code":"Q4102","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.6,"maximum":35.64,"gross_charge":44,"discounted_cash":13.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":28.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":13.59,"standard_charge_algorithm": "Lesser of $13.59 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":19.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":30.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":26.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":8.8,"methodology":"fee schedule"}]}]},{"description":"OASIS BURN 5X7 8213-3000-13","code_information":[{"code":"Q4103","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":22.2,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.2,"methodology":"fee schedule"}]}]},{"description":"OASIS BURN 5X7 8213-3000-13","code_information":[{"code":"Q4103","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.95,"maximum":29.97,"gross_charge":37,"discounted_cash":10.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":10.95,"standard_charge_algorithm": "Lesser of $10.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":10.95,"standard_charge_algorithm": "Lesser of $10.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":25.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":22.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":11.95,"methodology":"fee schedule"}]}]},{"description":"HC DERMAGRAFT PER CENTMR 11045","code_information":[{"code":"Q4106","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":511.8,"maximum":690.93,"gross_charge":853,"discounted_cash":252.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":690.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":690.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":690.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":554.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":597.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":511.8,"methodology":"fee schedule"}]}]},{"description":"HC DERMAGRAFT PER CENTMR 11045","code_information":[{"code":"Q4106","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":28.86,"maximum":690.93,"gross_charge":853,"discounted_cash":252.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":690.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":690.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":690.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":545.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":28.86,"standard_charge_algorithm": "Lesser of $28.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":28.86,"standard_charge_algorithm": "Lesser of $28.86 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":383.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":597.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":511.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":162.07,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":127.95,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":170.6,"methodology":"fee schedule"}]}]},{"description":"THERASKIN 101TSS 2.5X5.1 SQ CM","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":156,"maximum":210.6,"gross_charge":260,"discounted_cash":76.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":169,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":182,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"}]}]},{"description":"THERASKIN 101TSS 2.5X5.1 SQ CM","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.83,"maximum":210.6,"gross_charge":260,"discounted_cash":76.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":210.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":166.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":117,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":182,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":156,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"}]}]},{"description":"THERASKIN 4.0X6.5 SQ CM 26TS","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":90,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":97.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"}]}]},{"description":"THERASKIN 4.0X6.5 SQ CM 26TS","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.83,"maximum":121.5,"gross_charge":150,"discounted_cash":44.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":121.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":67.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":105,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":90,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"}]}]},{"description":"THERASKIN 5.1X7.6 SQ CM 102TSL","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":61.8,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":66.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"}]}]},{"description":"THERASKIN 5.1X7.6 SQ CM 102TSL","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.35,"maximum":83.43,"gross_charge":103,"discounted_cash":30.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":83.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":72.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"}]}]},{"description":"THERSKIN 100TSXS 2.5X2.5 SQ CM","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":306,"maximum":413.1,"gross_charge":510,"discounted_cash":150.96,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":413.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":413.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":413.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":331.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":357,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"}]}]},{"description":"THERSKIN 100TSXS 2.5X2.5 SQ CM","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.83,"maximum":413.1,"gross_charge":510,"discounted_cash":150.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":413.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":413.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":413.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":326.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":229.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":357,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":306,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"}]}]},{"description":"THERSKIN 7.6X15.24 SQ 103TSXL","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":55.8,"maximum":75.33,"gross_charge":93,"discounted_cash":27.53,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":60.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"}]}]},{"description":"THERSKIN 7.6X15.24 SQ 103TSXL","code_information":[{"code":"Q4121","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":41.85,"maximum":75.33,"gross_charge":93,"discounted_cash":27.53,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":50.33,"standard_charge_algorithm": "Lesser of $50.33 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":41.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":65.1,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":55.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.83,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX COR 1.5X2 SQCM PS12015","code_information":[{"code":"Q4132","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":446.4,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":483.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":520.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX COR 1.5X2 SQCM PS12015","code_information":[{"code":"Q4132","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":111.6,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":476.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":131.75,"standard_charge_algorithm": "Lesser of $131.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":131.75,"standard_charge_algorithm": "Lesser of $131.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":334.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":520.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX CORE 3X4 SQCM PS12034","code_information":[{"code":"Q4132","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":187.2,"maximum":252.72,"gross_charge":312,"discounted_cash":92.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":252.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":252.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":202.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":218.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.2,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX CORE 3X4 SQCM PS12034","code_information":[{"code":"Q4132","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.8,"maximum":252.72,"gross_charge":312,"discounted_cash":92.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":252.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":252.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":252.72,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":199.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":131.75,"standard_charge_algorithm": "Lesser of $131.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":131.75,"standard_charge_algorithm": "Lesser of $131.75 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":140.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":218.4,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":187.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.28,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.4,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.8,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.4,"methodology":"fee schedule"}]}]},{"description":"GRAFIX PRIME 16M DISC PS13016","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":670.8,"maximum":905.58,"gross_charge":1118,"discounted_cash":330.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":905.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":905.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":905.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":726.7,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":782.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":670.8,"methodology":"fee schedule"}]}]},{"description":"GRAFIX PRIME 16M DISC PS13016","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":153.02,"maximum":905.58,"gross_charge":1118,"discounted_cash":330.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":905.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":905.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":905.58,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":715.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":503.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":782.6,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":670.8,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":212.42,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.6,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":167.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":223.6,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX PRI 1.5X2 SQCM PS11015","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":446.4,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":483.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":520.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX PRI 1.5X2 SQCM PS11015","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":111.6,"maximum":602.64,"gross_charge":744,"discounted_cash":220.23,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":602.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":476.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":334.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":520.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":446.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":148.8,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX PRIME 3X4 SQCM PS11034","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":185.4,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":200.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":216.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":185.4,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIX PRIME 3X4 SQCM PS11034","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":46.35,"maximum":250.29,"gross_charge":309,"discounted_cash":91.47,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":250.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":139.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":216.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":185.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":46.35,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":61.8,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIXPL 1.5X2 PERSQCM PS13015","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":447,"maximum":603.45,"gross_charge":745,"discounted_cash":220.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":484.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":521.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":447,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIXPL 1.5X2 PERSQCM PS13015","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":111.75,"maximum":603.45,"gross_charge":745,"discounted_cash":220.52,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":603.45,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":476.8,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":335.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":521.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":447,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":141.55,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":149,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":111.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":149,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIXPL 3X4 PERSQCM PS13034","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":188.4,"maximum":254.34,"gross_charge":314,"discounted_cash":92.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":204.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":219.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.4,"methodology":"fee schedule"}]}]},{"description":"HC GRAFIXPL 3X4 PERSQCM PS13034","code_information":[{"code":"Q4133","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":47.1,"maximum":254.34,"gross_charge":314,"discounted_cash":92.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":254.34,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":200.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":153.02,"standard_charge_algorithm": "Lesser of $153.02 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":141.3,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":219.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":188.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":47.1,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.8,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY 2X4 PER SQ CM-WASTE","code_information":[{"code":"Q4195","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":201.6,"maximum":272.16,"gross_charge":336,"discounted_cash":99.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":218.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":235.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.6,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY 2X4 PER SQ CM-WASTE","code_information":[{"code":"Q4195","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.4,"maximum":272.16,"gross_charge":336,"discounted_cash":99.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":215.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":80.49,"standard_charge_algorithm": "Lesser of $80.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":80.49,"standard_charge_algorithm": "Lesser of $80.49 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":151.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":235.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY AM 2X2 PER SQ CM","code_information":[{"code":"Q4196","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":266.4,"maximum":359.64,"gross_charge":444,"discounted_cash":131.43,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":288.6,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.4,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY AM 2X2 PER SQ CM","code_information":[{"code":"Q4196","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":66.6,"maximum":359.64,"gross_charge":444,"discounted_cash":131.43,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":359.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":284.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":123.19,"standard_charge_algorithm": "Lesser of $123.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":123.19,"standard_charge_algorithm": "Lesser of $123.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":199.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":310.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":266.4,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":84.36,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":66.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":88.8,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY AM 2X4 PER SQ CM","code_information":[{"code":"Q4196","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":201.6,"maximum":272.16,"gross_charge":336,"discounted_cash":99.46,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":218.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":235.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.6,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY AM 2X4 PER SQ CM","code_information":[{"code":"Q4196","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":50.4,"maximum":272.16,"gross_charge":336,"discounted_cash":99.46,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":215.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":123.19,"standard_charge_algorithm": "Lesser of $123.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":123.19,"standard_charge_algorithm": "Lesser of $123.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":151.2,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":235.2,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":201.6,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.4,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.2,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY AM 6X9 PER SQ CM","code_information":[{"code":"Q4196","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":171,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":199.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171,"methodology":"fee schedule"}]}]},{"description":"HC PURAPLY AM 6X9 PER SQ CM","code_information":[{"code":"Q4196","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":42.75,"maximum":230.85,"gross_charge":285,"discounted_cash":84.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":182.4,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":123.19,"standard_charge_algorithm": "Lesser of $123.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":123.19,"standard_charge_algorithm": "Lesser of $123.19 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":128.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":199.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":171,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57,"methodology":"fee schedule"}]}]},{"description":"INFLIXIMAB (INFLECTRA) 10 MG/ML INJECTION","code_information":[{"code":"Q5103","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2130.78,"maximum":2876.56,"gross_charge":3551.3,"discounted_cash":1051.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2876.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2876.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2876.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2308.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2485.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.78,"methodology":"fee schedule"}]}]},{"description":"INFLIXIMAB (INFLECTRA) 10 MG/ML INJECTION","code_information":[{"code":"Q5103","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10.86,"maximum":2876.56,"gross_charge":3551.3,"discounted_cash":1051.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2876.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2876.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2876.56,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2272.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":11.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":11.55,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":14.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":24.33,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.97,"standard_charge_algorithm": "Lesser of $34.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.97,"standard_charge_algorithm": "Lesser of $34.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1598.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2485.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.26,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.7,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":14.23,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":15.23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":14.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":14.94,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":15.65,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":15.08,"methodology":"case rate"}]}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5104","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"78206-0162-01","type":"NDC"}],"standard_charges":[{"minimum":1726.72,"maximum":2331.07,"gross_charge":2877.86,"discounted_cash":851.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2331.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2331.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2331.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1870.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2014.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1726.72,"methodology":"fee schedule"}]}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5104","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"78206-0162-01","type":"NDC"}],"standard_charges":[{"minimum":24.89,"maximum":2331.07,"gross_charge":2877.86,"discounted_cash":851.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2331.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2331.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2331.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1841.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.97,"standard_charge_algorithm": "Lesser of $54.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.97,"standard_charge_algorithm": "Lesser of $54.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1295.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2014.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1726.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.38,"methodology":"case rate"}]}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION","code_information":[{"code":"Q5104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2067.26,"maximum":2790.8,"gross_charge":3445.43,"discounted_cash":1019.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2790.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2239.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2411.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2067.26,"methodology":"fee schedule"}]}]},{"description":"INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION","code_information":[{"code":"Q5104","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":24.89,"maximum":2790.8,"gross_charge":3445.43,"discounted_cash":1019.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2790.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2790.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2205.08,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":26.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":26.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":31.5,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":32.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.56,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":54.97,"standard_charge_algorithm": "Lesser of $54.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":54.97,"standard_charge_algorithm": "Lesser of $54.97 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1550.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2411.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2067.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":54.43,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.16,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.89,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.63,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.64,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.13,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.38,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.38,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":241.43,"maximum":325.92,"gross_charge":402.37,"discounted_cash":119.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":261.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":281.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":241.43,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.63,"maximum":325.92,"gross_charge":402.37,"discounted_cash":119.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":325.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":325.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":325.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":257.52,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":181.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":281.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":241.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.67,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":74.52,"maximum":100.6,"gross_charge":124.19,"discounted_cash":36.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":80.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.63,"maximum":100.6,"gross_charge":124.19,"discounted_cash":36.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":100.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":100.6,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":100.6,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":79.49,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":86.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":74.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.67,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA-EPBX 3000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":95.38,"maximum":128.76,"gross_charge":158.96,"discounted_cash":47.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":103.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":111.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.38,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA-EPBX 3000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.63,"maximum":128.76,"gross_charge":158.96,"discounted_cash":47.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":101.74,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":111.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":95.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.67,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA-EPBX 4000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":116.24,"maximum":156.93,"gross_charge":193.73,"discounted_cash":57.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":125.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.24,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA-EPBX 4000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.63,"maximum":156.93,"gross_charge":193.73,"discounted_cash":57.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":156.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":156.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":156.93,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":123.99,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":87.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":135.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":116.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.67,"methodology":"case rate"}]}]},{"description":"EPOETIN ALFA-EPBX 40000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":867.33,"maximum":1170.9,"gross_charge":1445.55,"discounted_cash":427.89,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1170.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1170.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1170.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":939.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"}]}]},{"description":"EPOETIN ALFA-EPBX 40000 UNIT/ML INJECTION SOLUTION","code_information":[{"code":"Q5105","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.63,"maximum":1170.9,"gross_charge":1445.55,"discounted_cash":427.89,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1170.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1170.9,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1170.9,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":925.16,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.75,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.78,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.69,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":1.08,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.92,"standard_charge_algorithm": "Lesser of $0.92 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":650.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1011.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":867.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.63,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.67,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.65,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.66,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.69,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.67,"methodology":"case rate"}]}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5107","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0206-01","type":"NDC"}],"standard_charges":[{"minimum":3016.61,"maximum":4072.43,"gross_charge":5027.68,"discounted_cash":1488.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4072.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4072.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4072.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3268,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3519.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3016.61,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5107","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0206-01","type":"NDC"}],"standard_charges":[{"minimum":25.62,"maximum":4072.43,"gross_charge":5027.68,"discounted_cash":1488.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4072.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4072.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4072.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3217.72,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.25,"standard_charge_algorithm": "Lesser of $34.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.25,"standard_charge_algorithm": "Lesser of $34.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2262.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3519.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3016.61,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.26,"methodology":"case rate"}]}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5107","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0207-01","type":"NDC"}],"standard_charges":[{"minimum":11381.04,"maximum":15364.4,"gross_charge":18968.39,"discounted_cash":5614.65,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15364.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15364.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15364.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12329.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13277.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11381.04,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5107","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0207-01","type":"NDC"}],"standard_charges":[{"minimum":25.62,"maximum":15364.4,"gross_charge":18968.39,"discounted_cash":5614.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":15364.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":15364.4,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":15364.4,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":12139.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":28.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":28.73,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":25.62,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":26.1,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":45.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":34.25,"standard_charge_algorithm": "Lesser of $34.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":34.25,"standard_charge_algorithm": "Lesser of $34.25 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":8535.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":13277.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":11381.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":33.36,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":26.66,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":28.53,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":27.46,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":27.99,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":29.33,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":28.26,"methodology":"case rate"}]}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5108","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0833-06","type":"NDC"}],"standard_charges":[{"minimum":6825.05,"maximum":9213.81,"gross_charge":11375.07,"discounted_cash":3367.03,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9213.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9213.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9213.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7393.8,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7962.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6825.05,"methodology":"fee schedule"}]}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5108","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0833-06","type":"NDC"}],"standard_charges":[{"minimum":100.93,"maximum":9213.81,"gross_charge":11375.07,"discounted_cash":3367.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9213.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9213.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9213.81,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7280.05,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":125.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":125.3,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":122.54,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":150.54,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":124.85,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":172.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":159.47,"standard_charge_algorithm": "Lesser of $159.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":159.47,"standard_charge_algorithm": "Lesser of $159.47 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5118.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7962.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6825.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":157.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.31,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":165.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":100.93,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":108,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":103.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":105.98,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":111.02,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":106.99,"methodology":"case rate"}]}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"Q5110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":231.18,"maximum":312.09,"gross_charge":385.29,"discounted_cash":114.05,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":250.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":269.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231.18,"methodology":"fee schedule"}]}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"Q5110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":312.09,"gross_charge":385.29,"discounted_cash":114.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":312.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":312.09,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":246.59,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.45,"standard_charge_algorithm": "Lesser of $0.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.45,"standard_charge_algorithm": "Lesser of $0.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":173.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":269.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":231.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.28,"methodology":"case rate"}]}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"Q5110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":350.2,"maximum":472.77,"gross_charge":583.66,"discounted_cash":172.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":379.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":408.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.2,"methodology":"fee schedule"}]}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"Q5110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":472.77,"gross_charge":583.66,"discounted_cash":172.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":472.77,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":373.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.45,"standard_charge_algorithm": "Lesser of $0.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.45,"standard_charge_algorithm": "Lesser of $0.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":262.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":408.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.2,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.28,"methodology":"case rate"}]}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"Q5110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":350.21,"maximum":472.78,"gross_charge":583.67,"discounted_cash":172.77,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":472.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":472.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":472.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":379.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":408.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.21,"methodology":"fee schedule"}]}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE","code_information":[{"code":"Q5110","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":472.78,"gross_charge":583.67,"discounted_cash":172.77,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":472.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":472.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":472.78,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":373.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":0.44,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.45,"standard_charge_algorithm": "Lesser of $0.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":0.45,"standard_charge_algorithm": "Lesser of $0.45 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":262.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":408.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":350.21,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.45,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":0.26,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":0.28,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":0.27,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":0.27,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":0.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":0.28,"methodology":"case rate"}]}]},{"description":"TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5114","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0847-44","type":"NDC"}],"standard_charges":[{"minimum":6750.69,"maximum":9113.43,"gross_charge":11251.14,"discounted_cash":3330.34,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9113.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9113.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9113.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7313.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7875.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6750.69,"methodology":"fee schedule"}]}]},{"description":"TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5114","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0847-44","type":"NDC"}],"standard_charges":[{"minimum":41.86,"maximum":9113.43,"gross_charge":11251.14,"discounted_cash":3330.34,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9113.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9113.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9113.43,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7200.73,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.84,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":44.43,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":56.84,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":45.26,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":71.58,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.21,"standard_charge_algorithm": "Lesser of $51.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":51.21,"standard_charge_algorithm": "Lesser of $51.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5063.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":7875.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":6750.69,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":50.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":52.38,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":62.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":41.86,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":44.79,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":43.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":43.95,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":46.05,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":44.37,"methodology":"case rate"}]}]},{"description":"RITUXIMAB-ABBS (TRUXIMA) 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5115","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0103-10","type":"NDC"}],"standard_charges":[{"minimum":1171.05,"maximum":1580.91,"gross_charge":1951.74,"discounted_cash":577.72,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1580.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1580.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1580.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1268.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1171.05,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-ABBS (TRUXIMA) 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5115","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0103-10","type":"NDC"}],"standard_charges":[{"minimum":31.08,"maximum":1580.91,"gross_charge":1951.74,"discounted_cash":577.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1580.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1580.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1580.91,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1249.12,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":31.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":53.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.91,"standard_charge_algorithm": "Lesser of $59.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.91,"standard_charge_algorithm": "Lesser of $59.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":878.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1366.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1171.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32.94,"methodology":"case rate"}]}]},{"description":"RITUXIMAB-ABBS (TRUXIMA) 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5115","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0104-50","type":"NDC"}],"standard_charges":[{"minimum":5724.23,"maximum":7727.7,"gross_charge":9540.37,"discounted_cash":2823.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7727.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7727.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7727.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6201.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6678.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5724.23,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-ABBS (TRUXIMA) 10 MG/ML CONCENTRATEINTRAVENOUS","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5115","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"63459-0104-50","type":"NDC"}],"standard_charges":[{"minimum":31.08,"maximum":7727.7,"gross_charge":9540.37,"discounted_cash":2823.95,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":7727.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":7727.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":7727.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6105.84,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":31.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":31.83,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":35.89,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":53.15,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":59.91,"standard_charge_algorithm": "Lesser of $59.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":59.91,"standard_charge_algorithm": "Lesser of $59.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4293.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6678.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5724.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":59.32,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":38.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":37.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":31.08,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":33.26,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":32.01,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":32.63,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":34.19,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":32.94,"methodology":"case rate"}]}]},{"description":"TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION","code_information":[{"code":"Q5116","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":10566.38,"maximum":14264.61,"gross_charge":17610.62,"discounted_cash":5212.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14264.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14264.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14264.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11446.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12327.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10566.38,"methodology":"fee schedule"}]}]},{"description":"TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION","code_information":[{"code":"Q5116","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":12.88,"maximum":14264.61,"gross_charge":17610.62,"discounted_cash":5212.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":14264.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":14264.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":14264.61,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":11270.8,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":18.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":18.97,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":16.37,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.12,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":45.21,"standard_charge_algorithm": "Lesser of $45.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":45.21,"standard_charge_algorithm": "Lesser of $45.21 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7924.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":12327.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":10566.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.29,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.85,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.96,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.4,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.52,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.63,"methodology":"case rate"}]}]},{"description":"TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5117","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0132-01","type":"NDC"}],"standard_charges":[{"minimum":15446.27,"maximum":20852.47,"gross_charge":25743.78,"discounted_cash":7620.16,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20852.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20852.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20852.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16733.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18020.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15446.27,"methodology":"fee schedule"}]}]},{"description":"TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5117","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0132-01","type":"NDC"}],"standard_charges":[{"minimum":13.45,"maximum":20852.47,"gross_charge":25743.78,"discounted_cash":7620.16,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20852.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20852.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20852.47,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16476.02,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":34.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":34.69,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":13.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.7,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":42.66,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":36.95,"standard_charge_algorithm": "Lesser of $36.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":36.95,"standard_charge_algorithm": "Lesser of $36.95 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11584.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":18020.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15446.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":36.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.95,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":26.7,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":25.7,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":26.2,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":27.45,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":26.45,"methodology":"case rate"}]}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5118","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":2512.82,"maximum":3392.3,"gross_charge":4188.02,"discounted_cash":1239.66,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3392.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3392.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3392.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2722.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2931.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2512.82,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5118","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":21.36,"maximum":3392.3,"gross_charge":4188.02,"discounted_cash":1239.66,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3392.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3392.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3392.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2680.34,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.69,"standard_charge_algorithm": "Lesser of $43.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.69,"standard_charge_algorithm": "Lesser of $43.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1884.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2931.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2512.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.54,"methodology":"case rate"}]}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5118","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":9366.14,"maximum":12644.29,"gross_charge":15610.23,"discounted_cash":4620.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12644.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12644.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12644.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10146.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10927.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9366.14,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5118","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":21.36,"maximum":12644.29,"gross_charge":15610.23,"discounted_cash":4620.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":12644.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":12644.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":12644.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":9990.55,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":21.51,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":21.36,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":41.19,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":43.69,"standard_charge_algorithm": "Lesser of $43.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":43.69,"standard_charge_algorithm": "Lesser of $43.69 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7024.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":10927.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9366.14,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":43.25,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":24.09,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":25.78,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":24.81,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":25.29,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":26.5,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":25.54,"methodology":"case rate"}]}]},{"description":"RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5119","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":1502.22,"maximum":2028,"gross_charge":2503.7,"discounted_cash":741.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2028,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2028,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2028,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1627.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1752.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1502.22,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5119","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":2028,"gross_charge":2503.7,"discounted_cash":741.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2028,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2028,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2028,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1602.37,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.91,"standard_charge_algorithm": "Lesser of $44.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.91,"standard_charge_algorithm": "Lesser of $44.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1126.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1752.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1502.22,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.64,"methodology":"case rate"}]}]},{"description":"RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5119","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7379.97,"maximum":9962.96,"gross_charge":12299.95,"discounted_cash":3640.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9962.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9962.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9962.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7994.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8609.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7379.97,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q5119","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":19.61,"maximum":9962.96,"gross_charge":12299.95,"discounted_cash":3640.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":9962.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":9962.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":9962.96,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":7871.97,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":23.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":23.59,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":20.45,"methodology":"case rate"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":20.83,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":38.13,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":44.91,"standard_charge_algorithm": "Lesser of $44.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":44.91,"standard_charge_algorithm": "Lesser of $44.91 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5534.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":8609.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7379.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":44.46,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":27.9,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":22.3,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":23.86,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":22.97,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":23.41,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":24.53,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":23.64,"methodology":"case rate"}]}]},{"description":"RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5123","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0224-01","type":"NDC"}],"standard_charges":[{"minimum":1217.83,"maximum":1644.07,"gross_charge":2029.71,"discounted_cash":600.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1644.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1644.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1644.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1319.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1420.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1217.83,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5123","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0224-01","type":"NDC"}],"standard_charges":[{"minimum":304.46,"maximum":1644.07,"gross_charge":2029.71,"discounted_cash":600.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1644.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1644.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1644.07,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1299.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1014.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1014.86,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":913.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1420.8,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":1217.83,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":385.65,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.95,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":304.46,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":405.95,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5123","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0326-01","type":"NDC"}],"standard_charges":[{"minimum":5958,"maximum":8043.3,"gross_charge":9929.99,"discounted_cash":2939.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8043.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8043.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8043.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6454.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6951,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5958,"methodology":"fee schedule"}]}]},{"description":"RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5123","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"55513-0326-01","type":"NDC"}],"standard_charges":[{"minimum":1489.5,"maximum":8043.3,"gross_charge":9929.99,"discounted_cash":2939.28,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8043.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":8043.3,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":8043.3,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":6355.2,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4965,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4965,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":4468.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":6951,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5958,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1886.7,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1986,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1489.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1986,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1754-01","type":"NDC"}],"standard_charges":[{"minimum":968.48,"maximum":1307.44,"gross_charge":1614.12,"discounted_cash":477.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1307.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1307.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1307.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1049.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1129.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":968.48,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1754-01","type":"NDC"}],"standard_charges":[{"minimum":242.12,"maximum":1307.44,"gross_charge":1614.12,"discounted_cash":477.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":1307.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":1307.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":1307.44,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":1033.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":807.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":807.06,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":726.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":1129.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":968.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":306.69,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.83,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":242.12,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":322.83,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1755-01","type":"NDC"}],"standard_charges":[{"minimum":3188.78,"maximum":4304.86,"gross_charge":5314.63,"discounted_cash":1573.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4304.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4304.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4304.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3454.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3720.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3188.78,"methodology":"fee schedule"}]}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1755-01","type":"NDC"}],"standard_charges":[{"minimum":797.2,"maximum":4304.86,"gross_charge":5314.63,"discounted_cash":1573.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":4304.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":4304.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":4304.86,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":3401.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":2657.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":2657.32,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":2391.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3720.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":3188.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1009.78,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.93,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":797.2,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1062.93,"methodology":"fee schedule"}]}]},{"description":"PEGFILGRASTIM-PBBK 6 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5130","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1627-01","type":"NDC"}],"standard_charges":[{"minimum":2048.54,"maximum":2765.52,"gross_charge":3414.22,"discounted_cash":1010.61,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2765.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2765.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2765.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2219.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2048.54,"methodology":"fee schedule"}]}]},{"description":"PEGFILGRASTIM-PBBK 6 MG/0.6 ML SUBCUTANEOUS SYRINGE","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5130","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"70121-1627-01","type":"NDC"}],"standard_charges":[{"minimum":512.14,"maximum":2765.52,"gross_charge":3414.22,"discounted_cash":1010.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2765.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2765.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2765.52,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2185.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1707.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1707.11,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1536.4,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2048.54,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":648.71,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.85,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":512.14,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":682.85,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-BAVI 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64406-0022-01","type":"NDC"}],"standard_charges":[{"minimum":5008.36,"maximum":6761.29,"gross_charge":8347.26,"discounted_cash":2470.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6761.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6761.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6761.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5425.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5843.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5008.36,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-BAVI 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64406-0022-01","type":"NDC"}],"standard_charges":[{"minimum":1252.09,"maximum":6761.29,"gross_charge":8347.26,"discounted_cash":2470.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":6761.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":6761.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":6761.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":5342.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":4173.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":4173.63,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":3756.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":5843.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":5008.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":1585.98,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":1669.46,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1252.09,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":1669.46,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-BAVI 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64406-0023-01","type":"NDC"}],"standard_charges":[{"minimum":9805.26,"maximum":13237.1,"gross_charge":16342.09,"discounted_cash":4837.26,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13237.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13237.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13237.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10622.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11439.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9805.26,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-BAVI 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64406-0023-01","type":"NDC"}],"standard_charges":[{"minimum":2451.32,"maximum":13237.1,"gross_charge":16342.09,"discounted_cash":4837.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":13237.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":13237.1,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":13237.1,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":10458.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":8171.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":8171.05,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":7353.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":11439.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":9805.26,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":3105,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":3268.42,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":2451.32,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":3268.42,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-BAVI 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64406-0024-01","type":"NDC"}],"standard_charges":[{"minimum":2130.23,"maximum":2875.8,"gross_charge":3550.37,"discounted_cash":1050.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2875.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2875.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2875.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2307.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2485.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.23,"methodology":"fee schedule"}]}]},{"description":"TOCILIZUMAB-BAVI 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q5133","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"64406-0024-01","type":"NDC"}],"standard_charges":[{"minimum":532.56,"maximum":2875.8,"gross_charge":3550.37,"discounted_cash":1050.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":2875.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":2875.8,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":2875.8,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2272.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":1775.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":1775.19,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1597.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":2485.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2130.23,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":674.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.08,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":532.56,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":710.08,"methodology":"fee schedule"}]}]},{"description":"PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11994-0011-01","type":"NDC"}],"standard_charges":[{"minimum":214.55,"maximum":289.64,"gross_charge":357.57,"discounted_cash":105.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":232.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.55,"methodology":"fee schedule"}]}]},{"description":"PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS SUSPENSION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"11994-0011-01","type":"NDC"}],"standard_charges":[{"minimum":51.7,"maximum":289.64,"gross_charge":357.57,"discounted_cash":105.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":289.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":289.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":289.64,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":228.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":51.7,"standard_charge_algorithm": "Lesser of $51.70 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":178.79,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":160.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":250.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":214.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":67.94,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":53.64,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":71.52,"methodology":"fee schedule"}]}]},{"description":"DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION","code_information":[{"code":"Q9963","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":7.92,"maximum":10.7,"gross_charge":13.2,"discounted_cash":3.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"}]}]},{"description":"DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION","code_information":[{"code":"Q9963","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.26,"maximum":10.7,"gross_charge":13.2,"discounted_cash":3.91,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":10.7,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.26,"standard_charge_algorithm": "Lesser of $0.26 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":6.6,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":2.64,"methodology":"fee schedule"}]}]},{"description":"HC ISOVUE 370 100ML 0270-131635","code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":30,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"}]}]},{"description":"HC ISOVUE 370 100ML 0270-131635","code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.14,"maximum":40.5,"gross_charge":50,"discounted_cash":14.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":40.5,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.14,"standard_charge_algorithm": "Lesser of $0.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":25,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":22.5,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":30,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":9.5,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":7.5,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":10,"methodology":"fee schedule"}]}]},{"description":"ISOVUE 300 30ML 00270-131535","code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":15,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"}]}]},{"description":"ISOVUE 300 30ML 00270-131535","code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":0.14,"maximum":20.25,"gross_charge":25,"discounted_cash":7.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":20.25,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":0.14,"standard_charge_algorithm": "Lesser of $0.14 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":12.5,"methodology":"fee schedule"},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":17.5,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":5,"methodology":"fee schedule"}]}]},{"description":"ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0220-05","type":"NDC"}],"standard_charges":[{"minimum":2607.35,"maximum":3519.92,"gross_charge":4345.57,"discounted_cash":1286.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3519.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3519.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3519.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2824.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3041.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2607.35,"methodology":"fee schedule"}]}]},{"description":"ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"67457-0220-05","type":"NDC"}],"standard_charges":[{"minimum":6.78,"maximum":3519.92,"gross_charge":4345.57,"discounted_cash":1286.29,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3519.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3519.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3519.92,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":2781.17,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.95,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":1955.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":3041.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":2607.35,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":825.66,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.12,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":651.84,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":869.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.19,"methodology":"case rate"}]}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0147-01","type":"NDC"}],"standard_charges":[{"minimum":379.47,"maximum":512.29,"gross_charge":632.45,"discounted_cash":187.21,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":411.1,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.47,"methodology":"fee schedule"}]}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) INTRAVENOUS SOLUTION","drug_information": {"unit": 0.071,"type": "ME"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"},{"code":"54288-0147-01","type":"NDC"}],"standard_charges":[{"minimum":6.78,"maximum":512.29,"gross_charge":632.45,"discounted_cash":187.21,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":512.29,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":404.77,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.95,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":284.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":442.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":379.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":120.17,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.49,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":94.87,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":126.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.19,"methodology":"case rate"}]}]},{"description":"METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":263.91,"maximum":356.28,"gross_charge":439.85,"discounted_cash":130.2,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":285.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":307.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.91,"methodology":"fee schedule"}]}]},{"description":"METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.78,"maximum":356.28,"gross_charge":439.85,"discounted_cash":130.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":356.28,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":281.51,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.95,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":197.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":307.9,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":263.91,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":83.58,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":65.98,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":87.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.19,"methodology":"case rate"}]}]},{"description":"METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":441.68,"maximum":596.27,"gross_charge":736.13,"discounted_cash":217.9,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":596.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":596.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":596.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":478.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":515.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":441.68,"methodology":"fee schedule"}]}]},{"description":"METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION","code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"0636","type":"RC"}],"standard_charges":[{"minimum":6.78,"maximum":596.27,"gross_charge":736.13,"discounted_cash":217.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":596.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":596.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":596.27,"methodology":"fee schedule"},{"payer_name":"Alliant Health","plan_name":"Commercial|All Plans","standard_charge_dollar":471.13,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":8.9,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Commercial|Pathway","standard_charge_dollar":7.95,"methodology":"case rate"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":11.59,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Commercial|LocalPlus","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial|Open Access","standard_charge_dollar":20.29,"standard_charge_algorithm": "Lesser of $20.29 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Employers Health Network","plan_name":"Commercial|All Plans","standard_charge_dollar":331.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Commercial|All Plans","standard_charge_dollar":515.3,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Commercial|All Plans","standard_charge_dollar":441.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":139.87,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.23,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":110.42,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":147.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":6.78,"methodology":"case rate"},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":7.25,"methodology":"case rate"},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":6.98,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":7.12,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":7.46,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":7.19,"methodology":"case rate"}]}]},{"description":"HC WHEELCHAIR VAN PER MILE OV 20","code_information":[{"code":"S0215","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":3.24,"maximum":3.24,"gross_charge":4,"discounted_cash":1.19,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.24,"methodology":"fee schedule"}]}]},{"description":"HC WHEELCHAIR VAN PER MILE OV 20","code_information":[{"code":"S0215","type":"HCPCS"},{"code":"0540","type":"RC"}],"standard_charges":[{"minimum":0.6,"maximum":358,"gross_charge":4,"discounted_cash":1.19,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":358,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.6,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":0.8,"methodology":"fee schedule"}]}]},{"description":"HC COVID-19","code_information":[{"code":"U0002","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":184.68,"maximum":184.68,"gross_charge":228,"discounted_cash":67.49,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.68,"methodology":"fee schedule"}]}]},{"description":"HC COVID-19","code_information":[{"code":"U0002","type":"HCPCS"},{"code":"0300","type":"RC"}],"standard_charges":[{"minimum":51.31,"maximum":184.68,"gross_charge":228,"discounted_cash":67.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial|All Other Plans","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|HMO","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Commercial|PPO","standard_charge_dollar":184.68,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|All Other Plans","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"BCBS - GA","plan_name":"Commercial|HMO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network P","standard_charge_dollar":113.91,"methodology":"fee schedule"},{"payer_name":"BCBS - TN","plan_name":"Commercial|Network S","standard_charge_dollar":90.31,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"Commercial|Ambetter Exchange","standard_charge_dollar":87.74,"standard_charge_algorithm": "Lesser of $87.74 or 171 Percent of Billed Charges","median_amount":87.74,"10th_percentile":82.61,"90th_percentile":87.74,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Non-Options","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"Commercial|Options","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"CareSource","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Peach State","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Wellcare","plan_name":"Medicaid|All Plans","standard_charge_dollar":57.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"Medicare|All Plans","standard_charge_dollar":51.31,"standard_charge_algorithm": "Lesser of $51.31 or 100 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicare|All Plans","standard_charge_dollar":54.9,"standard_charge_algorithm": "Lesser of $54.90 or 107 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"BCBS - GA","plan_name":"Medicare|BlueCare","standard_charge_dollar":52.85,"standard_charge_algorithm": "Lesser of $52.85 or 103 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare|Healthspring","standard_charge_dollar":53.88,"standard_charge_algorithm": "Lesser of $53.88 or 105 Percent of Billed Charges","median_amount":53.88,"10th_percentile":53.88,"90th_percentile":53.88,"count":"1 through 10","methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"Medicare|All Other Plans","standard_charge_dollar":56.44,"standard_charge_algorithm": "Lesser of $56.44 or 110 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare|HMO","standard_charge_dollar":54.39,"standard_charge_algorithm": "Lesser of $54.39 or 106 Percent of Billed Charges","count":"0","methodology":"fee schedule", "additional_payer_notes": "No services performed during 12-month lookback period."}]}]}],"modifier_information": [{"description": "Bilateral procedure", "code": "50", "modifier_payer_information": [{"payer_name": "Aetna","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Amerigroup","plan_name": "Medicare|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - GA","plan_name": "Medicare|BlueCare","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - GA","plan_name": "Commercial|All Other Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Centene","plan_name": "Commercial|Ambetter Exchange","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - GA","plan_name": "Commercial|HMO","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - GA","plan_name": "Commercial|Pathway","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Alliant Health","plan_name": "Commercial|All Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - TN","plan_name": "Commercial|Network P","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - TN","plan_name": "Commercial|Network S","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Cigna","plan_name": "Medicare|Healthspring","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|HMO","description": "150% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Other Plans","description": "150% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Item designated by FDA as Class III Devices", "code": "KF", "modifier_payer_information": [{"payer_name": "BCBS - GA","plan_name": "Medicare|BlueCare","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Amerigroup","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Aetna","plan_name": "Medicare|All Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Cigna","plan_name": "Medicare|Healthspring","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Other Plans","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|HMO","description": "116% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Centene","plan_name": "Commercial|Ambetter Exchange","description": "116% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Replacement of facial prosthesis including new impression/moulage", "code": "KM", "modifier_payer_information": [{"payer_name": "Amerigroup","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - GA","plan_name": "Medicare|BlueCare","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Centene","plan_name": "Commercial|Ambetter Exchange","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Aetna","plan_name": "Medicare|All Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Other Plans","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Cigna","plan_name": "Medicare|Healthspring","description": "95% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|HMO","description": "95% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Replacement of facial prosthesis", "code": "KN", "modifier_payer_information": [{"payer_name": "Cigna","plan_name": "Medicare|Healthspring","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|HMO","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Humana","plan_name": "Medicare|All Other Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Aetna","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Centene","plan_name": "Commercial|Ambetter Exchange","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "BCBS - GA","plan_name": "Medicare|BlueCare","description": "40% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Amerigroup","plan_name": "Medicare|All Plans","description": "40% payment adjustment for the item or service to which the modifier is appended"}]},{"description": "Technical component", "code": "TC", "modifier_payer_information": [{"payer_name": "Wellcare","plan_name": "Medicaid|All Plans","description": "89% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Employers Health Network","plan_name": "Commercial|All Plans","description": "92% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "Peach State","plan_name": "Medicaid|All Plans","description": "89% payment adjustment for the item or service to which the modifier is appended"},{"payer_name": "CareSource","plan_name": "Medicaid|All Plans","description": "89% payment adjustment for the item or service to which the modifier is appended"}]}],"general_contract_provisions": [ 
{ "payer_name": "Alliant Health", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be 64.96 Percent of Billed Charges when Billed Charges exceeds a threshold of $119,185.00" },{ "payer_name": "BCBS - GA", "plan_name": "Commercial|All Other Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - GA", "plan_name": "Commercial|HMO", "description": "Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - TN", "plan_name": "Commercial|Network P", "description": "Inpatient - Reimbursement for the entire encounter may be increased by 66 Percent of Billed Charges above 320,126.00 when Billed Charges exceeds a threshold of $320,126.00/Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "BCBS - TN", "plan_name": "Commercial|Network S", "description": "Inpatient - Reimbursement for the entire encounter may be increased by 56 Percent of Billed Charges above 297,382.00 when Billed Charges exceeds a threshold of $297,382.00/Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Centene", "plan_name": "Commercial|Ambetter Exchange", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Cigna", "plan_name": "Commercial|LocalPlus", "description": "Inpatient - Reimbursement for the entire encounter may be increased by 33.6 Percent of Billed Charges above 125,641.00 when Billed Charges exceeds a threshold of $125,641.00/Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Cigna", "plan_name": "Commercial|Open Access", "description": "Inpatient - Reimbursement for the entire encounter may be increased by 38.9 Percent of Billed Charges above 125,641.00 when Billed Charges exceeds a threshold of $125,641.00/Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Employers Health Network", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be 41.63 Percent of Billed Charges when Billed Charges exceeds a threshold of $111,490.00/Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Health One Alliance", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be 65 Percent of Billed Charges when Billed Charges exceeds a threshold of $84,365.00/Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Humana", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be 65 Percent of Billed Charges when Billed Charges exceeds a threshold of $141,422.00/Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "Multiplan", "plan_name": "Commercial|All Plans", "description": "Inpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges/Inpatient - Reimbursement for the entire encounter may be 65 Percent of Billed Charges when Billed Charges exceeds a threshold of $128,274.30" },{ "payer_name": "United", "plan_name": "Commercial|Non-Options", "description": "Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" },{ "payer_name": "United", "plan_name": "Commercial|Options", "description": "Outpatient - Reimbursement for the entire encounter may be limited to 100 Percent of Billed Charges" }]}